SD-OCT对原发性视网膜色素变性并发白内障患者行超声乳化联合人工晶状体植入术后视力预后的评估作用

目的　分析原发性视网膜色素变性（retinitis pigmentosa，RP）患者并发白内障行超声乳化联合人工晶状体植入术后视力的影响因素并探讨频域光学相干断层扫描（spectral domain optical coherence tomography，SD-OCT）在评估视力预后中的作用。方法　回顾性系列病例研究。收集RP并发白内障患者38例（58眼），均行白内障手术治疗。根据SD-OCT下黄斑区椭圆体带的形态将患者分为3组，A组:黄斑区椭圆体带缺失（19眼），B组:黄斑区椭圆体带可见但不连续（18眼），C组:黄斑区椭圆体带完整（21眼）。比较所有患者手术前后最佳矫正视力（best corrected visual acuity，BCVA)、组内手术前后BCVA和组间手术前后BCVA；利用Pearson相关分析，分析SD-OCT检测指标的临床意义；并进一步对术后BCVA与黄斑中心凹厚度之间关系进行分析。结果　逐步回归分析结果表明，术前BCVA和黄斑区椭圆体带长度是影响术后视力的主要因素。手术前后BCVA之间、术后BCVA与黄斑区椭圆体带长度之间均呈直线相关（r=0.855、-0.622，均为P<0.01）。A组、B组和C组术前BCVA分别为（2.41±1.05）logMAR、（1.17±0.64）logMAR和（0.83±0.59）logMAR，术后第1天BCVA分别为（1.16±0.90）logMAR、（0.52±0.27）logMAR和（0.21±0.19）logMAR。各组患眼术后第1天BCVA均好于其术前视力（t=5.246、4.632、6.198，均为P<0.01）。3组患眼术后第1天BCVA比较，差异有统计学意义（F=32.760，P<0.01）。A组、B组和C组黄斑区椭圆体带长度分别为（0.00±0.00）mm、（1.16±0.57）mm和（4.04±1.26）mm，黄斑中心凹厚度分别为（100.84±45.49）μm、（203.44±33.33）μm和（248.19±37.79）μm。术后BCVA与黄斑中心凹厚度之间呈直线正相关（r=-0.754，P<0.01）。结论　白内障超声乳化吸出联合人工晶状体植入术治疗RP并发白内障可有效改善视功能。术前视力差、黄斑区椭圆体带结构的破坏以及黄斑中心凹厚度变薄是患者手术后视力不良的指征，SD-OCT对评估视力预后具有一定临床意义。

Evaluating visual prognosis of cataract patients with primary retinitis pigmentosa after phacoemulsification and IOL implantation by SD-OCT

Objective To explore the factors influencing visual prognosis of cataract patients with retinitis pigmentosa(RP)after phacoemulsification and IOL implantation,and to investigate the significance of spectral domain optical coherence tomography(SD-OCT)in evaluating visual prognosis.Methods Retrospective case series study was conducted on 38 cataract patients(58 eyes)with RP.All patients were divided into 3 groups according to the shape of ellipsoid zone in macular region under SD-OCT,group A:Deletion of ellipsoid zone in macular region(19 eyes),group B:Visible and discontinuous ellipsoid zone in macular region(18 eyes),group C:Complete ellipsoid zone in macular region(21 eyes).The comparison between preoperative and postoperative best corrected visual acuity(BCVA)was conducted among all patients,in different group and among groups.Pearson correlation analysis was used to evaluate clinical significance of SD-OCT indexes.The correlation between postoperative BCVA and central foveal thickness were further analyzed.Results Stepwise regression analysis showed that preoperative BCVA and length of ellipsoid zone in macular region were the major influencing factors of postoperative visual prognosis.There was a linear correlation between preoperative and postoperative BCVA,as well as between the postoperative BCVA and length of ellipsoid zone in macular region(r=0.855,-0.622,all P<0.01).For group A,B and C,BCVA were(2.41±1.05)logMAR,(1.17±0.64)logMAR,(0.83±0.59)logMAR before operation,(1.16±0.90)logMAR,(0.52±0.27)logMAR,(0.21±0.19)logMAR at postoperative 1 day,respectively.BCVA at postoperative 1 day was better than that before operation for affected eyes in each group(t=5.246,4.632,6.198;all P<0.01).Significant difference was observed in BCVA at postoperative 1 day among three groups(F=32.760,P<0.01).The lengths of ellipsoid zone were(0.00±0.00)mm in group A,(1.16±0.57)mm in group B and(4.04±1.26)mm in group C.The central foveal thicknesses were(100.84±45.49)μm in group A,(203.44±33.33)μm in group B and(248.19±37.79)μm in group C.There was a linear positive correlation between postoperative BCVA and central foveal thickness(r=-0.754,P<0.01).Conclusion Phacoemulsification and IOL implantation can effectively improve visual function in cataract patient with RP.Poor preoperative BCVA,disrupted ellipsoid zone in macular region and thinner central foveal thickness are indications of poor postoperative vision.SD-OCT is of certain clinical significance to evaluate visual prognosis.