作者;刘新泉，郭鸣华，杨秋菊，陈洁，陈潞，徐芳

［摘要］  目的  探讨可调节式后房型人工晶体植入术后的临床疗效及调节效果。方法  将11例（16眼）单纯性白内障用超声乳化摘除并植入1CU可调节后房型人工晶体作为研究组，同时随机选取同期植入SN60AT后房型人工晶体10例（13眼）作为对照组。手术后随访3个月以上，主要观察远视力、最佳矫正远视力；35cm近视力、最佳矫正近视力；前房深度的变化及调节力的测定（分别用主观法和客观法）。结果  1CU可调节后房型人工晶体具有很好的组织耐受性，在囊袋中稳定，居中性好。研究组与对照组裸眼远视力分别为0.87±0.22和0.6±0.23，差异有显著性(t=3.068，P<0.05)；最佳矫正远视力分别为0.99±0.25和0.89±0.1，差异无显著性(t=0.714，P>0.05)。35cm近视力分别为0.63±0.16和0.38±0.24，差异有显著性(t=2.717，P<0.05)；最佳矫正近视力分别为0.99±0.25和0.86±0.14，差异有显著性(t=2.553，P<0.05)。两组调节幅度主观法（D）分别为3.65±0.91和4.37±1.52，差异无显著性(t=-1.787，P>0.05)；客观法（D）分别为0.88±0.22和0.27±0.08，信捷职称论文写作发表网，差异有非常显著性(t=-5.596，P<0.001)。在用2％毛果芸香碱后前房深度变浅（mm）分别为0.90±0.23和0.34±0.26，差异有非常显著性(t=4，P<0.001)。结论  这种可调式后房型人工晶体早期观察的结果具有良好的术后视功能，比普通的人工晶体具有更大的调节范围，但仍需要观察随着手术后的时间延长其屈光状态和调节能力的变异性及稳定性情况。
　　［关键词］  超声乳化；晶状体，人工；前房深度；调节力；1CU
   
    Clinical effects of an accommodative PC-IOL after implantation
       
    ［Abstract］  Objective  To evaluate the clinical effectiveness and accommodative range after implanting the 1CU accommodative PC-IOL (1CU).Methods  11 cases (16 eyes) had phacoemulsification and implantation of 1CU (HumanOptics). The other age?matched 10 cases (13eyes) were implanted with conventional IOLs (SN60AT) as the control group. Naked and best corrected distant acuity，naked and best corrected near acuity at 35cm were determined and the change in the anterior chamber depth measured after 3 months and amplitude of accommodation was measured with subjective and objective techniques.Results  The 1CU accommodative PC-IOLs after implantation had good centered and stable and no IOL-specific complications. Naked distant acuity of the eyes with 1CU and with SN60AT were 0.87±0.22 and 0.6±0.23 respectively between which there was significantly statistical differences (t=3.068，P<0.05). The best corrected distant acuity of both groups was 0.99±0.25 and 0.89±0.1 respectively between which no statistically significant(t=0.714，P>0.05).The near acuity at 35cm was 0.63 0.16 and 0.38±0.25 between which there was significantly statistical different (t=2.717，P<0.05). The best corrected near acuity was 0.99±0.25 and 0.86±0.14 between which there was significantly statistical differences. The accommodative range was 3.65±0.91 and 4.37±1.52 between which there was no statistical significant (t=1.787，P>0.05). The diopter measured by objective techniques was 0.88±0.22 and 0.28±0.08 respectively，there was significantly statistical difference. Decrease of anterior chamber depth after topical application of 2% pilocarpine eyedrops，when the depth was 0.90±0.23 and 0.34±0.26 respectively between which there was significantly statistical difference (t=4，P<0.001).Conclusion  In the present study，the 1CU accommodative PC-IOL showed that the eyes with 1CU had good visual acuity and increased accommodative range more than the control group with conventional IOLs. Further research is necessary to observe the changes of refraction of 1CU with the time longer after operation. 
   
