高度近视白内障患者术后疗效的影响因素研究

目的 比较综合性医院眼科与眼科专科医院高度近视白内障患者术后视力,分析高度近视白内障患者术后视力的影响因素。方法 选择在复旦大学附属华东医院及复旦大学附属眼耳鼻喉科医院进行超声乳化白内障摘除合并人工晶状体植入手术的眼轴长度≥26 mm的高度近视患者77例(77眼)。术前记录患者眼部生物学特征及眼底相干光层析成像(OCT)情况,并按医院不同分为2组,比较2组术后视力,并分析术后最佳矫正视力(BCVA)与术前眼部特征的相关性。结果 眼耳鼻喉科医院收治的高度近视白内障患者更年轻、眼轴长度更长、合并的黄斑疾病更多(P<0.05)。所有患者术后视力均有提高(P<0.001),2家医院平均术后BCVA差异无统计学意义(P=0.805)。单因素分析显示,高度近视白内障患者术后BCVA(logMAR)与眼轴长度、光感受器内外节连接(IS/OS)不连续及合并黄斑牵引性疾病呈正相关,与黄斑中心凹视网膜厚度呈负相关(P<0.05)。逐步向后多元线性回归分析显示高度近视白内障术后BCVA的独立影响因素为眼轴长度、IS/OS连续性及术前BCVA。结论 超声乳化白内障摘除合并人工晶状体植入手术治疗高度近视白内障安全有效,其疗效受眼轴长度、IS/OS连续性及术前BCVA影响。

Factors influencing the efficacy of cataract surgery in highly myopic patients

Objective To compare the postoperative visual acuity of highly myopic patients between the ophthalmic specialized hospital and the comprehensive hospital, and evaluate its influencing factors. Methods Seventy-Seven highly myopic cataract patients (77 eyes) with axial length no less than 26 mm who underwent phacomulsification and intraocular lens implantation surgery in Huadong Hospital and Eye & ENT Hospital of Fudan University were included in this study. The biological characteristics of the eyes and optical coherence tomography (OCT) of the fundus were recorded before the operation. The patients were divided into two groups according to the hospital. The postoperative visual acuity of the two groups was compared and the relationship between postoperative best corrected visual acuity (po-BCVA) and preoperative characteristics were analyzed. Results Highly myopic cataract patients in Eye & ENT Hospital were younger, with longer axial length and more vitreomacular traction diseases (P<0.05). Postoperative visual acuity improved in all patients (P<0.001) and there was no significant difference between the two hospitals(P=0.805). Univariate analysis showed that the po-BCVA (logMAR) was positively correlated with axial length, IS/OS discontinuity and vitreomacular macular traction disease, and negatively correlated with central foveal thickness (P<0.05). Backward stepwise multiple linear regression analysis showed that the independent influencing factors of the po-BCVA were axial length, IS/OS continuity and preoperative BCVA. Conclusions Phacoemulsification combined with intraocular lens implantation is safe and effective in the treatment of highly myopic cataract. Its efficacy is related to axial length, IS/OS continuity and preoperative BCVA.