目的探讨年龄相关性白内障患者的晶状体倾斜和偏心分布特征，并分析与其相关的影响因素。
方法采用横断面研究设计，连续收集2022年1—3月在武汉大学附属爱尔眼科医院就诊的50岁及以上双眼年龄相关性白内障患者585例1 170眼。采用扫频源三维眼前节光学相干断层扫描仪测量双眼晶状体的倾斜度、倾斜轴向、偏心量和偏心轴向；采用扫频光学生物测量仪测量双眼的眼球生物测量参数，包括角膜屈光力、白到白角膜直径、前房深度、晶状体厚度以及眼轴长度。晶状体倾斜度与偏心量的相关性评估采用Pearson线性相关分析；晶状体倾斜轴向与偏心轴向的相关性评估采用Spearman秩相关分析。年龄及眼球生物参数对晶状体倾斜度和偏心量的影响评估采用多重线性回归分析。
结果晶状体倾斜度为(4.69±1.59)°，其中倾斜度≥7°者占6.7%(78/1 170)，倾斜轴向主要位于颞下方，双眼呈对称镜像表现。晶状体偏心量为(0.19±0.11)mm，其中偏心量≥0.40 mm者占5.3%(62/1 170)，偏心轴向主要位于颞侧。晶状体倾斜度与其偏心量呈正相关( r＝0.422， P<0.001)，倾斜轴向与其偏心轴向呈正相关( r s ＝0.432， P<0.001)。不同眼别间晶状体倾斜度比较差异无统计学意义( t＝0.487， P＝0.626)；右眼晶状体偏心量明显大于左眼，差异有统计学意义( t＝2.563， P＝0.011)。不同性别间晶状体倾斜度和偏心量比较差异均无统计学意义( t＝1.500、1.566，均 P>0.05)。60～69岁、70～79岁、80～89岁组患者晶状体倾斜度均大于50～59岁组，80～89岁组患者晶状体偏心量明显大于60～69岁组，差异均有统计学意义(均 P<0.05)。眼轴长度≥25 mm组晶状体倾斜度小于<22 mm组和22～<25 mm组，差异均有统计学意义(均 P<0.001)。不同眼轴长度组患者晶状体偏心量总体比较差异无统计学意义( F＝1.433， P＝0.239)。多重线性回归分析结果显示，前房深度( B＝－0.474， t＝－2.115， P＝0.035)、眼轴长度( B＝－0.258， t＝－9.324， P<0.001)、晶状体偏心量( B＝5.646， t＝11.234， P<0.001)对晶状体倾斜度的影响有统计学意义。晶状体厚度( B＝－0.032， t＝－2.402， P＝0.017)、眼轴长度( B＝0.010， t＝4.406， P<0.001)、晶状体倾斜度( B＝0.032， t＝11.234， P<0.001)对晶状体偏心量的影响有统计学意义。
结论在50岁及以上的年龄相关性白内障患者中，6.7%的患者晶状体倾斜度≥7°，5.3%的患者晶状体偏心量≥0.40 mm。年龄越大，晶状体倾斜度和偏心量越大。眼轴长度越短，前房越浅，晶状体倾斜度越大。晶状体的倾斜度和倾斜轴向越大，则晶状体的偏心量和偏心轴向也越大。
ObjectiveTo investigate the characteristics of crystalline lens tilt and decentration distribution in age-related cataract patients and analyze the related factors.
MethodsA cross-sectional study was conducted.A total of 585 consecutive patients (1 170 eyes) with bilateral age-related cataracts over the age of 50 were enrolled at Aier Eye Hospital of Wuhan University from January 2022 to March 2022.Bilateral crystalline lens tilt and decentration magnitude and direction were measured by swept-source anterior segment optical coherence tomography.Corneal curvature, white-to-white corneal diameter, anterior chamber depth, lens thickness and axial length were measured using a swept-source optical coherence tomography biometer.The correlation of tilt magnitude and decentration magnitude of crystalline lens was assessed by Pearson linear correlation analysis.The correlation of tilt direction and decentration direction of crystalline lens was assessed by Spearman rank correlation analysis.The influence of age and ocular biometric parameters on crystalline lens tilt and decentration was analyzed by multiple linear regression analysis.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Aier Eye Hospital of Wuhan University (No.2022IRBKY0617).All patients signed the informed consent form before any medical examination.
ResultsThe mean tilt magnitude was (4.69±1.59)°, of which 6.7% had a tillt ≥7°, and the direction was mainly toward the inferotemporal side with a mirror symmetry between both eyes.The mean decentration magnitude was (0.19±0.11)mm, of which 5.3% had a decentration ≥0.4 mm, and the direction was mainly towards the temporal side.The crystalline lens tilt magnitude was positively correlated with decentration magnitude ( r=0.422, P<0.001) and the crystalline lens tilt direction was positively correlated with decentration direction ( r s =0.432, P<0.001).There was no significant difference in crystalline lens tilt magnitude between both eyes ( t=0.487, P=0.626), and the crystalline lens decentration was significantly greater in the right eye than in the left eye, with statistically significant difference ( t=2.563, P=0.011).There was no significant difference in crystalline lens tilt and decentration between male and female ( t=1.500, 1.566; both P>0.05).The crystalline lens tilt magnitude was significantly greater in 60-69 years, 70-79 years and 80-89 years groups than in 50-59 years group, and the crystalline lens decentration magnitude was significantly greater in the 80-89 years group than in the 60-69 years group (all P<0.05).The crystalline lens tilt magnitude was smaller in the axial length ≥25 mm group than in the <22 mm group and the 22-<25 mm group, and the differences were statistically significant (both P<0.001).There was no significant difference in crystalline lens decentration magnitude among different axial length groups ( F=1.433, P=0.239).The multiple linear regression analysis revealed that the effects of anterior chamber depth ( B=-0.474, t=-2.115, P=0.035), axial length ( B=-0.258, t=-9.324, P<0.001) and crystalline lens decentration ( B=5.646, t=11.234, P<0.001) on crystalline lens tilt were statistically significant.The influence of lens thickness ( B=-0.032, t=-2.402, P=0.017), axial length ( B=0.010, t=4.406, P<0.001) and crystalline lens tilt ( B=0.032, t=11.234, P<0.001) on crystalline lens decentration were statistically significant.
ConclusionsAmong age-related cataract patients aged 50 and above, 6.7% have crystalline lens tilt ≥7°, and 5.3% have crystalline lens decentration ≥0.4 mm.The older the age, the greater the crystalline lens tilt and decentration.The shorter the axial length and the shallower the anterior chamber, the greater the tilt of the lens.The greater the tilt magnitude and decentration, the greater the decentration magnitude and decentration.
吴义芬,张莹,王勇. 年龄相关性白内障患者晶状体倾斜和偏心分布特征及其影响因素分析[J]. 中华实验眼科杂志,2025,43(03)：233-240.
DOI:10.3760/cma.j.cn115989-20221107-00518版权归中华医学会所有。
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吴义芬：实施研究、采集及分析/解释数据、统计分析、起草文章；张莹：对文章的知识性内容作批评性审阅；王勇：酝酿和设计试验、对文章的知识性内容作批评性审阅及定稿
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