年龄相关性白内障术后视力再下降患者的临床特征分析

目的　分析年龄相关性白内障术后视力再下降患者的临床特征，为该病诊断和治疗提供依据。方法　收集2017年1月至2020年6月在北京朝阳医院眼科就诊的年龄相关性白内障术后视力再下降患者，回顾性分析其疾病构成比、裸眼视力、最佳矫正视力（BCVA）、等效球镜度、前房深度及眼底病变等。结果　本研究共收集283例（397眼）白内障术后视力再下降患者，导致白内障术后视力再下降的主要原因有屈光不正（30.0%）、后发性白内障 (PCO，23.2%)、人工晶状体位置改变（3.8%）、眼底病变（25.7%）、视神经疾病（4.5%）、眼表疾病（3.3%）、多因素复杂眼病（7.1%）及原因不明（2.5%），共8类；但主要由其中5种眼病引起，即屈光不正、PCO、糖尿病视网膜病变、高度近视性眼底病变、年龄相关性黄斑变性，此5种眼病占术后视力再下降患者的72.5%（288眼）。屈光不正及PCO患者BCVA通过治疗均可明显提高。结论　年龄相关性白内障患者术后视力再下降原因复杂，其中半数患者通过治疗可再次显著提高视力。

Analysis of the clinical features for patients suffering with vision decline again after age-related cataract surgery

Objective　To investigate the clinical features for patients suffering with vision decline again after age-related cataract surgery and provide evidences for their diagnosis and treatment.Methods　Patients suffering vision decline again after cataract surgery in Beijing Chaoyang Hospital were involved from January 2017 to June 2020. The composition ratio of diseases, naked vision, best corrected visual acuity (BCVA), spherical equivalent, anterior chamber depth and fundus diseases were investigated to retrospective analyzed the reasons of vision decline.Results　Totally 283 patients (397 eyes) were involved. The main reasons leading to vision decline again included refractive error (30.0%), posterior capsular opacification (PCO, 23.2%), intraocular lens position change (3.8%), fundus diseases (25.7%), optic neuropathy (4.5%), ocular surface diseases (3.3%), multifactorial complex ocular diseases (7.1%), and unexplained causes (2.5%). The most important causes lied in 5 diseases, including refractive error, PCO, diabetic retinopathy, fundus lesions of high myopia and age-related macular degeneration. These 5 diseases accounted for 72.5% (288 eyes) of all patients suffering with postoperative vision decline again. The BCVA of refractive error and PCO patients could significantly improve after proper treatments.Conclusion　The reasons leading to postoperative vision decline again are complicated, and the BCVA of about half of all the patients can obviously improve after proper treatments.