［Key words］  phacoemulsification；lenses，artificial；anterior chamber depth；accommodation；1CU
   
    随着现代白内障手术的进步，患者在超声乳化及人工晶体植入手术后能够迅速恢复良好的视力，但是由于术眼调节力基本丧失，所以需要根据患者视远、视近时的不同需要而佩戴眼镜加以矫正。而目前应用的多焦点人工晶体虽然兼顾了远近视力，但其具有眩光、复视及对比敏感度降低的不足［1］。德国HumanOptics公司的1CU可调节人工晶体是一种能够随着晶状体囊袋牵张和松弛而自动变化焦点的人工晶体。杨浦区眼防所自2004年以来应用1CU可调节式后房型人工晶体，并以SN60AT后房型人工晶体作为对照，现将临床资料完整病例的观察结果报告如下。
   
    1  资料与方法
   
    1.1  一般资料  自2004年3月起在我院因单纯老年性白内障行超声乳化及人工晶体植入术的患者中，植入可调节式后房型人工晶体1CU（HumanOptics）11例，其中男7例，女4例，共16眼，见表1；年龄58～76岁，平均68.2岁；同期对照组用随机数字法选取植入SN60AT后房型人工晶体（Alcon）10例，男6例，女4例，共13眼，见表2；年龄61～77岁，平均72.7岁。术后随访3个月以上。
   
    1.2  人工晶体  本文应用的1CU可调节式后房型人工晶体是由吸收紫外线的亲水性丙烯酸酯材料制成的可折叠一片式人工晶体，光学部直径5.5mm，全长9.8mm，屈光指数1.46。它采用独特的可调节四襻设计，最大限度地维持囊袋的形状，使囊袋完全张开，将悬韧带和睫状肌的力量通过囊袋均匀地传递到4个襻，再传递到光学部使人工晶体在囊袋内前后移动，达到均匀调节的目的。植入人工晶体后，光学区的后囊膜没有发现有后囊膜皱褶，说明在360°范围内表面的压力是均匀的。

表1  1CU可调节式后房型人工晶体植入患者的相应临床资料

表2  SN60AT后房型人工晶体植入患者的相应临床资料

    1.3  手术方法  所有手术均由同一位术者完成。眼部局部麻醉后，上方透明角膜缘作3.2mm切口，前房注入黏弹剂，做直径5～5.5mm连续环形撕囊，尽可能做到正圆及正中。水分离晶状体核后，在囊袋内进行超声乳化，利用自动灌注/抽吸系统吸净晶状体皮质，前、后囊抛光后，囊袋内注入黏弹剂，将1CU人工晶体通过推注器植入到囊袋内，用晶状体调位钩将1CU人工晶体的4个襻展开于晶状体囊袋的周边部。吸净黏弹剂，恢复前房。所有病例手术顺利，无并发症发生。
   
    1.4  手术后检查  除对两组病例进行眼前节裂隙灯、角膜曲率、眼压、裸眼及矫正远、近视力的检查外，还进行调节幅度的检查。调节幅度用主观法、客观法和点2％毛果芸香碱缩瞳后测量前房深度。主观法是通过调节近点的测量确定眼的调节能力。在矫正远视力的状态下，嘱手术眼看近视力表中的0.5视标，由远处向眼前移动直至视标模糊为止。再进行调节幅度的换算［调节幅度＝100/距离（cm）-视远的屈光度］。客观法即动态的视网膜检影。使用德国产HEINE BETA 200带状光检影镜。所有病例的检查均由同一医师进行。分别测量手术眼注视35cm和5m处视标时的屈光状态，取两者屈光之差作为调节范围。前房深度测量：在患者手术后3个月以上复诊时，用Alcon公司的Ultrascan A/B超，先在未使用影响瞳孔大小和睫状肌状态药物的情况下，测量前房深度；然后用2％毛