摘要背景 后囊膜混浊(PCO)是白内障术后的常见并发症,客观、有效地评价PCO有助于PCO的防治,而以往的评价方法存在许多问题.Pentacam图片法是一种评价后囊膜形态的直观方法,了解异常后囊膜在Pentacam上的表现有助于PCO的预防和治疗. 目的 探讨晶状体后囊膜病变在Pentacam图片上的特点及分析模式的选择.方法 纳入2011年1-10月在中山大学中山眼科中心门诊复诊的白内障术后患者82例84眼,其中无后囊膜病变患者30例30眼,发生后囊膜病变患者52例54眼.患眼充分扩瞳后,采用裂隙灯显微镜照相法获取后囊膜的后反光照片,再使用Pentacam三维眼前节分析系统以50帧/2 s的速度对患眼进行扫描,获取后囊膜的冠状面Pentacam图像,使用Image J软件对其进行灰度分析,获取并比较中央4 mm和3 mm直径内的平均像素密度值,分析PCO在Pentacam图片上的特点;分析2种不同面积分析模式下受到前囊膜干扰的患眼百分比. 结果 无后囊膜病变患者30例30眼,其后囊膜在Pentacam图片显示为完全透明;年龄性相关性白内障术后并发PCO的患者共48例50眼,在Pentacam图片上,珍珠型PCO表现为蓝色背景下不同程度的灰度区,纤维化型PCO表现为白色外观;中央4 mm区及3 mm区的平均像素密度值分别为37.07 U(像素单位)和38.65 U,两者比较差异无统计学意义(P=0.606).囊袋阻滞综合征患者3例3眼,Pentacam图像呈现出均一、灰色外观,中央3 mm区平均像素密度值分别为12.40、15.68和36.77U.囊膜皱褶患者1例1眼,Pentacam图片显示为蓝色背景下的灰色条带状混浊,中央3 mm区的平均像素密度值为48.34 U.中央4 mm分析模式下,14.81％ (8/54)的患眼检测结果受前囊膜遮挡的影响,中央3 mm分析模式下所有患眼均不受前囊膜影响.结论 不同晶状体后囊膜病变的Pentacam图片表现各有特点,Pentacam图片显示中央4 mm区及3 mm区分析模式下患眼平均像素密度值无差异,中央3 mm区分析模式在判断晶状体囊膜透明性方面具有更好的适用性.

abstractsBackground Posterior capsule opacification (PCO) is a common complication following cataract surgery.Establishing an objective morphological evaluation method of PCO is of important clinical significance for the prevention of PCO,but there are many problems in previous evaluating methods,and pentacam picture appears to be a useful method of assessing PCO.Recognizing the characters of different types of posterior capsule disorder and optimizing the evaluation details in tentacam picture are helpful for us to prevent and treat PCO.Objective This study was to investigate the characters of posterior capsule disorders with Pentacam tomograms.Methods Eightyfour eyes of 82 patients were included in Zhongshan Ophthalmic Center from January to October in 2011.Slit-lamp photography and retroilluminated photography were captured after full mydriasis,and then the Pentacam imaging was performed by using 50-scan acquisition protocol,and high-resolution Pentacam tomograms were reconstructed and analyzed by Image J software.The features of the posterior capsule disorders in Pentacam tomogram were assessed,and the mean pixel-intensity at the central 4-mm diameter and 3-mm diameter was calculated and compared.The percentage of eyes being interfered by the anterior capsule in the two analyed areas was calculated.This study was approved by Zhongshan Ophthalmic Center,and uritten informed consent was obtained from each patient prior to any examination.Results The posterior capsular membranes were completely clear under the blue background in 30 eyes without posterior capsulaopathy on the Pentacam images.In 54 eyes of 52 patients with PCO,different intensities of gray patches were exhibited on the blue background in the elschnig-pearl-type PCO,and white-color nontransparence patches were seen in the fibrosis-type PCO.The mean pixel-intensity value (inter-quartile range) was 37.07 U and 38.65 U at the central 4-mm area and 3-mm area respectively,without significant difference between them (P=0.606).Capsular block syndrome was found in 3 eyes of 3 patients,showing even gray appearance on the Pentacam images and mean pixel-intensity of 12.40,15.68 and 36.77 U at the central 3-mm area.The gray strip-like appearance on the blue background was seen in 1 eye with capsular shrinkage,and the mean pixel-intensity was 48.34 U at the central 3-mm area.The examination outcomes of 14.81％ (8/54) eyes were disturbed by the anterior capsule in the central 4-mm analysis mode,but the outcomes were unaffected in central 3-mm analysis mode.Conclusions Different types of posterior capsule disorders appear particular scenery in Pentacam tomograms.There is no difference of mean pixel-intensity between the central 4-mm analysis mode and the central 3-mm analysis mode.A central 3-mm analysis mode is more available to justify the penetrability of the posterior capsule.