白内障手术前后瞳孔直径、Kappa角及瞳孔中心位移的变化

doi:10.3760/cma.j.cn115909-20221005-00382

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摘要目的：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。

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Abstract：Objective: To explore the alternations of pupil diameter, kappa angle, and pupil center shift before and after cataract surgery. Methods: This prospective study included 147 cataract patients (147 eyes) treated in the Department of Ophthalmology, the Second Affiliated Hospital of Chongqing Medical University from March to May 2022. We used the visual quality analyzer to measure photopic pupil diameter (PPD), scotopic pupil diameter (SPD), photopic Kappa (PK), scotopic Kappa (SK), pupil center shift @size (PCS@S), and pupil center shift @angle (PCS@A) before and one month after the operation. We used paired sample t-test and rank-sum test to analyze the alternations of each parameter before and after the operation. Results: PPD before and after the operation were 3.30 ± 0.52 mm and 3.06 ± 0.52 mm, showed a statistically signifcant difference (t=13.12, P<0.001). SPD before and after the operation were 4.69 ± 0.78 and 4.27 ± 0.76 mm, also showed a statistically signifcant difference (t=16.61, P<0.001). PK and SK were 0.25 (0.14, 0.53) mm and 0.30 (0.15, 0.52) mm respectively before surgery, and 0.38 (0.24, 0.61) mm and 0.34 (0.22, 0.50) mm respectively after surgery. PK increased after surgery (Z=-3.25, P<0.001), but SK had no signifcant difference (Z=-1.04, P=0.295). The PCS@S before and after surgery were 0.1 (0.05, 0.13) mm and 0.06 (0.04, 0.10) mm, showed smaller after surgery (Z=-3.78, P<0.001). The preoperative and postoperative PCS@Awere 138? (76?, 179?) and 126? (80?, 164?), respectively, indicating a clockwise change (Z=-1.76, P=0.042). There was no correlation between SK and SPD before and after the operation (P>0.05). And there was also no correlation between PK and PPD before and after the operation (P>0.05). There was a positive correlation between PCS@S and SK before and after surgery (r=0.38, P<0.001; r=0.26, P=0.010), but no correlations of PCS@S with SPD and PPD (all P>0.05). Conclusions: One month after cataract surgery, PPD, SPD, and PCS@S decreased. The PCS@A changed clockwise, the center of the scotopic pupil in both eyes was mainly located above the photopic pupil center before and after surgery. PK increased, and SK changed non-signifcantly. These alternations should be considered when choosing intraocular lens before cataract operation.

收稿日期: 2022-10-05

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通讯作者: 马华锋（ORCID：0000-0003-4417-1840），Email：hf_m9981@aliyun.com

引用本文:

王滨, 马华锋, 李会, 等. 白内障手术前后瞳孔直径、Kappa角及瞳孔中心位移的变化[J]. 中华眼视光学与视觉科学杂志, 2023, 25(5): 372-378. Bin Wang, Huafeng Ma, Hui Li, et al. Changes in Pupil Diameter, Kappa Angle and Pupil Centre Shift before and after Cataract Surgery. Chinese Journal of Optometry Ophthalmology and Visual science, 2023, 25(5): 372-378. DOI: 10.3760/cma.j.cn115909-20221005-00382

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https://www.cjoovs.com/CN/ 10.3760/cma.j.cn115909-20221005-00382 或 https://www.cjoovs.com/CN/Y2023/V25/I5/372