[1]雷蕊莲,赵军梅.青光眼-白内障联合术后患者屈光误差及其与术前眼球生物学参数的相关性[J].眼科新进展,2022,42(6):480-484.[doi:10.13389/j.cnki.rao.2022.0098]
　LEI Ruilian,ZHAO Junmei.Analysis of refractive error and its correlation with preoperative ocular biometric parameters in patients after glaucoma-cataract combined surgery[J].Recent Advances in Ophthalmology,2022,42(6):480-484.[doi:10.13389/j.cnki.rao.2022.0098]
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青光眼-白内障联合术后患者屈光误差及其与术前眼球生物学参数的相关性/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
42卷
期数:
2022年6期
页码:
480-484
栏目:
应用研究
出版日期:
2022-06-05

文章信息/Info

Title:
Analysis of refractive error and its correlation with preoperative ocular biometric parameters in patients after glaucoma-cataract combined surgery
作者:
雷蕊莲; 赵军梅
030001　山西省太原市，山西医科大学第一临床医学院（雷蕊莲）；030001 山西省太原市，山西省眼科医院青光眼科（赵军梅）
Author(s):
LEI Ruilian1; ZHAO Junmei2
1.The First Clinical Medical College of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China
2.Department of Glaucoma,the Shanxi Eye Hospital,Taiyuan 030001,Shanxi Province,China
关键词:
青光眼; 白内障; 联合手术; 屈光误差; 生物学参数
Keywords:
glaucoma;  cataract;  combined surgery;  refractive error;  biometric parameters
分类号:
R778
DOI:
10.13389/j.cnki.rao.2022.0098
文献标志码:
A
摘要:
目的　对比分析原发性急性闭角型青光眼(PAACG)、原发性慢性闭角型青光眼(PCACG)、原发性开角型青光眼(POAG)患者行青光眼-白内障联合手术（青白联合手术）后3个月的屈光状态，评估术前眼球生物学参数对患者术后屈光状态的影响。方法　回顾性临床研究。选择2020年2月至2021年2月于山西省眼科医院行青白联合手术的青光眼合并白内障患者90例（108眼），其中PAACG组30例（33眼）,PCACG组30例（38眼），POAG组30例（37眼）。所有患者术前均采用IOLMaster 700测量眼轴长度、中央角膜厚度、角膜曲率、前房深度、晶状体厚度、白到白距离（WTW），使用仪器自带的SRK-T公式计算人工晶状体度数及预留屈光度。术后3个月对患者进行综合验光，计算术后屈光误差。比较三组患者术后3个月的屈光误差分布，及术前眼球生物学参数与屈光误差的相关性。结果　三组患者间术前中央角膜厚度、角膜曲率、WTW差异均无统计学意义(均为P>0.05)。POAG组较PAACG组和PCACG组患者术前眼轴更长、前房更深、晶状体更薄，差异均有统计学意义(均为P<0.05)，PAACG组与PCACG组患者间术前眼轴长度、前房深度、晶状体厚度相比差异均无统计学意义(均为P>0.05)。术后3个月，PAACG组、PCACG组、POAG组患者绝对屈光误差分别为(0.53±0.75)D、(0.51±0.70)D、(0.05±0.47)D。远视误差组患者术前眼轴长度短于近视误差组，术前前房深度浅于近视误差组，术前晶状体厚度厚于近视误差组，两组间相比差异均有统计学意义(均为P<0.05)；两组患者间术前中央角膜厚度、角膜曲率与WTW之间差异均无统计学意义(均为P>0.05)。术后屈光误差与术前眼轴长度、前房深度均呈负相关(r=-0.62、-0.48，均为P=0.00)，与术前晶状体厚度呈正相关(r=0.54，P=0.00)，与术前中央角膜厚度、角膜曲率、WTW均无显著相关性(均为P>0.05)。结论　使用SRK-T公式计算人工晶状体度数时，PAACG、PCACG患者比POAG患者呈现较大的屈光误差，且多为远视误差。术前短眼轴、浅前房及厚晶状体患者青白联合手术后更趋于远视误差。
Abstract:
