摘要
目的:探讨不同人工晶状体(IOL)装载方法对术中襻与光学部黏附发生率的影响。方法:纳入2021年7月至2022年7月于北京大学第三医院眼科行常规白内障摘除联合IOL植入术患者439例(439只眼)。其中，男性214例(214只眼)，女性225例(225只眼)；年龄59~79岁，平均年龄(68.7±9.5)岁。按照植入疏水性丙烯酸IOL的类型，分为Tecnis ZCB00组、Tecnis ZXR00组、Tecnis ZMT组及A1UV组；按照IOL的装载方法，分为常规装载组、复方电解质装载组、黏弹剂装载组、双襻间隔装载组、预装组、复方电解质+黏弹剂装载组及复方电解质+黏弹剂+双襻间隔装载组。比较植入患者术中襻与光学部黏附发生率、黏附类型以及是否需要额外器械辅助的差异。年龄符合正态分布以±s表示，组间比较采用单因素方差分析；性别、黏附发生率、黏襻类型及额外辅助方法等分类变量以例数和百分比描述，组间比较采用卡方检验。结果:Tecnis ZCB00组、Tecnis ZXR00组、Tecnis ZMT组及A1UV组患者分别为45例(45只眼)、29例(29只眼)、28例(28只眼)及87例(87只眼)，组间年龄比较的差异无统计学意义(F＝1.536，P>0.05)；性别比较的差异无统计学意义(χ2＝5.327，P>0.05)。各组术中襻黏附发生率分别为15.6%、3.4%、14.3%及34.5%，组间比较的差异有统计学意义(χ2＝15.658，P<0.05)。A1UV组襻黏附发生率高于其他三组，比较的差异均有统计学意义(χ2＝5.267，10.698，4.149；P<0.05)。各组术中需要额外器械辅助率分别为2.2%、0、7.1%及24.1%，组间比较的差异有统计学意义(χ2＝19.723，P<0.05)。A1UV组需要额外器械辅助率最高，高于其他三组，比较的差异均有统计学意义(χ2＝10.257，8.547，5.231；P<0.05)。黏附现象发生率较高植入A1UV型IOL的患者250例(250只眼)中常规装载组、复方电解质装载组、黏弹剂装载组、双襻间隔装载组、预装组、复方电解质+黏弹剂装载及复方电解质+黏弹剂+双襻间隔装载组分别纳入20例(20只眼)、17例(17只眼)、30例(30只眼)、56例(56只眼)、61例(61只眼)、15例(15只眼)及51例(51只眼)；年龄组间比较的差异无统计学意义(F＝0.267，P>0.05)；性别组间比较的差异无统计学意义(χ2＝4.229，P>0.05)。IOL不同装载方法襻黏附需额外器械辅助率分别为55.0%、5.9%、10.0%、8.9%、31.1%、40.0%及31.4%，组间比较的差异有统计学意义(χ2＝28.780，P<0.05)。不同装载方法对襻黏附发生类型比较的差异有统计学意义(χ2＝31.490，P<0.05)。不同装载方法对单襻黏光学部、双襻黏光学部、双襻环抱及未黏比较的差异均有统计学意义(χ2＝10.976，12.928，10.793，10.400；P<0.05)。结论:在Tecnis ZCB00、Tecnis ZXR00、Tecnis ZMT及A1UV型IOL中，A1UV的襻与光学部黏附现象较重。常规装载法、复方电解质装载法、黏弹剂装载法、双襻间隔装载法、预装法、复方电解质+黏弹剂装载法及复方电解质+黏弹剂+双襻间隔装载法中添加复方电解质眼内冲洗液效果较好，且黏附现象发生较轻。
Abstract
Objective:The aim of this study is to investigate the effect of the intraocular lens (IOL) loading methods on the incidence of the adhesion phenomenon.Methods:439 patients (439 eyes) who underwent phacomulsification for cataract extraction combined with IOL implantation at the Ophthalmology Department of Peking University Third Hospital from July 2021 to July 2022 were included. Among them, there were 214 males (214 eyes) and 225 females (225 eyes) with the averge age of (68.7±9.5) years (ranged from 59 to 79 years). According to the types of hydrophobic acrylic IOLs, they were divided into Tecnis ZCB00, Tecnis ZXR00, Tecnis ZMT, and A1UV group. According to the methods of loading for IOL, they were divided into conventional loading method, composite electrolyte loading method, viscoelastic agent loading method, double loop interval loading method, pre loading method, composite electrolyte+ viscoelastic agent loading method, and composite electrolyte+ viscoelasticagent+ double loop interval loading method. The differences in the incidence of adhesion phenomena, adhesion types, and the need for additional instrument assistance were compared. The age were in accordance with normal distribution, which was expressed as ±s, and compared with one-way ANOVA. The incidence of adhesion, loading method, adhesion type and additional instruments methods, were described by the number of cases and percentage, and chi-square test was used for comparison between