[1]孔佳怡,张自峰,李曼红,等.玻璃体切割联合超声乳化人工晶状体植入术治疗黄斑疾病合并白内障患者的屈光预测误差分析[J].眼科新进展,2024,44(5):370-375.[doi:10.13389/j.cnki.rao.2024.0072]
　KONG Jiayi,ZHANG Zifeng,LI Manhong,et al.Refractive prediction error in vitrectomy combined with phacoemulsification and intraocular lens implantation for patients with macular disease and cataract[J].Recent Advances in Ophthalmology,2024,44(5):370-375.[doi:10.13389/j.cnki.rao.2024.0072]
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玻璃体切割联合超声乳化人工晶状体植入术治疗黄斑疾病合并白内障患者的屈光预测误差分析/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
44卷
期数:
2024年5期
页码:
370-375
栏目:
应用研究
出版日期:
2024-04-30

文章信息/Info

Title:
Refractive prediction error in vitrectomy combined with phacoemulsification and intraocular lens implantation for patients with macular disease and cataract
作者:
孔佳怡; 张自峰; 李曼红; 田超伟; 王雨生
710032　陕西省西安市，空军军医大学西京医院眼科、全军眼科研究所
Author(s):
KONG Jiayi; ZHANG Zifeng; LI Manhong; TIAN Chaowei; WANG Yusheng
Department of Ophthalmology，Eye Institute of Chinese PLA，Xijing Hospital，Fourth Military Medical University，Xi’an 710032，Shaanxi Province，China
关键词:
黄斑疾病; 白内障; 联合手术; 玻璃体切割术; 超声乳化白内障吸除术; 人工晶状体; 屈光误差
Keywords:
macular disease;  cataract;  combined operation;  vitrectomy;  phacoemulsification;  intraocular lens;  refractive error
分类号:
R774.5
DOI:
10.13389/j.cnki.rao.2024.0072
文献标志码:
A
摘要:
目的　分析玻璃体切割联合超声乳化白内障吸除及人工晶状体（IOL）植入术治疗黄斑疾病合并白内障患者术后屈光预测误差（PE）。
方法　本研究纳入2014年5月至2022年11月于空军军医大学西京医院眼科行玻璃体切割联合超声乳化白内障吸除及IOL植入术的黄斑疾病合并白内障患者96例（96眼）。分析患者术后最佳矫正视力（BCVA）和实际等效球镜度（SE），计算PE和绝对屈光误差（ARE），并分析PE与眼轴长度（AL）、前房深度（ACD）、晶状体厚度（LT）、平坦角膜曲率（Kf)、陡峭角膜曲率(Ks)、平均角膜曲率(Km)、角膜散光度（Cyl）、眼压(IOP)、BCVA、角膜散光轴向、黄斑疾病诊断分类和术中玻璃体内填充物种类的相关性。
结果　术后早期（术后3 d内），96例患者BCVA与术前比较差异无统计学意义（P>0.05）。96例患者术后早期实际SE与术前预测屈光度比较差异有统计学意义（P<0.05），ARE为（1.47±2.54）D，其中近视漂移患者61例，PE为（-1.81±3.07）D，远视漂移患者35例，PE为（0.87±0.96）D。术后1个月，12例随访患者BCVA与术前比较差异无统计学意义（P>0.05），12例随访患者术后1个月实际SE与术前预测屈光度、术后早期实际SE之间以及术后早期实际SE与术前预测屈光度之间比较差异均无统计学意义（均为P>0.05）。术后随访时间大于1年（术后长期）的6例患者，末次随访时BCVA与术前比较差异无统计学意义（P>0.05）。相关性分析显示，近视漂移患者术后早期PE与术前AL、Cyl均呈负相关（均为P<0.05）；近视漂移患者术后早期PE与黄斑疾病诊断分类相关（P<0.05），且病理性近视黄斑裂孔患者较其他类型黄斑疾病患者近视漂移程度更大（P<0.05）；近视漂移患者术后早期PE与术前ACD、TL、Kf、Ks、Km、IOP、BCVA，玻璃体内填充物种类以及角膜散光轴向均无相关性（均为P>0.05）。远视漂移患者术后早期PE与术前Cyl呈正相关（P<0.05）；远视漂移患者术后早期PE与玻璃体内填充物种类存在相关性（P<0.05），且术中玻璃体内硅油填充患者较玻璃体内无填充物患者远视漂移程度更大（P<0.05）。远视漂移患者术后早期PE与术前AL、ACD、TL、Kf、Ks、Km、IOP、BCVA，黄斑疾病诊断分类以及角膜散光轴向均无相关性（均为P>0.05）。
结论　黄斑疾病合并白内障患者行玻璃体切割联合超声乳化IOL植入术后早期存在以近视漂移为主的PE，其漂移程度随时间的增加可逐渐减轻。屈光漂移的方向和程度可能与患眼术前AL、Cyl，黄斑疾病诊断分类和术中玻璃体内填充物种类有关。
Abstract:
Objective　To analyze the refractive prediction error (PE) in combined vitrectomy, phacoemulsification, and intraocular lens (IOL) implantation for patients with macular disease and cataract.
Methods　This study encompassed 96 patients (96 eyes) diagnosed with macular disease and cataract, who underwent combined vitrectomy, phacoemulsification and IOL implantation at the Department of Ophthalmology in Xijing Hospital, Air Force Military Medical University from May 2014 to November 2022. The best corrected visual acuity (BCVA) and actual spherical equivalent (SE) were studied, PE and absolute refractive error (ARE) were calculated, and the correlations between PE and axial length (AL), anterior chamber depth (ACD), lens thickness (LT), flat keratometry (Kf), steep keratometry (Ks), mean keratometry (Km), corneal astigmatism degree (cylinder, Cyl), intraocular pressure (IOP), BCVA, corneal astigmatism axis, the classification of macular diseases, and the type of intraoperative vitreous fillers were analyzed.
