超高度轴性近视白内障患者的视力预后及其影响因素

目的　前瞻性研究超高度轴性近视白内障患者的视力预后及其影响因素 ,为人工晶状体 (IOL)屈光度数的选择提供依据。方法　选择 2 4例 (43只眼 )超高度轴性近视 (屈光度数>- 10 0 0D ,眼轴长度 >2 7 0 0mm)合并轻、中度白内障患者 ,详细检查超声乳化白内障吸除人工晶状体植入术前、后的远视力 (VA)、最佳矫正视力 (BCVA)、近视力 (NVA)、眼轴长度及眼底病变程度 ,并进行统计学比较和多元逐步回归分析。结果　 (1)术后 1个月VA、BCVA、NVA均较术前明显提高(P <0 0 1) ;(2 )术前NVA和眼底病变程度明显影响术后视力 (P <0 0 1) ;(3)术前NVA≥ 0 1和眼轴长度 <2 9 0 0mm的患者术后视力分别好于术前NVA≤ 0 0 8和眼轴长度≥ 2 9 0 0mm的患者 (P <0 0 1) ;(4)术后NVA≤ 0 2 5的术眼主观感觉近距离视物能力下降。结论　术前NVA是视力预后的重要影响因素和预测指标 ;手术医师应根据术前NVA和患者对近距离工作的要求 ,慎重选择IOL的屈光度数。

The visual outcome and related factors in cataract patients with extreme myopia

OBJECTIVE: A prospective study was performed to analyze the visual outcome and factors related to the visual outcome in cataract patients with extreme myopia, in order to provide a principle for intraocular lens (IOL) diopter chosen. METHODS: 43 cases were included in the present series (myopia over 10.00 D, axial length over 27.00 mm, with clear cornea and slight or moderate opacity of the lens). Distance and near visual acuity (NVA), best corrected visual acuity and the fundus were examined before and after the phacoemulsification and implantation of IOL. chi(2) test and stepwise regression analysis were used to identify the predictive factors. RESULTS: (1) Distance visual acuity, NVA and best corrected visual acuity were markedly improved in most cases. (2) NVA and fundus pathologic changes were two important factors for predicting post-operative visual acuity. (3) The prognosis was better in cases with NVA better than 20/200, and in cases with axial length below 29.00 mm. (4) Some cases with postoperative NVA worse than 20/80 complained of difficulty in reading. CONCLUSIONS: NVA is an important factor influencing the outcome of vision and is an important parameter for predicting the outcome of vision in cataract patients with extreme myopia. IOL diopter should be determined carefully by preoperative NVA and the patients' demand for near work.