高度近视合并白内障患者术后人工晶状体位移对屈光度的影响

目的探讨高度近视合并白内障患者行超声乳化摘出联合人工晶状体植入术后人工晶状体位移对屈光度的影响。方法收集2017年6月至2018年1月在我院行白内障超声乳化摘出联合人工晶状体植入术的高度近视合并白内障患者21例27眼,记录术后1 d、1周、1个月的裸眼视力、最佳矫正视力及屈光度,使用IOL Master生物测量仪测量眼轴长度、晶状体厚度及角膜曲率,使用Tomey SS1000眼前节光学相干断层扫描(anterior segment optical coherence tomography,AS-OCT)测量有效晶状体位置,观察术后人工晶状体在囊袋内的位移,并分析其对术后屈光度的影响。结果高度近视合并白内障患者术后1 d、1周、1个月屈光度分别为(-1.59±1.64)D、(-1.80±1.66)D、(-1.47±1.39)D,术后各时间点屈光度比较差异无统计学意义(F=0.295,P=0.746)。运用Spearman秩相关分析发现,术后屈光度变化与人工晶状体位移呈正相关(r=0.355,P=0.008),且术后1个月绝对屈光度误差与眼轴长度呈正相关(r=0.514,P=0.006),运用Pearson相关分析发现术后1个月绝对屈光度误差与术前角膜曲率及晶状体厚度均无相关性(均为P>0.05)。结论高度近视合并白内障患者术后人工晶状体位移是术后屈光度变化的主要影响因素。高度近视合并白内障手术患者眼轴越长术后绝对屈光误差越大。

Effect of intraocular lens displacement on diopter after cataract surgery in high myopia eyes

Objective　To investigate the effect of intraocular lens displacement on diopter after phacoemulsification and intraocular lens implantation in patients with high myopia.Methods　Between June 2017 and January 2018，27 eyes of 21 patients with high myopia and underwent phacoemulsification and intraocular lens implantation were enrolled in our hospital.The uncorrected visual acuity，the best corrected visual acuity and diopter were recorded on day 1，1 week，and 1 month after operation.The axial length，corneal curvature and lens thickness were measured using IOL Master.The effective lens position was measured using Tomey SS1000 Anterior segment OCT，and the displacement of intraocular lens was observed，and the influence of postoperative diopter was analyzed.Results　In patients with high myopia and cataract，the average refraction on day 1，1 week，1 month after operation was （-1.59±1.64）D，（-1.80±1.66）D，（-1.47±1.39）D.There was no significant difference in refractive power at the three time-points （F=0.295，P=0.746）.The postoperative diopter changes were positively correlated with the intraocular lens displacement via Spearman rank correlation （r=0.355，P=0.008）.Absolute refractive error was positively correlated with the axial length （r=0.514，P=0.006） at 1 month after operation using Spearman rank correlation，but was not correlated with corneal curvature and lens thickness by Pearson correlation analysis （both P>0.05）.Conclusion　The intraocular lens displacement is the main influencing factor of refractive changes.The longer the ocular axis of patients with high myopia following the combined cataract surgery is，the greater the absolute refractive error is.