作者：王兆艳，张卯年，李星星，崔霞 作者单位：（100853）中国北京市，中国人民解放军总医院眼科
【摘要】目的：探讨高龄老年人角膜前面屈折力特点及其对白内障手术的影响。方法：对199903/200408在我院住院接受白内障手术的大于75岁517眼进行角膜前面屈折力测定，同时观察不同术式术后3mo角膜前表面屈光变化，随机选择门诊年龄18～40岁年轻人50例100眼作对照，并进行统计学分析。结果：本研究组垂直经线角膜屈折力为43.4±1.5D，水平经线角膜屈折力43.1±1.6D，逆规散光情况达38.5%，明显高于青年组，超声乳化手术方式对角膜表面屈光状态影响不大，但小切口无缝线术式可使角膜散光状态朝向逆规性改变。结论：高龄老年人不同经线角膜屈折力发生改变，逆规散光增加，针对此变化，该组人群白内障手术切口方向或缝线松紧亦应做相应改变。
【关键词】 高龄;角膜;屈折力;散光;白内障
Analysis of the characteristic of corneal anterior refractive power and association with cataract surgery in venerable aged population
ZhaoYan Wang, MaoNian Zhang, XingXing Li, Xia Cui
Department of Ophthalmology, Peoples Liberation Army General Hospital, Beijing 100853, China
Correspondence to: ZhaoYan Wang. Department of Ophthalmology, Peoples Liberation Army General Hospital, Beijing 100853, China. [email protected]
Abstract AIM: To investigate the characteristic of radius of curvature of corneal anterior surface and the association with cataract surgery in venerable aged population. METHODS: The radius of curvature of corneal anterior surface of 517 cases over 75 years old, hospitalized in our department from March, 1999 to August, 2004, were examined before cataract surgery, and the change was compared within 3 months after surgery. Fifty volunteers aged 1840 were randomly selected as normal control group. The data were recorded and analyzed.RESULTS: The refractive power in vertical line of aged group was 43.42±1.46D, in horizontal line was 43.13±1.62D, againsttherule astigmatism was 38.5% and were significantly higher than those of control group. Phacoemulsification had no notable effect on the radius of curvature of the anterior corneal surface, but the small incision cataract extraction made the radius of curvature of corneal anterior surface become againsttherule astigmatism change.CONCLUSION: The refractive power of elderly people changes, especially in horizontal line, astigmatism increases, and cataractous surgery incision and suture should correspondingly change.
KEYWORDS: venerable aged; cornea; refractive power; astigmatism; cataract
0引言
老年人视力降低，除有白内障、黄斑变性等常见原因外，角膜屈光状态改变也是其中原因之一。我们在门诊病房日常工作中，常常发现高龄老年的角膜前表面光学形态较年轻人发生改变。为研究这一现象对视力的影响，本文回顾性分析了199903/200408在我院眼科住院接受白内障手术、年龄大于75岁的患者角膜屈光状态及对白内障手术切口的影响，报告如下。
1对象和方法
1.1对象
高龄老年组：整体选择199903/200408在我院住院接受白内障手术+人工晶状体植入术患者，入选标准：角膜透明，眼压正常，无明显沙眼、青光眼、眼睑下垂、斜视及角膜缘明显变性，从未接受过内外眼手术，屈光度≤±3.0D，眼别不限，检查合作。符合上述标准的共517眼，年龄75～97(平均82.5)岁。其中男455例，女9例，男性中有27例双眼行白内障手术，因本研究组中女性太少，所以未将性别作为一个因素考虑，本研究组对象出生地来自全国各地，但其中487例近20a一直居住在北京。青年对照组：随机选择门诊年龄18～40岁年轻人50例100眼作对照，眼部入选标准同老年组。
1.2方法
用德国Zeiss公司生产的角膜曲率仪对上述患者进行测量。检测每个患者角膜前面中央光学区（optic zone）两个主要经线上的屈折力，测量3次，取其平均值，45°轴以上者(包括45°)作为垂直经线，45°轴以下者作为水平经线计算，按统计学方法进行处理，并进行显著性检验，白内障术后的相关检查以术后3mo为标准。全部手术由本文第一作者完成，其中行白内障超声乳化+折叠人工晶状体植入术者为342眼，手术切口长3.2mm，切口位于12点角巩膜缘或稍后；行白内障小切口囊外摘除+人工晶状体植入术者为175眼，切口位置选在12点角膜缘后1.5～2.0mm，长约5.5～6.0 mm，为直线切口。
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