不同手术方式对高度近视合并白内障患者黄斑区视网膜厚度及视力的影响

目的比较高度近视合并白内障患者进行小切口手法碎核白内障摘出术与白内障超声乳化吸出术对黄斑区视网膜厚度的影响。方法 64例(80眼)高度近视合并白内障患者随机分为A、B两组,A组行小切口手法碎核白内障手术,B组行白内障超声乳化吸出术。术后1周、4周、8周和12周观察两组患者最佳矫正视力(best corrected visual acuity,BCVA),术前及术后1周进行角膜内皮细胞计数。采用Zeiss-Humphrey OCT3仪于术前1周,术后1周、4周、6周、8周和12周分别检查术眼黄斑中心凹视网膜厚度。结果 A、B组术后BCVA较术前均有所提高,差异均有统计学意义(均为P<0.05),术后各时间点两组BCVA比较差异均无统计学意义(均为P>0.05)。A、B两组术后角膜内皮细胞丢失率分别为6.95%和7.19%,差异无统计学意义(P>0.05)。A、B组术后1周时黄斑中心凹视网膜厚度分别为(189.37±24.95)μm和(191.87±22.61)μm,与术前(158.13±19.11)μm和(159.20±16.18)μm相比,差异均有统计学意义(均为P<0.05),组间比较差异无统计学意义(P>0.05);术后4周、6周时两组黄斑中心凹视网膜平均厚度仍较术前明显增厚,差异均有统计学意义(均为P<0.05),但组间比较差异均无统计学意义(均为P>0.05);术后8周、12周时A、B组黄斑中心凹视网膜厚度均恢复至术前水平,组间比较差异均无统计学意义(均为P>0.05)。B组术后发现黄斑囊样水肿1眼,第12周复查时已消退。结论高度近视合并白内障患者行不同方式白内障手术后早期黄斑区视网膜厚度均有增加,但是大多达不到黄斑囊样水肿的诊断标准,在8周左右黄斑区视网膜厚度几乎恢复正常。

Effect of different surgical procedures on macular thickness and visual acuity in patients with high myopia combined with cataract

Objective To compare the macular thickness in patients with high myopia combined with cataract following phacoemulsification and manual small incision nuclear fracture cataract surgery( MSINFCS). Methods Sixty-four patients (80 eyes) with high myopia combined with cataract were randomized into MSINFCS group (group A) and phacoemulsification group (group B).The best corrected visual acuity (BCVA) in two groups were observed at postoperative 1 week,4 weeks,8 weeks and 12 weeks,the endothelial cells were counted before operation and 1 week after operation.Optical coherence tomography (OCT) was detected to analyze the macular fovea thickness changes at 1 week before operation and 1 week,4 weeks,6 weeks,8 weeks and 12 weeks after operation. Results BCVA of both two groups improved postoperatively,there were statistical difference compared with pre-operation(both P<0.05),and no statistical difference in postoperative BCVA between two groups at different time points(both P>0.05).The loss rates of endothelium cell of two groups were 6.95% and 7.19%,there was no statistical difference(P>0.05).The mean macular fovea thickness of group A and B at postoperative 1 week were (189.37±24.95)μm and (191.87±22.61)μm,compared with pre-operation (158.13±19.11)μm and (159.20±16.18)μm,there were statistical differences (both P<0.05),but there was no statistical difference between two groups(P>0.05).The mean macular fovea thickness at postoperative 4 weeks and 6 weeks in two groups were still obviously thicker than that before operation,there were statistical differences(both P<0.05),but no statistical difference between two groups(both P>0.05).The mean macular fovea thickness at postoperative 8 weeks and 12 weeks in two groups were recovered to pre-operation,there was no statistical difference between two groups(both P>0.05).After examined by OCT,1 case was found with cystoid macular edema in group B,disappeared at postoperative 12 weeks. Conclusion Following different cataract surgical procedures,the mean macular fovea thickness is increased at early postoperative period,but it doesn’t reach the cystoid macular edema level.The mean macular fovea thickness returns to the preoperative level at postoperative 8 weeks.