【摘要】 目的：评估白内障术后疏水性丙烯酸人工晶状体Sensar AR40e和硅胶人工晶状体的后囊膜混浊(PCO)，并用能客观评估PCO的软件量化分析。方法：共选择98眼行标准的超声乳化白内障吸除术，人工晶状体囊袋内固定。所有眼随机植入Sensar AR40e或硅胶人工晶状体，但同一患者植入的人工晶状体必须不同。在第1～2a时后照法拍摄后囊膜图像，通过去除浦肯野反光、增强对比度、过滤后增强低密度的PCO等方法处理后用POCO软件分析对比。结果：术后1a疏水性丙烯酸人工晶状体PCO百分比为0.32±0.13，硅胶人工晶状体为0.39±0.17(P=0.37)。2a时疏水性丙烯酸人工晶状体PCO百分比为0.42±0.20，硅胶晶状体为0.34±0.18(P=0.50)。患者术后1，2a时疏水性丙烯酸人工晶状体PCO的严重级别分别是0.50±0.30和0.82±0.58，与硅胶人工晶状体的0.63±0.35和0.55±0.35相比，无统计学意义（P=0.52,P=0.69)。结论：POCO后囊膜混浊量化分析系统提供了客观而且可重复性强的量化PCO的方法，也是研究预防PCO技术的有力工具。
【关键词】 后囊膜混浊；量化；丙烯酸；人工晶状体
Abstract
AIM: To evaluate posterior capsular opacification (PCO) with hydrophobic acrylic intraocular lens (IOL, Sensar AR40e) and silicone IOLs after cataract surgery, to use a software program developed to provide an objective assessment of the amount of PCO in the digital images of the posterior capsule to quantify PCO.
METHODS: Ninetyeight eyes underwent standardized phacoemulsification and "in the bag" IOL placement, were randomized to receive a three piece lens of hydrophobic acrylic or silicone, but lens materials were different in one case. In year 1 and 2, digitized retroillumination images were taken from the posterior capsule. Images were analyzed by POCO software program, removing the Purkinje light reflexes, contrast enhancement, filtering to enhance lowdensity PCO.
RESULTS: The percentage of PCO were 0.32±0.13 of hydrophobic acrylic IOLs in year 1, compared with 0.39±0.17 of silicone (P=0.37). In year 2, the percentage of PCO were 0.42±0.20 with hydrophobic acrylic IOLs and 0.34±0.18 with silicone IOLs (P=0.50). Of those patients with PCO in year 1 and 2, severity grades were 0.50±0.30 and 0.82±0.58 of hydrophobic acrylic cases, compared with 0.63±0.35 and 0.55±0.35 of patients with silicone IOLs (P=0.52,P=0.69) with no statistical significance.
CONCLUSION: The POCO system is capable of producing an objective and repeatable measure of PCO that is relevant to assessing techniques of PCO prevention.
KEYWORDS:posterior capsular opacification;quantification; acrylate; intraocular lens
INTRODUCTION
Posterior capsular opacification (PCO) is a common complication after cataract surgery in modern times. According to previous reports, the incidence of PCO of the first 5 years after cataract operation is 3%50%, in which the different frequencies must have some relationship with the different observation evaluation systems. Clinically, the evaluation of PCO mainly depends on the examiners rich clinical experience, but it can only determine the nature rather than the quantity. With digital photographic image acquisition systems, we evaluated PCO with the new hydrophobic acrylic intraocular lens (IOL, Sensar AR40e) and silicone IOLs after cataract surgery. At the same time, we adopted the software [the posterior capsule opacity (POCO) software system] to make quantification and comparison so that we might minimize observation bias and enhance accuracy as well.
MATERIALS AND METHODS
Patients were recruited in a continuous cohort following approval from the hospital ethics committee. We chose as the object of our study the patients who were hospitalized and had their operation for cataract in our hospital from October 2006 to September 2007. The 49 cases (98 eyes) in all were chosen as samples, in which 19 cases (38 eyes) were male, 30 cases (60 eyes) were female. The patients age ranged from 23 to 86 years and the average age was 71.5 years. The preoperative visual acuity was 0.05 0.6. The average time of follow up was 23.4±0.9 months. The classification of lens nucleus was strictly carried out according to LOCSⅡ standard, 21 eyes for Grade N1, 65 eyes for Grade N2 and 12 eyes for Grade N3. In the process of the surgery with the employment of a random table the order of operation for every patient’s two eyes was randomized with controlled blinded trials. For each patient one eye was implanted with Sensar AR40e, and the other with AQ110NV (28 eyes) or SI40NB (21 eyes) silicone IOL. All the surgery was performed between October 2006 and September 2007 by a single surgeon, in the course of which there were some minor accidents, such as capsulorhexis rim tear, failure to place the IOL into the capsular bag, posterior capsules rupture and vitreous loss. All the evaluation and observation of quantifying the postoperative PCO was completed by the same person.
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