白内障术后晶状体后囊膜混浊及远期视力下降影响因素分析

目的探讨白内障术后晶状体后囊膜混浊(posterior capsular opacification,PCO)发生及术后远期视力下降的影响因素。方法收集行白内障超声乳化摘出联合人工晶状体植入术的年龄相关性白内障患者37例(47眼),记录患者术前、术后的眼部检查情况及是否行后囊膜抛光处理等术中情况,于术后2a对PCO进行分级评价。结果 47眼中,有25眼在术后2a发生了PCO,其中18眼混浊已累及中心3mm区,4眼已行YAG激光后囊膜切开术,后囊膜切开率8.5%。统计分析显示,PCO和混浊累及中心3mm区的发生率在是否行后囊膜抛光眼之间的差异均有统计学意义(均为P<0.05)。在各因素中,行后囊膜抛光是发生PCO以及混浊累及中心3mm区仅有的保护性因素。累及中心3mm区的PCO、眼底疾病和黄斑病变与术后2a视力变化之间的关联均有统计学意义(均为P<0.05)。结论白内障术后发生累及中心3mm区的PCO可导致术后远期视力下降;术中行后囊膜抛光处理可显著降低PCO的发生率和严重程度。

Effective factors on posterior capsular opacification and long-term visual impairment after cataract surgery

Objective To investigate the effective factors on posterior capsular opacification(PCO) and long-term visual impairment after cataract surgery.Methods Forty-seven eyes(37 patients) with age-related cataract who had received phacoemulsification and intraocular lens implantation were enrolled in this study.The patients’ surgical-related factors such as posterior capsule polishing were documented,and visual acuity,anterior and posterior segment of the eyes were examined before and after the surgery.Degrees of PCO were evaluated under dilated pupil at two years after surgery.Results PCO was observed in 25 eyes of the 47 eyes at two years after surgery,in which PCO involving central 3 mm area was found in 18 eyes,4 eyes underwent Nd:YAG laser posterior capsulotomy,the posterior capsulotomy rate was 8.5%.Statistics showed that there were statistical differences in the incidence of PCO and PCO involving central 3 mm area between posterior capsule polishing group and none-polishing group(both P<0.05).Posterior capsule polishing was found to be the only protective factor among various factors for PCO and PCO involving central 3 mm area.Analysis of the influencing factors on the visual impairment at two years after surgery showed that there were statistically significant associations between PCO involving central 3 mm area,ocular fundus disease,macular disease and post-operative visual impairment(all P<0.05).Conclusion PCO involving central 3 mm area is the main factor that is responsible for the long-term visual impairment after cataract surgery.Posterior capsule polishing significantly decrease the incidence and severity of PCO.