中国眼耳鼻喉科杂志2024，Vol.24Issue(3) ：182-190.DOI:10.14166/j.issn.1671-2420.2024.03.005

3D CT眼球重建技术用于评估高度近视白内障眼球形态和人工晶状体度数预测精确度的研究

Application of 3D CT eyeball reconstruction technology in morphological assessment of the eyeball and intraocular lens power calculation in high myopia cataract

买尔哈巴·玉素甫 刘晓弟 甫拉提·阿布都热衣木
中国眼耳鼻喉科杂志2024，Vol.24Issue(3) ：182-190.DOI:10.14166/j.issn.1671-2420.2024.03.005
✕
  • NETL
  • NSTL
  • 万方数据

3D CT眼球重建技术用于评估高度近视白内障眼球形态和人工晶状体度数预测精确度的研究

Application of 3D CT eyeball reconstruction technology in morphological assessment of the eyeball and intraocular lens power calculation in high myopia cataract

买尔哈巴·玉素甫 1刘晓弟 1甫拉提·阿布都热衣木1
扫码查看

作者信息

  • 1. 新疆维吾尔自治区人民医院眼科 乌鲁木齐 830002
  • 折叠

摘要

目的 探索 3D CT 眼球重建技术在评估高度近视白内障眼球形态和人工晶状体(IOL)度数预测精确度的应用.方法 收集 2021 年 8-12 月行白内障超声乳化吸除联合IOL植入术的高度近视患者,眼轴长度(AL)≥26.5 mm,共计 52 例(52 眼),随访 1 个月.完善眼眶薄层 CT(扫描层厚 0.3 mm),记录眼底黄斑萎缩、牵引、新生血管病变(ATN)分级,比较术后最佳矫正视力(BCVA)和屈光度平均绝对误差(MAE),分析不同类型后巩膜葡萄肿的眼球形态之间的差异.利用 SPSS 20.0 对数据进行统计分析,P<0.05 为差异有统计学意义.结果 高度近视眼 3D CT 眼球形态分类如下:球形 8 眼(15.4％)、椭球形 4 眼(7.7％)、锥形13眼(25％)、鼻侧扭曲形12眼(23.1％)、颞侧扭曲形 7眼(13.5％)、桶形8 眼(15.4％).在年龄<60岁患者组中,球形 8 眼(25.0％)、锥形8 眼(25.0％),比例最高,椭球形1 眼(3.1％)、颞侧扭曲形4 眼(10.5％),比例最低;在年龄≥60 岁患者组中,没有球形眼球,而锥形 5 眼(25％)和鼻侧扭曲形 7 眼(35％),比例最高,提示随着年龄增加,后巩膜葡萄肿出现比例增加,差异有统计学意义(P<0.001).同时,当AL<28 mm时,球形眼球 7 眼(38.9％),比例最高;而当 AL≥30 mm时,没有球形眼球,锥形 6眼(26.1％)、颞侧扭曲形 5眼(21.7％)和桶形 5 眼(21.7％),比例增加,提示随着AL增加,后巩膜葡萄肿发生率增加,并且容易出现黄斑区的葡萄肿,差异有统计学意义(P<0.001).无后巩膜葡萄肿的球形眼球患者白内障术后有 87.5％的患者BCVA达到 20/40 及以上,而伴有后巩膜葡萄肿者视力预后不佳,尤其锥形有6 眼(46.2％)和颞侧扭曲有 3 眼(42.9％)的BCVA<20/40,差异有统计学意义(χ2=46.755,P<0.001).高度近视黄斑ATN分级提示,锥形、颞侧扭曲和桶形眼球的眼底病变更加明显,分级更高.高度近视眼中有 30眼(57.7％)白内障术后 MAE<0.5 D,其中椭球形、锥形和颞侧扭曲形眼球IOL 度数预测准确性最差,仅有25％、53.9％和 37.5％眼MAE<0.5 D;球形和鼻侧扭曲形眼球预测性最好,有 75％眼MAE<0.5 D,差异有统计学意义(χ2=80.035,P<0.001).结论 高度近视眼轴越长,越容易出现眼球畸形.其中,锥形、颞侧扭曲和桶形等眼球往往伴有严重的近视黄斑病变,白内障术后的视力预后也不佳.球形和鼻侧扭曲形眼球,白内障术中IOL度数预测性更佳,可能与后巩膜葡萄肿位置远离黄斑区域,从而生物测量更加准确有关.

