有晶状体眼后房型人工晶状体植入术后拱高的预测研究

Prediction of the vaulting after posterior chamber intraocular lens implantation

目的:探讨影响有晶状体眼后房型人工晶状体植入术后1个月拱高的因素,建立并验证预测拱高公式。方法:(1)回顾性系列病例研究,纳入2019年8月1日至12月30日于苏州大学附属理想眼科医院行有晶状体眼后房型人工晶状体植入术83例(83只眼)患者,年龄(27±5)岁。所有患者术前行完整术前检查,包括眼轴长度、前房深度、综合验光、眼压、角膜厚度、3种仪器的角膜水平直径、水平和垂直沟到沟直径、晶状体厚度、角膜屈光力及明暗瞳孔直径。通过收集患者资料进行相关性分析及多元线性回归(步进法)确定拱高影响因素并建议预测公式。(2)横断面研究,纳入2020年3月1日至6月1日于苏州大学附属理想眼科医院行有晶状体眼后房型人工晶状体植入术的65例(65只眼)患者,年龄(26±5)岁,通过分析患者实际拱高与预测拱高之间的组间相关系数并行Bland-Altman一致性检验,验证拱高预测公式的准确性和可靠性。结果:(1)人工晶状体尺寸对术后1个月拱高影响最大(β=0.942, P<0.001),其次为水平沟到沟直径(β=-0.517, P<0.001)、晶状体厚度(β=-0.376, P<0.001)以及垂直沟到沟直径(β=-0.257, P=0.017)。其余因素影响均无统计学意义(均 P>0.05)。建立回归方程为术后1个月拱高(μm)=-1 369.05+657.12×人工晶状体尺寸-287.41×水平沟到沟直径-432.50×晶状体厚度-137.33×垂直沟到沟直径(拟合度 R=0.813, R2=0.660,校正 R2=0.643)。(2)预测拱高为(497.31±102.75)μm,实际拱高为(514.62±152.99)μm。96.92%(63/65)的患者处于理想拱高,3.08%(2/65)的患者拱高过高,未出现拱高过低病例。组间相关系数为0.581。Bland-Altman检验显示实际拱高较预测值平均高17.31 μm,差值的95%置信区间为-260.28~294.90 μm。 结论:人工晶状体尺寸、晶状体厚度、水平沟到沟直径与垂直沟到沟直径是影响及预测有晶状体眼后房型人工晶状体植入术后1个月拱高的因素。预测公式具有良好的准确性及可靠性。

Objective To investigate the influencing factors on the vaulting one month after implantable collamer lens(ICL)implantation,and to develop and verify a prediction formula.Methods The first half of this study was retrospective case series study,and the second half was cross-sectional stydy.A total of 83 eyes of 83 patients who underwent ICL implantation in the Lixiang Eye Hospital of Soochow University were included in the first half of the study,with an average age of(27±5)years,from August 1,2019 to December 30,2019.All patients underwent a complete preoperative examination,including axis length,anterior chamber depth,comprehensive optometry,intraocular pressure,central corneal thickness,white-to-white diameter,horizontal and vertical sulcus-to-sulcus diameter(STS),crystalline lens thickness(LT),corneal curvature,and bright and dark pupil diameter.Multiple linear regression(stepwise)was used to develop a prediction formula.In the validation part,a total of 65 people(65 eyes)were included,with an average age of(26±5)years,from March 1,2020 to June 1,2020.The accuracy and reliability of the formula were verified by the intergroup correlation coefficient and Bland-Altman consistency test.Results At 1 month after surgery,ICL size had the greatest impact on the vaulting(β=0.942,P<0.001),followed by horizontal STS(β=-0.517,P<0.001),LT(β=-0.376,P<0.001),and vertical STS(β=-0.257,P=0.017).The influence of other factors was not statistically significant(all P>0.05).The regression equation was as follows:the vaulting(μm)=-1369.05+657.12×ICL size-287.41×horizontal STS-432.50×LT-137.33×vertical STS(the fitting degree R=0.813,R2=0.660,and corrected R2=0.643).In the verification part,the predicted average vaulting was(497.31±102.75)μm,while the actual vaulting was(514.62±152.99)μm.About 96.92%(63/65)of the patients were fitted in the moderate vault,and 3.08%(2/65)were in the high vault.The intergroup correlation coefficient was 0.581.According to the Bland-Altman test,the actual vaulting was 17.31μm,higher than the predicted value,and the 95%confidence interval of the difference was-260.28 to 294.90μm.Conclusion The ICL size,horizontal and vertical STS and LT are the factors that affect and predict the vaulting one month after ICL implantation,and our prediction formula has good accuracy and reliability.