超声乳化术中联合应用囊袋张力环对不同眼轴长度超高度近视合并白内障患者的临床疗效

目的探讨超声乳化术中联合囊袋张力环植入对不同眼轴长度(axial length,AL)超高度近视合并白内障患者的疗效和安全性。方法选取2016年10月至2019年6月于我院治疗的超高度近视合并白内障患者56例(56眼)。将患者随机分成两组观察组28例(28眼),其中AL为27~<30 mm者12眼,AL≥30 mm者16眼;对照组28例(28眼),其中AL为27~<30 mm者14眼,AL≥30 mm者14眼。观察组超声乳化术中联合应用囊袋张力环植入,对照组术中不植入张力环。术后随访3个月,检测各组患者视力、眼压、角膜内皮细胞计数、人工晶状体偏心量和倾斜度,同时对各组患者进行主观视觉质量量表评分。结果两组不同AL患者术后3个月最佳矫正视力均较术前升高(均为P<0.05);两组不同AL患者间比较差异则均无统计学意义(均为P>0.05)。两组不同AL患者术后3个月眼压和角膜内皮细胞计数均较术前降低(均为P<0.05);两组不同AL患者间比较差异则均无统计学意义(均为P>0.05)。术后1个月和3个月两组不同AL患者各自组间水平偏心量、垂直偏心量及总偏心量比较,差异均无统计学意义(均为P>0.05)。术后1个月和3个月两组27 mm≤AL<30 mm患者组间水平倾斜度、垂直倾斜度及总倾斜度比较,差异均无统计学意义(均为P>0.05)。术后1个月,观察组AL≥30 mm患者水平倾斜度和总倾斜度均低于对照组同级AL患者,差异均有统计学意义(均为P<0.05);垂直倾斜度比较差异无统计学意义(P>0.05)。术后3个月,观察组AL≥30 mm患者垂直倾斜度和总倾斜度均低于对照组同级AL患者,差异均有统计学意义(均为P<0.05);水平倾斜度比较差异无统计学意义(P>0.05)。术后3个月两组患者主观视觉质量评分均高于术前;两组间同级AL患者观察组均高于对照组,差异均有统计学意义(均为P<0.05)。术后随访3个月,两组患者均未发生眼压升高、角膜内皮失代偿、人工晶状体脱位、眼内炎、视网膜脱离等并发症。结论超声乳化术中联合应用囊袋张力环治疗超高度近视合并白内障安全稳定,并能获得理想的视觉质量。

Clinical effect of combined application of capsular tension ring implantation in patients having ultra-high myopia combined with cataract atdifferent axial lengths

Objective　 To investigate the effect of combined application of capsular tension ring implantation in patients having ultra-high myopia combined with cataract at different axial length (AL). Methods　 The study recruited 56 eyes of 56 cases having ultra-high myopia combined with cataract who received treatment in our hospital from October 2016 to June 2019. The patients were divided into two groups: Observation group (28 eyes; 28 cases), including 12 eyes with AL 27-<30 mm and 16 eyes with AL ≥ 30 mm, and receiving phacoemulsification combined with capsular tension ring implantation; and control group (28 eyes; 28 cases), including 14 eyes with AL 27-<30 mm and 14 eyes with AL ≥ 30 mm), only receivingphacoemulsification. All patients were followed up for 3 months. Visual acuity, intraocular pressure (IOP), corneal endothelial cell count, IOL eccentricity and tilt were detected, and subjective visual quality scale was measured for patients in each group. Results　 Best corrected visual acuity (BCVA) at postoperative 3 months was higher than that before operation for patients with different AL in two groups (all P<0.05); no statistical difference was found among patients with different AL in both two groups (both P>0.05). IOP and corneal endothelial cell count at postoperative 3 months were lower than those before operation for patients with different AL between two groups (all P<0.05); no statistical difference was found among patients with different AL in both two groups (both P>0.05). No statistical difference was found in horizontal eccentricity, vertical eccentricity and total eccentricity at postoperative 1 month and 3 months among patients with different AL in both two groups (all P>0.05). No statistical difference was found in horizontal eccentricity, vertical eccentricity and total eccentricity at postoperative 1 month and 3 months for patients with 27 mm ≤AL <30 mm between the two groups (all P>0.05). At postoperative 3 months, the horizontal eccentricity and total eccentricity for patients with AL ≥ 30 mm in observation group were higher than those in control group, and statistical differences were found (both P<0.05), but no statistical difference was found in vertical eccentricity (P>0.05). At postoperative 3 months, vertical eccentricity and total eccentricity for patients with AL ≥ 30 mm in observation group were lower than those in control group, and statistical differences were found (both P<0.05), but no statistical difference was found in horizontal eccentricity (P>0.05).At postoperative 3 months, subjective visual quality scale was higher than that before operation in both two groups, also higher for patients with different AL between two groups (all P<0.05). 3-month follow-up showed that there were no complications such as elevated IOL, corneal endothelium decompensation, IOL dislocation, endophthalmitis or retinal detachment for patients in both two groups. Conclusion　Combined application of capsular tension ring implantation is safe and stable for treatment of ultra-high myopia and cataract, and can achieve the desired visual quality.