Abstract

Objective To explore the application of 3D CT eyeball reconstruction technology in high myopia cataract intraocular lens(IOL)power calculation and vision prediction.Methods A prospective study was conducted on patients who had undergone cataract phacoemulsification combined with IOL implantation in the department of ophthalmology from August to December 2021.The follow-up period was 1 month.A total of 52 patients(52 eyes)with high myopic cataract and axial length(AL)≥26.5 mm were collected.All patients completed orbital thin CT(scanning layer thickness 0.3 mm).The atrophic,tractional and neovascular(ATN)grading of the fundus,best corrected visual acuity(BCVA)and mean absolute error(MAE)after surgery were recorded during the follow-up period,and the differences in the ocular morphology of different types of posterior scleral staphyloma were analyzed.SPSS 20.0 was used for statistical analysis of the data and there was a statistically significant difference when P<0.05.Results The classification of 3D CT eyeball morphology in 52 patients with high myopia was as follows:spherical in 8 eyes(15.4%),elliptical in 4 eyes(7.7%),conical in 13 eyes(25%),nasal distorted in 12 eyes(23.1%),temporal distorted in 7 eyes(13.5%),barrel in 8 eyes(15.4%).Among the patients with age＜60 years old,the proportion of spherical 8 eyes(25.0%)and conical 8 eyes(25.0%)were the highest,the proportion of elliptical 1 eye(3.1%)and temporal distorted 4 eyes(10.5%)was the lowest.However,in the patients with age≥60 years old,there was no spherical eyeball,while the proportion of 5 eyes with conical shape(25%)and 7 eyes with nasal distorted shape(35%)was the highest,suggesting that the proportion of posterior scleral staphyloma increased with age,with a statistically significant difference(P＜0.001).At the same time,when the AL was less than 28 mm,the proportion of spherical eyeballs(38.9%)was the highest.However,when the AL≥30 mm,there was no spherical eyeball,and the proportion of conical 6 eyes(26.1%),temporal distorted 5 eyes(21.7%)and barrel shaped 5 eyes(21.7%)increased,suggesting that with the increase of the AL,the incidence of posterior scleral staphyloma increased,and it was easy to find staphyloma in the macular area,and the difference was statistically significant(P＜0.001).After cataract surgery,87.5%of spherical eyeball patients without posterior scleral staphyloma had BCVA of 20/40 or more,while those with posterior scleral staphyloma had poor visual prognosis,especially 6 eyes(46.2%)with conical shape and 3 eyes(42.9%)with temporal distortion(BCVA＜20/40),and the difference was statistically significant(χ2=46.755,P＜0.001).The ATN grading of macular lesions in high myopia suggested that the fundus lesions of conical shape,temporal distortion and barrel eyeball were more obvious,and the grading was higher.The MAE of 30 eyes(57.7%)with high myopia after cataract surgery was less than 0.5 D,and the accuracy of IOL degree prediction of elliptical,conical and temporal distortion eyeballs were the worst,which only 25%,53.9%and 37.5%of the eyes had MAE less than 0.5 D.Spherical and nasal distorted eyeballs achieved the best,with MAE＜0.5 D in 75%of the patients(χ2=80.035,P＜0.001).Conclusions It is more likely to develop eye deformities when the AL is longer.Among them,conical shaped,temporal distorted,and barrel shaped eyeballs often have more serious myopic macular lesions and the visual prognosis after cataract surgery is also poor.Spherical shaped and nasal distorted eyeballs have better predictability of IOL degree during cataract surgery,which may be related to the posterior scleral staphyloma being located away from the macular area,resulting in more accurate biological measurements.

关键词

高度近视/白内障/后巩膜葡萄肿/3D/CT/屈光度误差

Key words

High myopia/Cataract/Staphyloma of posterior sclera/3D CT/Refractive error

引用本文复制引用

基金项目

新疆维吾尔自治区人民医院院内项目(20210228)

出版年

2024
中国眼耳鼻喉科杂志
复旦大学附属眼耳鼻喉科医院

中国眼耳鼻喉科杂志

CSTPCD
影响因子：0.555
ISSN：1671-2420
段落导航相关论文