飞秒激光前囊膜切开术与手工连续环形撕囊术对人工晶状体居中性的影响

Effects of femtosecond laser-assisted anterior capsulotomy versus manual continuous curvilinear capsulorhexis on intraocular lens centration

目的通过测量并比较飞秒激光前囊膜切开术与连续环形撕囊术术后患者前囊口形态、大小和位置参数,评估其对人工晶状体居中性的影响。方法收集了2015年3月至2016年7月在我院行白内障手术的年龄相关性白内障患者80例(80眼),其中飞秒组40例(40眼),患者行飞秒激光前囊膜切开术;手工组40例(40眼),患者行手工连续环形撕囊术。两组患者年龄、性别构成、眼轴长度和等效球镜度数差异均无统计学意义(均为P>0.05),具有可比性。两组术后1周、1个月、1 a复查用数字化裂隙灯照相和Pentacam眼前节分析仪采集眼前节图像,用Image-Pro-Plus 6.0图像分析软件来测量前囊口的水平和垂直直径、圆度、囊膜缘包裹人工晶状体光学部的最大和最小距离、包裹度。运用重复测量方差分析、确切概率法、广义估计方程模型来分析两组间参数差异和人工晶状体居中性预测因子。结果飞秒组和手工组术后1周、1个月,两组间垂直直径、圆度、最大距离、最小距离、包裹度、水平偏移,差异均有统计学意义(均为P<0.05);两组间水平直径、垂直偏移,差异均无统计学意义(均为P>0.05)。术后1 a,两组间最大距离、最小距离、包裹度、水平偏移,差异均有统计学意义(均为P<0.05);两组间垂直和水平直径、圆度、垂直偏移,差异均无统计学意义(均为P>0.05)。在飞秒组中,术后1周、1个月、1 a水平偏移均未出现≥0.4 mm者;在手工组中,术后1周、1个月、1 a水平偏移≥0.4 mm眼数和<0.4 mm眼数比分别为2/38、4/36、8/32。术后1 a,两组水平偏移≥0.4 mm的分布差异有统计学意义(P<0.05)。在单变量广义估计方程模型中,撕囊类型是水平偏移的显著预测因子。而在所有的撕囊参数中,仅包裹度差异有统计学意义(P=0.001)。术后1周、1个月、1 a飞秒组包裹度与水平偏移均存在负相关性(r=-0.89,P<0.05;r=-0.72,P<0.05;r=-0.58,P<0.05);术后1周手工组包裹度与水平偏移亦存在负相关性(r=-0.68,P<0.05),而术后1个月、1 a手工组包裹度与水平偏移均无相关性(r=-0.41,P>0.05;r=-0.33,P>0.05)。结论飞秒激光前囊膜切开术制作的前囊口更圆、更居中,大小更精准,囊袋内人工晶状体位置更稳定,居中性更好。

Objective To assess the effects of femtosecond laser-assisted anterior capsulotomy versus manual continuous curvilinear capsulorhexis on intraocular lens （IOL） centration by measuring and comparing shape,size and positional parameters.Methods Eighty cases （80 eyes） with age-related cataract from March 2015 to July 2016 in our hospital were collected.Forty patients （40 eyes） in the femtosecond group underwent femtosecond laser anterior capsulotomy and 40 patients （40 eyes） in the annular group were treated with annular continuous capsulorhexis.At postoperative 1 week,1 month,1 year,the slit lamp digital photography and Pentacam anterior segment analyzer were used to collect the anterior segment images,and the parameters include horizontal and vertical diameter,roundness,package and partial centre of IOL were analyzed by image analysis software image-pro-plus 6.0.Using repeated measurement of variance analysis,Fisher exact probability,and Generalized estimation equations（GEE）,the differences between parameters of the groups and IOL decentration predictor were analyzed.Results The vertical diameter,roundness,maximum distance,minimum distance,package and horizontal deviation were statistically significant between the femtosecond group and the annular group at 1 week and 1 month after operation （all P〈0.05）,and there was no significant difference in horizontal diameter and vertical deviation between two groups （all P〉0.05）.At 1 year after operation,the maximum distance,minimum distance,package and horizontal deviation between two groups were statistically significant （all P〈0.05）.There was no significant difference in vertical and horizontal diameter,roundness,and vertical deviation between two groups （all P〉0.05）.There was no patient with horizontal shift ≥0.4 mm in the femtosecond group at 1 week,1 month and 1 year;The ratio of cases with horizontal shift ≥0.4 mm and 〈0.4 mm in the annular group at 1 week,1 month and 1 year were 2/38,4/36,8/32,respectively.There was significant difference in the horizontal shift ≥0.4 mm between the two groups after 1 year（P〈0.05）.In the univariate generalized estimating equation model,the capsulorhexis type was a significant predictor of horizontal shift.Of all the capsulorhexis parameters,the difference of inclusion degree was statistically significant （P=0.001）.There was negative correlation between the horizontal shift and package at different time points in the femtosecond group at 1 week,1 month and 1 year（r=-0.89,P〈0.05;r=-0.72,P〈0.05;r=-0.58,P〈0.05）;There was negative correlation between the horizontal shift and package at different time points in the annular group at 1 week（r=-0.68,P〈0.05）,but no correlation at 1 month and 1 year（r=-0.41,P〉0.05;r=-0.33,P〉0.05）.Conclusion The anterior capsule made by femtosecond laser anterior capsulotomy is more round,centered and accurate,pocket IOL position is more stabled and neutral.