Results　In the early postoperative period (within 3 days after surgery), no statistically significant disparity in BCVA was observed compared to preoperative data among the 96 patients studied (P>0.05). The ARE was determined to be (1.47±2.54) D, indicating a substantial deviation between the actual SE and preoperative predictive refraction of the 96 patients (P<0.05). Among them, 61 patients had a myopic shift, 35 patients had a hyperopic shift, and the values of PE were (-1.81±3.07) D and (0.87±0.96) D, respectively. At the 1-month mark after surgery, there was no statistically significant difference in BCVA compared to the preoperative data of 12 follow-up patients (P>0.05). Similarly, no statistically significant differences were found between every two of the three data, namely the actual SE one month after surgery, the preoperative predictive refraction, and the actual SE in the early postoperative period of the 12 follow-up patients (all P>0.05). Also, no disparity was observed in BCVA at the last follow-up (P>0.05) among the 6 patients who were followed up for over 1 year (long-term postoperative follow-up). The correlation analysis revealed that, in the early postoperative period, the PE of patients with myopic shift was negatively correlated with both preoperative AL and Cyl measurements (both P<0.05). The early postoperative PE of patients with myopic shift was associated with the diagnostic classification of macular diseases (P<0.05), and the degree of myopic shift was observed to be significantly greater in patients with pathological myopia macular holes compared to those with other macular diseases (P<0.05). Additionally, the early postoperative PE of patients with myopic shift was uncorrelated with preoperative ACD, TL, Kf, Ks, Km, IOP, BCVA, the type of intraoperative vitreous fillers and the corneal astigmatism axis (all P>0.05). In contrast, for patients exhibiting hyperopic shift, the PE observed in the early postoperative period exhibited a positive correlation with preoperative Cyl (P<0.05).
Conclusion　Refractive prediction error may occur in patients with macular disease and cataract in the initial postoperative period after the vitrectomy combined with phacoemulsification and IOL implantation, predominantly caused by myopic shift. However, over time, there is a significant reduction in the magnitude of this refractive error. The direction and extent of diopter drift appear to be influenced by preoperative AL, Cyl, the specific diagnosis of macular disease, and the type of vitreous cavity filler utilized in the surgical procedure.

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备注/Memo

备注/Memo:
国家自然科学基金（编号：81770936）；陕西省重点研发计划项目（编号：2024SF-YBXM-320）；西京医院临床医学研究助推专项（编号：XJZT24LZ13）
更新日期/Last Update: 2024-05-05