摘要
目的 分析轴性高度近视眼超声乳化白内障吸除联合IOL植入术后屈光误差原因以及优化Haigis公式和SRK/T公式的准确性.方法 回顾性研究.选取2008年5月至2013年12月于温州医科大学附属眼视光医院就诊的137例（137只眼）轴性高度近视眼白内障（眼轴≥26 mm）患者.术前IOL Master测量眼轴长度、角膜屈光力（K）、前房深度,应用优化Haigis公式及SRK/T公式预留IOL度数,主觉验光确认手术前后屈光状态.术中植入单焦点可折叠IOL,预留度数以优化Haigis公式在-1.96 D～-7.39 D.应用两公式术后3个月平均绝对屈光度数误差值（MAE）按眼轴长度分组为26 mm≤眼轴长度≤28 mm,28 mm＜眼轴长度≤30 mm,30 mm＜眼轴长度≤32 mm,32 mm＜眼轴长度≤34 mm和按K分组为40.00～ 42.00 D,42.01～ 44.00 D,44.01～46.00 D,46.01 ～ 48.00 D后分别进行单因素方差分析,应用直线相关、P-P图正态分布检验、Bland-Altman图及直线回归对两个公式的准确性进行比较.结果 （1）IOL度数与眼轴长度、K、前房深度以及术前近视度数回归关系为P=118.966-1.860眼轴长度-1.255K （F=472.86,P=0.00）.（2）按眼轴长度分组单因素方差分析：应用优化Haigis公式术后3个月平均绝对屈光度数误差值（MAE）组间差异均无统计学意义（F=2.73,P=0.06）.SRK/T公式术后3个月MAE中26 mm≤眼轴长度≤28 mm组（-0.05± 1.04）D与30 mm＜眼轴长度≤32mm组（0.94±1.21）D、32 mm＜眼轴长度≤34mm组（0.84±0.86）D组间存在统计学差异（t=-0.99,P=0.00;t=-0.89,P=0.00）,其余各组间差异无统计学意义.按K分组单因素方差分析：应用优化Haigis公式和SRK/T公式术后3个月MAE各组间差异均无统计学意义（F=0.32,P=0.81;F=0.56,P=0.65）.（3）优化Haigis公式和SRK/T公式预留度数的一致性范围（差值均数±1.96）为（-1.6,1.0）D.术前应用SRK/T公式和优化Haigis公式预留屈光度与术后3个月实际屈光度数均存在直线关系（F=9.35,P=0.00;F=7.85,P=0.00）.结论 眼轴长度为影响轴性高度近视白内障术后屈光误差的主要因素,其次为K.对于长眼轴患者,SRK/T公式和优化Haigis公式预测的一致性较好.在不同眼轴长度分段中,优化Haigis公式准确性无明显差异,SRK/T公式在眼轴长度为26 ～28 mm较眼轴长度为30～34 mm误差小.而两公式在不同K分段中的准确性无明显差异。
Objective To investigate the factors that influence the postoperative refractive error in long axial high myopic eyes,and to compare the accuracy of optimized Haigis and SRK/T formulas.Methods Retrospective study.From May 2008 to December 2010,137 high myopic eyes （with axial length （AL） greater than or equal to 26mm） of 137 patients,who got cataract surgeries at Eye Hospital of Wenzhou Medical University,were enrolled for this study.The AL,corneal curvature （K）,and anterior chamber depth （ACD） were measured by IOL-Master preoperatively.The intraocular lens （IOL） power was determined by optimized Haigis and SRK/T formulas,respectively.The preoperative and postoperative refractions were measured with phoropter.The target refraction after monofocal foldable IOL implantation was between-1.96 D to-7.39 D depending on the optimized Haigis formula.The mean absolute error （MAE） equals to the absolute difference between the target refraction and the 3 months postoperative actual refraction.One-way analysis of variance was used to analyze the MAE by two formulas to find the difference between each pair of both groups,which the AL groups were as follow：26 mm≤AL≤28 mm,28 mm〈AL≤30 mm,30 m〈AL≤32 mm,32 mm〈AL≤34 mm and K was grouped into 40.00-42.00 D,42.01-44.00 D,44.01-46.00 D and 46.01-48.00 D.Linear correlation,P-P figure of normal distribution test Bland-Altman plot and linear regression were used to compare the accuracy of two IOL power formulas and analyze the correlation between the 3 months postoperative refractive error and the parameters obtained preoperatively.Results （1） The IOL power is related to AL,K,ACD and preoperative spherical equivalent,the regression formulas is P=118.966-1.860AL-1.255K （F=472.86,P=0.00）.（2） In AL groups：No statistical difference of MAE was found between each pair of groups by optimized Haigis （F=2.73,P=0.06）.However,MAE difference were found between group 26 mm≤AL≤28 mm （-0.05 ± 1.04）D and group 30 mm〈AL≤32 mm （0.94± 1.21）D,group 32 mm〈AL≤34 mm （0.84±0.86） D by SRK/T formula （t=-0.99,P=0.00;t=-0.89,P=0.001）.In K groups：There was no statistical MAE difference by optimized Haigis or SRK/T formula between each pair of groups （F=0.32,P=0.81;F=0.56,P=0.65）.（3） The limits of agreement （mean difference ± 1.96 SD） of refraction difference between two formulas was （-1.6,1.0） D.The preoperative predicted refraction by the two formulas and the 3 months postoperative refractive error showed linear relationship （F=9.35,P=0.00;F=7.85,P=0.00）.Conclusions AL was the main factor affecting refractive error after long-axial high myopic eye cataract surgery,followed by K.For preoperative prediction,SRK/T formula and optimized Haigis formula show no difference.In AL subgroups,optimized Haigis formula showed no significant difference in accuracy,comparing with SRK/T formula induced less refractive error in 26-28mm group than in 30-34 mm group.There was no significant difference between SRK/T formula and optimized Haigis formulas in the K subgroups.
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2015年第4期276-281,共6页
Chinese Journal of Ophthalmology
关键词
近视
超声乳化白内障吸除术
晶体
人工
晶体植入
眼内
轴长度
眼
Myopia
Phacoemulsification
Lenses；intraocular
Lens implantation；intraocular
Axial length；eye
