我国白内障摘除手术效果及影响因素分析

目的探讨我国开展白内障摘除手术的效果及其影响因素。方法病例对照研究。对全国白内障复明手术信息报告系统中2017年1至12月全国31个省(直辖市、自治区)上报的接受白内障摘除手术的2078479例患者信息进行统计描述。分析白内障摘除手术后3 d、3个月患者视力改善情况及年龄、性别、术前矫正视力、既往病史、手术方式等对白内障摘除手术效果的影响。手术效果根据术后最佳矫正视力分为效果良好、效果一般、效果差。采用Wilcoxon秩和检验及多分类logistic回归模型等进行统计学分析。结果2078479例患者中,女性1197942例(57.64%),男性880537例(42.36%);患者年龄为(69±11)岁;白内障类型以年龄相关性白内障(1928440例,92.78%)为主。术前、术后3 d、术后3个月矫正视力填写完整的病例分别有1608385、1126961、389020例。手术后患者视力状况有了明显改善,术后3 d、术后3个月与术前矫正视力(最小分辨角对数转换后)的差值中位数分别为-0.48、-0.52,四分位数间距分别为0.60、0.73,术后3 d、术后3个月与术前比较差异均有统计学意义(Z=551599.30,206815.35;均P<0.01)。多因素分析显示,发生术后并发症(效果一般:OR=0.50,95%CI为0.46~0.55;效果良好:OR=0.31,95%CI为0.28~0.33)、术前瞳孔状态异常(效果一般:OR=0.52,95%CI:0.44~0.61;效果良好:OR=0.55,95%CI为0.47~0.63)、术前眼压异常(效果一般:OR=0.86,95%CI为0.79~0.93;效果良好:OR=0.45,95%CI为0.42~0.49)、既往高血压病史(效果一般:OR=0.90,95%CI为0.85~0.95;效果良好:OR=0.88,95%CI为0.83~0.93)和糖尿病病史(效果一般:OR=0.86,95%CI为0.80~0.93;效果良好:OR=0.92,95%CI为0.86~0.99)是影响手术效果的危险因素;术前矫正视力好(术前矫正视力0.2~0.4,效果一般:OR=2.20,95%CI为2.06~2.34,效果良好:OR=5.25,95%CI为4.94~5.59;术前矫正视力0.5~0.7,效果一般:OR=1.08,95%CI为0.96~1.21,效果良好:OR=6.35,95%CI为5.69~7.08;术前矫正视力≥0.8,效果一般:OR=0.73,95%CI为0.60~0.89,效果良好:OR=6.58,95%CI为5.51~7.86)、小切口囊外白内障摘除术(效果一般:OR=3.19,95%CI为2.35~4.33;效果良好:OR=6.79,95%CI为5.13~8.97)和超声乳化白内障吸除术(效果一般:OR=2.12,95%CI为1.60~2.81;效果良好:OR=3.34,95%CI为2.59~4.32)为手术效果的保护因素。结论我国白内障患者行白内障摘除手术后视力状况有明显改善,但仍有部分患者处于中度视力损伤状态;手术效果受术前矫正视力、术前眼压、术前瞳孔状态、手术方式、术后并发症等多种因素影响。

Visual outcome of cataract surgery and its influencing factors in China

Objective To explore the visual outcome of cataract surgery and its influencing factors in China.Methods A case-control study.The information of 2078479 patients who underwent cataract extraction of 31 provinces(municipalities and autonomous regions)recorded in the National Cataract Surgery Information Reporting System during January to December,2017 were analyzed.The postoperative visual outcomes of 3 days after surgery and 3 months after surgery were analyzed.The effects of age,gender,preoperative corrected visual acuity,past medical history,and surgical methods on the results of cataract surgery were analyzed.Surgery effect was divided into ideal effect,moderate effect and poor effect according to the best corrected visual acuity after operation.Wilcoxon rank sum test and multinomial logistic regression model were used for statistical analysis.Results There were 1197942 female patients(57.64%)and 880537 male patients(42.36%)in all 2078479 cases.The average age was(69±11)years old.The main type of cataract was age-related(1928440 cases;92.78%).There were 1608385 cases,1126961 cases and 389020 cases with complete corrected visual acuity before surgery,3 days after surgery and 3 months after surgery,respectively.The median difference of corrected visual acuity of preoperative versus three days after surgery,and preoperative versus three months after surgery were-0.48,-0.52 respectively(after logarithm of the minimum angle of resolution conversion).The interquartile ranges were 0.60 and 0.73 respectively.The differences were statistically significant(Z=551599.30,206815.35;both P<0.01).Multivariate analysis showed that postoperative complications(moderate effect:OR=0.50,95%CI:0.46 to 0.55;ideal effect:OR=0.31,95%CI:0.28 to 0.33),preoperative pupil abnormal(moderate effect:OR=0.52,95%CI:0.44 to 0.61;ideal effect:OR=0.55,95%CI:0.47 to 0.63),preoperative intraocular pressure abnormalities(moderate effect:OR=0.86,95%CI:0.79 to 0.93;ideal effect:OR=0.45,95%CI:0.42 to 0.49),history of hypertension(moderate effect:OR=0.90,95%CI:0.85 to 0.95;ideal effect:OR=0.88,95%CI:0.83 to 0.93)and history of diabetes(moderate effect:OR=0.86,95%CI:0.80 to 0.93;ideal effect:OR=0.92,95%CI:0.86 to 0.99)were predictors of worse outcome.Good preoperative corrected visual acuity(0.2 to 0.4 for moderate effect:OR=2.20,95%CI:2.06 to 2.34;for ideal effect:OR=5.25,95%CI:4.94 to 5.59;0.5 to 0.7 for moderate effect:OR=1.08,95%CI:0.96 to 1.21;for ideal effect:OR=6.35,95%CI:5.69 to 7.08;above 0.8 for moderate effect:OR=0.73,95%CI:0.60 to 0.89;for ideal effect:OR=6.58,95%CI:5.51 to 7.86),small incision extracapsular extraction(moderate effect:OR=3.19,95%CI:2.35 to 4.33;ideal effect:OR=6.79,95%CI:5.13 to 8.97)and phacoemulsification(moderate effect:OR=2.12,95%CI:1.60 to 2.81;ideal effect:OR=3.34,95%CI:2.59 to 4.32)were predictors of better outcome.Conclusions Visual acuity of patients in China improve significantly after cataract surgery.However,some patients still suffer moderate visual impairment.The effect of surgery can be affected by many factors,such as preoperative corrected visual acuity,preoperative intraocular pressure,preoperative pupil status,surgical approach and postoperative complications,etc.