晶状体功能失调指数在年龄相关性白内障诊断及手术中的应用

Application of dysfunctional lens index in the diagnosis of age-related cataract and phacoemulsification

目的探讨采用iTrace视功能分析仪测量晶状体功能失调指数（DLI）在不同类型年龄相关性白内障诊断及手术中的价值。方法采用回顾性病例观察方法。纳入2016年11月至2017年4月于济南市明水眼科医院行白内障手术的年龄相关性白内障手术患者132例132眼，根据白内障类型分为核型组39例39眼、皮质型组48例48眼和后囊下型组45例45眼。术前记录最佳矫正视力（LogMAR视力），根据LOCSⅢ分级体系判断晶状体混浊程度并评分，采用iTrace视功能分析仪测量DLI值，所有患者进行常规白内障超声乳化摘出术，记录术中超声乳化累积释放能量（CDE）值。采用Pearson相关检验分析各参数间的相关性。结果核型组患者DLI与LogMAR视力、晶状体核混浊度（NO）评分值、晶状体核颜色（NC）评分值、CDE值均呈负相关（r＝－0.593、－0.618、－0.606、－0.524，均P〈0.01）。皮质型组和后囊下型组患者DLI与LogMAR视力、LOCS Ⅲ评分值均呈负相关（皮质型组：r＝－0.653、－0.614，均P〈0.01；后囊下型组：r＝－0.583、－0.577，均P〈0.01），2个组DLI与CDE值均无明显相关性（r＝－0.245，P＝0.093；r＝－0.225，P＝0.137）。3个组患者LogMAR视力、LOCS Ⅲ评分值与CDE值均呈正相关。结论 对于不同类型的年龄相关性白内障，DLI与LogMAR视力和LOCS Ⅲ分级评分值均呈负相关，可以反映视力损害程度和晶状体混浊程度。DLI可以为核型白内障的术中超声乳化能量使用情况提供参考。

ObjectiveTo assess the value of dysfunctional lens index （DLI） measured by iTrace visual function analyzer in the diagnosis of age-related cataract and phacoemulsification.Methods A prospective study was performed.One hundred and thirty-two cases （132 eyes） with age-related cataract were recruited from November 2016 to April 2017 in Jinan Mingshui Eye Hospital.The subjects were divided into nuclear group （39 eyes）, cortical group （48 eyes） and posterior subcapsular group （45 eyes） according to the type of cataract.The preoperative best corrected distant visual acuity （LogMAR vision） were recorded.The opacification degrees of lens were determined by LOCS Ⅲ grading system.The DLI value was measured by iTrace visual function analyzer.All patients underwent traditional phacoemulsification, and cumulative dissipated energy （CDE） values were recorded.The correlation between various parameters was evaluated using Pearson correlation coefficients.Results In nuclear group, the DLI was negatively correlated with LogMAR vision, nuclear opacity （NO） scores, nuclear color （NC） scores and CDE （r=-0.593, -0.618, -0.606, -0.524; all at P〈0.01）. In cortical group and posterior subcapsular group, the DLI was negatively correlated with LogMAR and LOCS Ⅲ scores （cortical group： r=-0.653, -0.614; both at P〈0.01; posterior subcapsular group： r=-0.583, -0.577; both at P〈0.01）, but no significant correlation was observed between CDE and DLI.The CDE showed an obvious positive linear correlation with LogMAR and LOCS Ⅲ scores in the 3 groups. Conclusions For different patterns of age-related cataract, the DLI shows good correlations with LogMAR and LOCS Ⅲ scores, and can reflect the degrees of visual impairment and lens opacity.The DLI can provide references for energy use in phacoemulsification of nuclear cataract.