groups.Results:There were 45 cases (45 eyes), 29 cases (29 eyes), 28 cases (28 eyes), and 87 cases (87 eyes) implanted with Tecnis ZCB00, Tecnis ZXR00, Tecnis ZMT, and A1UV, respectively. There was no statistically significant difference in age (F=1.536, P>0.05) and gender (χ2=5.327, P>0.05) between the groups. The incidence of adhesion during IOL implantation in the Tecnis ZCB00, Tecnis ZXR00, Tecnis ZMT, and A1UV groups was 15.6%, 3.4%, 14.3%, and 34.5%, respectively. The differences between the groups were statistically significant (χ2=15.658, P<0.05). The incidence of adhesion in the A1UV group was higher than that of other groups, and the differences were statistically significant (χ2=5.267, 10.698, 4.149; P<0.05). The rates of additional instrument assistance during the four IOL surgeries were 2.2%, 0, 7.1%, and 24.1%, respectively, with a statistically significant difference (χ2=19.723, P<0.05). The A1UV group had the highest rate of requiring additional equipment assistance, which was higher than other groups, and the difference between them was statistically significant (χ2=10.257, 8.547, 5.231; P<0.05). The conventional loading method, composite electrolyte loading method, viscoelastic agent loading method, double loop interval loading method, pre loading method, composite electrolyte+ viscoelastic agent loading method, and composite electrolyte+ viscoelastic agent+ double loop interval loading method groups of 250 cases (250 eyes) of A1UV IOL were included with 20 cases (20 eyes), 17 cases (17 eyes), 30 cases (30 eyes), 56 cases (50 eyes), 61 cases (61 eyes), 15 cases (15 eyes), and 51 cases (51 eyes), respectively. There was no statistically significant difference between the groups in the average age (F=0.267, P>0.05) and gender (χ2=4.229, P>0.05) between them. The different loading method groups had additional instrument assistance rates of 55.0%, 5.9%, 10.0%, 8.9%, 31.1%, 40.0%, and 31.4%, respectively with a statistically significant (χ2=28.780, P<0.05). There was a statistical significance in comparing the types of adhesive adhesion between different loading methods (χ2=31.490, P<0.05). Different loading methods had statistically significant differences in the comparison of single loop adhesive optical department, double loop adhesive optical department, double loop embracing and non adhesive (χ2=10.976, 12.928, 10.793, 10.400; P<0.05).Conclusions:Among Tecnis ZCB00, Tecnis ZXR00, Tecnis ZMT, and A1UV IOLs, the rate of adhesion phenomenon between the haptic and optical part of A1UV is the highest. Among the conventional, composite electrolyte, viscoelastic agent, double loop interval, pre loading method, composite electrolyte+ viscoelastic agent, and composite electrolyte+ viscoelastic agent+ double loop interval loading method, compound electrolyte eye rinse solution is the most effective for installation, and the rate of adhesion phenomenon is lowest.
万方数据