Objective　To evaluate the refractive outcomes and the effects of preoperative ocular biometric parameters on refractive outcomes in patients with primary acute angle-closure glaucoma (PAACG), primary chronic angle-closure glaucoma (PCACG), and primary open-angle glaucoma (POAG) three months after glaucoma-cataract combined surgery. Methods　In this retrospective clinical study, 90 patients (108 eyes) receiving glaucoma-cataract combined surgery at Shanxi Eye Hospital from February 2020 to February 2021 were enrolled, including 30 (33 eyes) with PAACG in the PAACG group, 30 (38 eyes) with PCACG in the PCACG group, and 30 (37 eyes) with POAG in the POAG group. Before surgery, axial length (AL), central corneal thickness (CCT), keratometry (K), anterior chamber depth (ACD), lens thickness (LT), and white-to-white distance (WTW) were measured by IOL Master 700, and the intraocular lens power and reserved diopter were calculated using the SRK-T formula contained in IOL Master 700. Refraction was checked three months after surgery to estimate the postoperative refractive error (RE). RE distribution at three months after surgery among the three groups was compared, and the correlation between RE and preoperative ocular biometric parameters was analyzed. Results　There was no significant difference in the preoperative CCT, K and WTW among the three groups (all P>0.05). Patients in the POAG group had a longer ocular axis, deeper anterior chamber, and thinner lens compared with the PAACG and PCACG groups (all P<0.05), but there was no significant difference in AL, ACD and LT between the PAACG and PCACG groups (all P>0.05). Three months after surgery, the absolute RE in the PAACG, PCACG and POAG groups was (0.53±0.75) D, (0.51±0.70) D, and (0.05±0.47) D, respectively. The preoperative AL and ACD in the hyperopic RE group were less than those in the myopic RE group, while the preoperative LT was greater than that in the myopic RE group (all P<0.05). There was no significant difference in CCT, K and WTW between the hyperopic and myopic RE groups (all P>0.05). The postoperative RE was negatively correlated with the preoperative AL and ACD (r=-0.62, -0.48, both P=0.00) and is positively correlated with the preoperative LT (r=0.54, P=0.00), but had no significant correlation with the preoperative CCT, K and WTW (all P>0.05). Conclusion　When the intraocular lens power is calculated using the SRK-T formula, PAACG and PCACG patients have a higher RE than POAG patients, and RE is mostly hyperopic RE. Patients with a shorter ocular axis, shallower anterior chamber and thicker lens are more likely to have hyperopic RE after glaucoma-cataract combined surgery.

