有晶状体眼人工晶状体后房方位与拱高的相关性

doi:10.3760/cma.j.cn115909-20200401-00127

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摘要目的：探讨有晶状体眼人工晶状体（ICL）后房方位与拱高的相关性。方法：回顾性系列病例研究。选择2017年6月至2019年6月在重庆爱尔麦格眼科医院因第一只眼将ICL置于水平位拱高高于750 μm 而另一只眼将同长度ICL置于垂直位的双眼中高度近视患者32例。术前检查包括裂隙灯显微镜下测量角膜水平直径（WTW）及超声生物显微镜（UBM）测量前房深度（ACD）、睫状沟到沟（STS）水平直径、STS垂直直径以及晶状体厚度（LT）。术后随访大于6个月，采用UBM测量拱高。数据采用配对 t检验、多元回归分析和受试者工作特征（ROC）曲线分析。结果：ICL置于垂直位眼较对侧眼术后拱高小（280±205）μm，差异有统计学意义（t=5.375，P<0.001），双眼STS水平-垂直直径差异为（0.42±0.21）mm。多元线性回归显示，双眼拱高差异与STS水平-垂直直径差异具有相关性（调整 R2 =0.545，F=10.30，P<0.001），与WTW、ACD和LT无明显相关性。以垂直位ICL拱高下降至理想范围（250～750 μm）为标准，对双眼STS水平-垂直直径差异绘制ROC曲线：曲线下面积（AUC）为0.917， 95%CI 0.764～0.985，P<0.001，最佳临界值为0.3，灵敏度为83.33%，特异性为100%。以双眼拱高差异≥100、200、300 μm为标准，分别对双眼STS水平-垂直直径差异绘制ROC曲线：AUC≥100 μm为 0.859，P≥100 μm=0.007，最佳临界值为0.30，灵敏度为76.92%，特异性为100%；AUC≥200 μm为0.778， P≥200 μm=0.008，最佳临界值为0.36，灵敏度为77.78%，特异性为71.43%；AUC≥300 μm为0.754， P≥300 μm=0.015，最佳临界值为0.36，灵敏度为85.71%，特异性为66.67%。结论：ICL置于水平位后拱高偏高者，如果STS水平-垂直直径差异>0.3 mm，ICL置于垂直位拱高有极高的可能性下降至理想范围。

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关键词 ：拱高, 有晶状体眼人工晶状体植入术, 超声生物显微镜, 睫状沟到沟

Abstract： Objective: To study the relationship between the posterior chamber position and vault after implantation of the implantable collamer lens (ICL). Methods: This was a retrospective case series study. From June 2017 to June 2019, 32 cases of middle and high myopia with ICLs in the horizontal or vertical position were selected in Chongqing Aier Maige Ophthalmology Hospital because the vault of one eye was higher than 750 μm and an ICL at the same length was placed in the vertical position in the contralateral eye. The preoperative examination included the measurement of white-to-white (WTW) diameter under a slit lamp microscope, anterior chamber depth (ACD), sulcus-to-sulcus (STS) horizontal diameter, STS vertical diameter and lens thickness (LT) measured by ultrasound biomicroscopy (UBM). The vault was also measured by UBM. The data were analyzed by a paired t test,multiple linear regression and the receiver operating characteristic (ROC) curve. Results: The vault of the ICL in the vertical position decreased significantly (280±205 μm) compared with that in the horizontal position (t=5.375, P<0.001), and the horizontal-vertical diameter difference in the STS in both eyes was 0.42±0.21 mm. Multiple linear regression showed that the difference in vault was significantly related to the difference in the STS horizontal-vertical diameter (adjusted R2 =0.545, F=10.30, P<0.001), but not related to WTW, ACD or LT. The ROC curve was drawn for the horizontal-vertical diameter difference in STS in both eyes according to the standard of the vertical ICL vault falling into the ideal range (250-750 μm). The area under the curve (AUC) was 0.917, 95%CI 0.764-0.985, P<0.001. The optimal cut-off value was 0.3, the sensitivity was 83.33%, and the specificity was 100%. The ROC curve was drawn for the horizontal-vertical diameter difference in STS in both eyes according to the standard of vault difference in both eyes 100, 200 and 300 μm and above: AUC≥100 μm was 0.859, P≥100 μm=0.007, the optimal cut-off value was 0.3, sensitivity was 76.92%, specificity was 100%; AUC≥200 μm was 0.778, P≥200 μm=0.008,the optimal cut-off value was 0.36, sensitivity was 77.78%, specificity was 71.43%; AUC≥300 μm was 0.754, P≥300 μm=0.015, the optimal cut-off value was 0.36, sensitivity was 85.71%, specificity was 66.67%. Conclusions: In the case of a high vault in the horizontal position, if the horizontal-vertical diameter difference is STS>0.3 mm, there is a high probability that the vault of the ICL in the vertical position can be reduced to the ideal range.

Key words： vault phakic intraocular lenses ultrasound biomicroscopy sulcus-to-sulcus

收稿日期: 2020-04-01

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通讯作者: 彭艳丽（ORCID：0000-0001-7937-4774），Email：pengyanli@aierchina.com

引用本文:

王红霞彭艳丽赵中秀刘夏露. 有晶状体眼人工晶状体后房方位与拱高的相关性[J]. 中华眼视光学与视觉科学杂志, 2020, 22(10): 738-743. Hongxia Wang, Yanli Peng, Zhongxiu Zhao, Xialu Liu. The Relationship between the Posterior Chamber Position and Vault after Implantation of the Implantable Collamer Lens. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(10): 738-743. DOI: 10.3760/cma.j.cn115909-20200401-00127

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20200401-00127 或 https://www.cjoovs.com/CN/Y2020/V22/I10/738

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