LASIK术中瞳孔中心移位的观察研究

目的:探讨LASIK手术中患者所发生的瞳孔中心移位的特点。方法:LASIK手术患者203例394眼术前应用VISX波前像差仪在暗室中进行虹膜照相检查,显示术前瞳孔直径。LASIK术中利用VISXS4-IR激光机进行虹膜定位检查,显示术中的瞳孔直径,以及瞳孔缩小后的中心移位情况。结果:在暗室中右眼平均瞳孔直径为6.9±2.1mm,左眼瞳孔直径为6.8±2.3mm;术中394眼瞳孔均缩小,右眼瞳孔平均为3.25±0.48(2.3～4.7)mm,左眼瞳孔平均为3.16±0.57(1.9～4.7)mm,术中左眼瞳孔直径较右眼明显偏小。术中394眼均发生了瞳孔中心移位,其中,85.2%右眼瞳孔中心向上方移位,平均移位距离为x=0.18mm,y=0.16mm;71.0%瞳孔中心向鼻上方移位。76.7%左眼瞳孔中心向上方移位,平均移位距离为x=-0.31mm,y=0.11mm;75.6%瞳孔中心向鼻上方移位。结论:LASIK手术时患者瞳孔较暗光时明显缩小,此时有一定程度的瞳孔中心移位。

Predictive factors for photic phenomena after refractive,rotationally asymmetric,multifocal intraocular lens implantation

AIM： To investigate the independent factors associated with photic phenomena in patients implanted with refractive,rotationally asymmetric,multifocal intraocular lenses（MIOLs）.METHODS： Thirty-four eyes of 34 patients who underwent unilateral cataract surgery,followed by implantation of rotationally asymmetric MIOLs were included.Distance and near visual acuity outcomes,intraocular aberrations,preferred reading distances,preoperative and postoperative refractive errors,mesopic and photopic pupil diameters,and the mesopic and photopic kappa angles were assessed.Patients were also administered a satisfaction survey.Photic phenomena were graded by questionnaire.Independent-related factors were identified by correlation and bivariate logistic regression analyses.RESULTS： The distance from the photopic to the mesopic pupil center（pupil center shift） was significantly associated with glare/halo symptoms [odds ratio（OR）=2.065,95% confidence interval（CI）=0.916-4.679,P=0.006] and night vision problems（OR=1.832,95% CI=0.721-2.158,P=0.007）.The preoperative photopic angle kappa was significantly associated with glare/halo symptoms（OR=2.155,95% CI=1.065-4.362,P=0.041）.The photopic angle kappa was also significantly associated with glare/halo symptoms（OR=2.155,95% CI=1.065-4.362,P=0.041） and with night vision problems（OR=1.832,95% CI=0.721-2.158,P=0.007） in patients implanted with rotationally asymmetric MIOLs.CONCLUSION： A large pupil center shift and misalignment between the visual and pupillary axis（angle kappa）may play a role in the occurrence of photic phenomena after implantation of rotationally asymmetric MIOLs.

白内障手术前后瞳孔直径、Kappa角及瞳孔中心位移的变化

目的:探讨白内障手术前后瞳孔直径、Kappa角、瞳孔中心位移的变化情况。方法:前瞻性临床研究。连续纳入2022年3—5月在重庆医科大学附属第二医院江南院区眼科就诊的白内障患者147例(147眼)。采用视觉质量分析仪测量术前及术后1个月的明视瞳孔直径(PPD)及暗视瞳孔直径(SPD)、明视Kappa角(PK)及暗视Kappa角(SK)、瞳孔中心位移大小(PCS@S)及瞳孔中心位移方向(PCS@A)。使用配对样本t检验或秩和检验分析手术前后各指标变化。结果:手术前PPD、SPD分别为(3.30±0.52)(4.69±0.78)mm,手术后分别为(3.06±0.52)(4.27±0.76)mm,PPD、SPD手术前后的差异均有统计学意义(t=13.12,P<0.001;t=16.61,P<0.001)。手术前PK、SK分别为0.25(0.14,0.53)、0.30(0.15,0.52)mm,手术后分别为0.38(0.24,0.61)、0.34(0.22,0.50)mm,手术后PK增大(Z=-3.52,P<0.001),SK无明显变化(Z=-1.04,P=0.295)。手术前后PCS@S分别为0.10(0.05,0.13)、0.06(0.04,0.10)mm,术后小于术前(Z=-3.78,P<0.001)。手术前后PCS@A分别为138?(76?,179?)、126?(80?,164?),术后顺时针方向变化(Z=-1.76,P=0.042)。手术前后SK和SPD之间、PK和PPD之间均无相关性(均P>0.05)。术前、术后PCS@S与SK均呈正相关(r=0.38,P<0.001;r=0.26,P=0.010),PCS@S与SPD、PPD均无相关性(均P>0.05)。结论:白内障手术后1个月PPD、SPD、PCS@S均减小;PCS@A顺时针变化,且无论术前和术后,双眼暗视瞳孔中心均主要位于明视瞳孔中心的上方;PK增大,SK无明显变化。白内障术前选择人工晶状体时应考虑以上改变。