超声乳化术治疗高度近视并发性白内障的疗效及其术后视力影响因素分析

目的：观察超声乳化术治疗高度近视并发性白内障的疗效，探究影响其术后疗效的因素。方法选取浠水县人民医院眼科2013年1月至2015年1月收治的行超声乳化联合人工晶状体植入术治疗的高度近视并发性白内障患者85例(92眼)，依据WHO 2003《盲及视力损害分类标准》，将术后100 d最佳矫正视力<0.3 D的患眼设为视力损伤组，其余设为视力正常组，记录患者的年龄、性别、近视时间、眼轴长度、角膜屈光度、角膜散光度、后巩膜葡萄肿、黄斑病、玻璃体后脱离、术后并发症，术后15 d、100 d裸眼视力及最佳矫正视力、眼底和黄斑区检查等情况，对单因素得到的可疑因素行多因素非条件Logistic逐步回归分析。结果所有患者手术顺利，术后15 d裸眼视力，58眼(63.04%)<0.3 D，34眼(36.96%)≥0.3 D；最佳矫正视力，44眼(47.83%)<0.3 D，48眼(52.17%)≥0.3 D。术后100 d裸眼视力，42眼（45.65%)<0.3 D，50眼(54.35%)≥0.3 D；最佳矫正视力，30眼(32.61%)<0.3 D，62眼(67.39%)≥0.3 D。至随访结束，出现6眼晶状体后囊膜Ⅰ级（Odrich分级）浑浊，给予YAG激光治疗后均可见眼底；92眼术后眼底和黄斑区检查发现均有高度近似眼底变化，其中32眼黄斑病变，15眼漆裂纹，12眼Fuchs斑，8眼裂孔，8眼脉络膜新生血管，7眼劈裂，4眼前膜，1眼出血。单因数分析显示，两组患者的年龄、近视时间、眼轴长度、角膜散光度、后巩膜葡萄肿、黄斑病比较差异均有统计学意义(P<0.05)；而两组患者的玻璃体后脱离、角膜屈光度、性别比较差异均无统计学意义(P>0.05)；对以上可疑因素行多因素非条件Logistic回归分析发现，眼轴长度(≥30 mm)、角膜散光度(≥1.30 D)、合并后巩膜葡萄肿、合并黄斑病是影响患者术后疗效的独立危险因素(P<0.05)。结论眼轴长度≥30 mm、角膜散光度≥1.30 D、合并后巩膜葡萄肿、合并黄斑病均能降低超声乳化术治疗高度近视并发性白内障术后疗效，治疗中需加以重视。

Efficacy of phacoemulsification in the treatment of patients with high myopia complicated cataract and the influence factors of postoperative visual acuity

Objective To observe the efficacy of phacoemulsification on high myopia complicated cataract, and to explore the influencing factors of postoperative curative effect. Methods A total of 85 cases (92 eyes) of pa-tients with high myopia complicated cataract, who admitted to Department of Ophthalmology of Xishui County People's Hospital of Huanggang City and underwent phacoemulsification surgery from January 2013 to January 2015, were select-ed and divided into the visual impairment group (BCVA<0.3 D) and the normal vision group according to WHO 2003"Blindness and Visual Impairment Classification Criteria"100 days after operation. The patient's age, sex, time of myo-pia, axial length, corneal refractive error, corneal astigmatism degree, posterior staphyloma, macular disease, posterior vitreous detachment, postoperative complications, postoperative visual acuity at 15 days and 100 days after operation, and the best corrected visual acuity, retinal and macular inspection were recorded. Univariate logistic stepwise regression analysis was performed on identified univariate factors. Results All patients were successfully operated. Fifteen days after surgery, the uncorrected visual acuity of 58 (63.04%) eyes was smaller than 0.3 D, and that of 34 (36.96%) eyes was bigger than or equal to 0.3D;the best corrected visual acuity of 44 (47.83%) eyes was smaller than 0.3 D, and that of 48 (52.17%) eyes was bigger than or equal to 0.3 D. 100 days after surgery, the uncorrected visual acuity of 42 (45.65%) eyes was smaller than 0.3 D, and that of 50 eyes (54.35%) was bigger than or equal to 0.3 D;the best corrected visual acuity of 30 (32.61%) eyes was smaller than 0.3 D, and that of 62 eyes (67.39%) was bigger than or equal to 0.3 D. To the end of the follow-up, there were six lens capsuleⅠlevel (Odrich classification) turbidity, and the fundus could be seen after YAG (yttrium-alumlnum-garnet) laser treatment;Ninety-two eyes were found to have a highly simi-lar changes of fundus by postoperative retinal and macular retinal examination, among of which, 32 eyes were macula le-sions, 15 eyes were paint crack, 12 eyes were Fuchs spot, 8 eyes were holes, 8 eyes were choroidal neovascularization, 7 eyes were split, 4 eyes were front film, one eye was hemorrhage. Univariate factor analysis showed that there were signif-icant differences between the two groups in age, myopia time, axial length, corneal astigmatism, posterior staphyloma (P<0.05);there were no significant differences in the posterior vitreous detachment, corneal refractive power and gender (P>0.05);multivariate unconditional logistic regression analysis showed that the axial length (≥30 mm), corneal astig-matism (≥1.30 D), combined posterior staphyloma and combined macular disease were the independent risk factors af-fecting the postoperative efficacy of patients (P<0.05). Conclusion The axial length≥30 mm, corneal astigmatism≥1.30 D, combined posterior staphyloma and combined macular disease can reduce the efficacy of phacoemulsification in the treatment of high myopia complicated cataract, which should be paid attention to in the treatment.