参考文献/References:

［1］　KANG S Y,HONG S,WON J B,GJ S,KIM C Y.Inaccuracy of intraocular lens power prediction for cataract surgery in angle-closure glaucoma［J］.Yonsei Med J,2009,50(2):206-210.
［2］　HUANG G,GONZALEZ E,PENG P H,LEE R,LEEUNGURASATIEN T,HE M,et al.Anterior chamber depth,iridocorneal angle width,and intraocular pressure changes after phacoemulsification:narrow vs open iridocorneal angles［J］.Arch Ophthalmol,2011,129(10):1283-1290.
［3］　PAKRAVAN M,ALVANI A,ESFANDIARI H,GHAHARI E,YASERI M.Post-trabeculectomy ocular biometric changes［J］.Clin Exp Optom,2017,100(2):128-132.
［4］　BAE H W,LEE Y H,KIM D W,LEE T,HONG S,GJ S,et al.Effect of trabeculectomy on the accuracy of intraocular lens calculations in patients with open-angle glaucoma［J］.Clin Exp Ophthalmol,2016,44(6):465-471.
［5］　ONG C,NONGPIUR M,PETER L,PERERA S.Combined approach to phacoemulsification and trabeculectomy results in less ideal refractive outcomes compared with the sequential approach［J］.J Glaucoma,2016,25(10):e873-e878.
［6］　LAW S K,MANSURY A M,VASUDEV D,CAPRIOLI J.Effects of combined cataract surgery and trabeculectomy with mitomycin C on ocular dimensions［J］.Br J Ophthalmol,2005,89(8):1021-1025.
［7］　CHUNG J K,WI J M,LEE K B,AHN B H,HWANG Y H,KIM M,et al.Long-term comparison of postoperative refractive outcomes between phacotrabeculectomy and phacoemulsification［J］.J Cataract Refract Surg,2018,44(8):964-970.
［8］　SHRIVASTAVA A K,BEHERA P,KACHER R,KUMAR B.Effect of anterior chamber depth on predictive accuracy of seven intraocular lens formulas in eyes with axial length less than 22 mm［J］.Clin Ophthalmol,2019,13:1579-1586.
［9］　RETZLAFF J A,SANDERS D R,KRAFF M C.Development of the SRK/T intraocular lens implant power calculation formula［J］.J Cataract Refract Surg,1990,16(3):333-340.
［10］　赵江月,刘野,王静,陆璐,张劲松.同轴微切口白内障手术后视觉质量及IOL的稳定性［J］.中华眼视光学与视觉科学杂志,2014,16(8):452-455.
ZHAO J Y,LIU Y,WANG J,LU L,ZHANG J S.Visual quality of coaxial microincision cataract surgery and the stability of microincision intraocular lens［J］.Chin J Optom Ophthalmol Vis Sci,2014,16(8):452-455.
［11］　郁琪华,邬一楠,沈降.白内障手术前后眼轴和屈光状态的变化［J］.眼科,2016,25(2):90-93.
YU Q H,WU Y N,SHEN J.The changes in axial length and refraction before and after cataract surgery［J］.Ophthalmol CHN,2016,25(2):90-93.
［12］　ALVANI A,PAKRAVAN M,ESFANDIARI H,SAFI S,YASERI M,PAKRAVAN P.Ocular biometric changes after trabeculectomy［J］.J Ophthalmic Vis Res,2016,11(3):296-303.
［13］　张鹏程,张婕,严宏.眼压对青光眼-白内障联合术患者人工晶状体计算公式选择的影响［J］.眼科新进展,2018,38(2):146-149.
ZHANG P C,ZHANG J,YAN H.Effects of intraocular pressure on the selection of intraocular lens calculation formulas for cataract and glaucoma surgery［J］.Rec Adv Ophthalmol,2018,38(2):146-149.
［14］　ZHANG N,TSAI P L,CATOIRA-BOYLE Y P,MORGAN L S,HOOP J S,CANTOR L B,et al.The effect of prior trabeculectomy on refractive outcomes of cataract surgery［J］.Am J Ophthalmol,2013,155(5):858-863.
［15］　OLSEN T.Sources of error in intraocular lens power calculation［J］.J Cataract Refract Surg,1992,18(2):125-129.
［16］　杨斐,侯宪如,吴慧娟,鲍永珍.年龄相关性白内障合并浅前房患者白内障术后屈光状态研究［J］.中华眼科杂志,2014,50(2):84-88.
YANG F,HOU X R,WU H J,BAO Y Z.Analysis of refractive status after cataract surgery in age-related cataract patients with shallow anterior chamber［J］.Chin J Ophthalmol,2014,50(2):84-88.
［17］　OLSEN T.Prediction of the effective postoperative (intraocular lens) anterior chamber depth［J］.J Cataract Refract Surg,2006,32(3):419-424.
［18］　KIM K N,LIM H B,LEE J J,KIM C S.Influence of biometric variables on refractive outcomes after cataract surgery in angle-closure glaucoma patients［J］.Korean J Ophthalmol,2016,30(4):280-288.
［19］　SEO S,LEE C E,KIM Y K,LEE S Y,JEOUNG J W,PARK K H.Factors affecting refractive outcome after cataract surgery in primary angle-closure glaucoma［J］.Clin Exp Ophthalmol,2016,44(8):693-700.
［20］　SENTHIL S,DESHMUKH S,TURAGA K,PESALA V,BANDELA P K,GANESH J,et al.Surgically induced astigmatism and refractive outcomes following phacotrabeculectomy［J］.Indian J Ophthalmol,2020,68(4):609-614.
［21］　代志强,王保君,杨华,李新民.巩膜瓣可调整缝线的小梁切除术对角膜散光的影响［J］.眼科新进展,2017,37(9):882-885.
DAI Z Q,WANG B J,YANG H,LI X M.Effects of trabeculectomy with removable suture in sclera flap on astigmatism of cornea ［J］.Rec Adv Ophthalmol,2017,37(9):882-885.

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更新日期/Last Update: 2022-06-05