中央孔型眼内镜植入术后拱高的影响因素

目的 探讨中央孔型眼内镜（ICL）植入术后中央拱高的影响因素及分析导致极端拱高的可能原因。设计 回顾性病例系列。研究对象 2018-2019年北京同仁眼科中心接受V4c型ICL植入术的患者138例（276眼）。方法 回顾患者术前眼部生物测量参数包括屈光度（SE）、角膜水平直径即白到白（WTW）、前房深度（ACD）、前房容积（ACV）、前房角（Angle）、眼轴长度（AL）、晶状体厚度（LT）及术中植入ICL的直径。术后1周用眼前节OCT测量患者的拱高（Vault）。采用多元逐步回归分析确定拱高值和眼部生物参数的相关性。按拱高大小分为三组，分别为低拱高组（＜250 μm）、正常拱高组（250~1000 μm）和高拱高组（>1000 μm），对三组间眼部参数进行比较，分析造成极端低拱高和极端高拱高的可能影响因素。主要指标 术后拱高值。结果 术后1周平均拱高为（645±247）μm。多元逐步回归分析得到拱高的回归方程为：Vault（μm）=180.954×ACD(mm) +99.805×WTW（mm）-2517.5，调整r2为0.069。低拱高组、正常拱高组、高拱高组三组间的ICL直径（127.9±3.8 mm、127.3±3.6 mm、130.2±2.8 mm）和ACD（2.95±0.29 mm、3.19±0.24 mm、3.29±0.22 mm）均有统计学差异（P均＜0.05）；年龄、SE、Angle、ACV、WTW、CCT、K1、K2差异无统计学意义（P均>0.05）。结论ACD和WTW是影响术后拱高的关键因素。同时，晶状体偏厚是极端拱高的可能影响因素。提示在临床上遇到非年龄性晶状体偏厚者，在ICL的选择上需要综合考虑更多因素。

Influencing factors of vault after implantable collamer lens with central port implantation

Objective To explore the related factors affecting vault after implantable collamer lens implantation with central port. Design Retrospective case series. Participants 138 patients (276 eyes) who received ICL V4c implantation in Beijing Tongren Eye Center from January 2018 to November 2019. Methods Preoperative ocular biometric parameters were collected, including diopter, white to white (WTW), anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (Angle), axial length (AL), lens thickness (LT) and ICL size. The vault was measured by anterior chamber-optical coherence tomography (AS-OCT) one week after surgery. Multiple stepwise regression analysis was used to determine the correlation between vault and preoperative biological parameters. The possible factors contributing to extremely low vault height (vault<250 μm) and extremely high Vault height (Vault > 1000 μm) were further analyzed. Main Outcome Measures Vault. Results The mean vault after the operation was 645±247 μm. The regression equation of arch height was obtained by using multiple step-by regression analysis: Vault (μm) =180.954×ACD (mm) +99.805×WTW (mm) -2517.5, and the adjusted r2 was 0.069. The ICL size was 127.9±3.8 mm, 127.3±3.6 mm, 130.2±2.8 mm and the ACD was 2.95±0.29 mm, 3.19±0.24 mm, 3.29±0.22 mm respectively, in low vault height groups, normal vault height group, and high vault height ( all P<0.05). There was no significant differences in age, SE, Angle, ACV, WTW, CCT, K1 and K2 among the three groups ( all P>0.05). Conclusion Vault is positively correlated with ACD and WTW, among which ACD has the greatest influence on vault. Moreover, LT was an important factor in both the low vault group and the high vault group. This suggests that non-age-related LT should be taken into consideration in the selection of ICL size in clinic.