基于扫频源OCT技术光学生物测量仪对IOL倾斜测量的可行性评价及倾斜特征分析

Analysis of the feasibility of measurements and characteristics of intraocular lens tilt using swept-source optical coherence tomography biometer

目的分析基于扫频源光学相干断层扫描(OCT)技术光学生物测量仪IOLMaster 700评估人工晶状体(IOL)倾斜测量的可行性、IOL倾斜特征及相关影响因素。方法采用横断面研究,纳入2018年7—9月于首都医科大学附属北京同仁医院行白内障超声乳化吸除联合IOL植入术术后患者185例242眼,其中右眼119眼,左眼123眼。采用IOLMaster 700扫描获取眼内IOL位置图像及κ角、α角、角膜曲率、前房深度(ACD)、瞳孔直径(PD)、眼轴长度(AL)等,计算IOL倾斜方向及幅度。采用合并组内相关标准差及组内相关系数计算法评估3次IOL倾斜测量的可重复性。采用Pearson线性相关分析或Spearman秩相关分析评估IOL倾斜的双眼对称性及IOL倾斜与不同影响因素之间的相关关系。IOL倾斜影响因素评估采用多元线性回归分析法。结果IOL倾斜测量具有较好的可重复性,合并组内相关标准差IOL倾斜方向为5.16°,IOL倾斜幅度为0.13°;双眼IOL倾斜具有镜像对称性,右眼IOL倾斜方向为-89.60~87.53°,平均(18.85±29.65)°,倾斜幅度为1.32~7.05°,平均(4.16±1.26)°。左眼IOL倾斜方向为-84.30~89.44°,平均(21.17±32.38)°,倾斜幅度为0.58~7.40°,平均(3.80±1.31)°。右眼和左眼IOL倾斜方向和倾斜幅度之间分别呈中等和弱正相关(r=0.473,P<0.001;r=0.335,P=0.011)。IOL倾斜幅度与α角、IOL屈光度均呈弱正相关(r s=0.272,P=0.003;r=0.285,P=0.002),与ACD、PD、AL呈弱负相关(r=-0.303,P=0.001;r=-0.233,P=0.011;r s=-0.331,P<0.001)。将IOL倾斜幅度与α角、ACD、PD、AL、IOL屈光度纳入多元线性回归分析,采用逐步后退法,建立回归方程为:IOL倾斜幅度=10.503+1.456×α角-0.532×ACD-0.196×AL(R 2=0.400;F=8.588,P<0.001)。结论基于扫频源OCT技术光学生物测量仪可作为IOL倾斜评估的有效方法。IOL倾斜双眼存在镜面对称。

Objective To evaluate the feasibility of measurement and characteristics of intraocular lens(IOL)tilt using the swept-source optical coherence tomography(SS-OCT)biometer(IOLMaster 700)and to explore its potentially relevant parameters.Methods A cross-sectional study was conducted.Two hundred and forty-two eyes(119 right eyes,123 left eyes)of 185 patients after phacoemulsification and IOL implantation were included in Beijing Tongren Hospital from July to September 2018.The IOL position,angleκ,angleα,corneal curvature,anterior chamber depth(ACD),pupil diameter(PD),and axial length(AL)were obtained by IOLMaster 700,and the IOL tilt direction and magnitude were calculated.The within-subject standard deviation and intraclass correlation coefficient were used to evaluate the repeatability of three IOL tilt measurements.Binocular symmetry of IOL tilt and the correlation between IOL tilt and different influencing factors were evaluated by Pearson linear correlation analysis or Spearman rank correlation analysis.Influencing factors for IOL tilt were assessed by multiple linear regression analysis.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital,Capital Medical University(No.TRECKY2018-049).Patients were informed of the purpose and methods of this study and signed the written informed consent.Results The repeatability of IOL tilt measurements was excellent with a within-subject standard deviation of 5.16°for IOL tilt direction and 0.13°for IOL tilt magnitude.IOL tilt was mirror symmetric in both eyes.The IOL tilt direction in right eyes ranged from-89.60°to 87.53°with a mean of(18.85±29.65)°,and the tilt magnitude ranged from 1.32°to 7.05°with a mean of(4.16±1.26)°.The IOL tilt direction in left eyes ranged from-84.30°to 89.44°with a mean of(21.17±32.38)°,and the tilt magnitude ranged from 0.58°to 7.40°with a mean of(3.80±1.31)°.There were moderate and weak positive correlations of IOL tilt direction and tilt magnitude between both eyes(r=0.473,P<0.001;r=0.335,P=0.011).IOL tilt magnitude was weakly positively correlated with angleαand IOL diopter(r s=0.272,P=0.003;r=0.285,P=0.002),and was weakly negatively correlated with ACD,PD and AL(r=-0.303,P=0.001;r=-0.233,P=0.011;r s=-0.331,P<0.001).In backward stepwise regression analysis,the regression equation of IOL tilt magnitude,angleα,ACD,PD,AL and IOL diopter in multiple linear regression analysis was as follows:IOL tilt magnitude=10.503+1.456×angleα-0.532×ACD-0.196×AL(R 2=0.400;F=8.588,P<0.001).Conclusions The SS-OCT biometer can be an effective method to assess IOL tilt.IOL tilt is mirror symmetric between the right eyes and left eyes.