黄斑前膜合并白内障患者白内障超声乳化人工晶状体植入联合玻璃体切割术前后屈光状态改变  被引量:14

Refractive shift following the combination of phacoemulsification, intraocular lens implantation and vitrectomy in the eyes with idiopathic macular epiretinal membrane

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作  者:余盈盈[1] 黎晓新[1] 鲍永珍[1] 

机构地区:[1]北京大学人民医院眼科教育部视觉损伤与修复重点实验室视网膜脉络膜疾病诊治研究北京市重点实验室,100044

出  处:《中华实验眼科杂志》2014年第11期1025-1029,共5页Chinese Journal Of Experimental Ophthalmology

摘  要:背景 特发性黄斑前膜(IMEM)合并年龄相关性白内障(ARC)是老年人常见的眼部疾病,其主要治疗方法为白内障超声乳化人工晶状体(IOL)植入联合玻璃体切割术,而确定术前计算IOL屈光度时所用的IOL Master光学生物测量仪测量的眼轴长度是否受黄斑前膜的影响对术眼术后获得准确的屈光度至关重要.目的 了解IMEM患者行白内障联合玻璃体手术后屈光变化的特征.方法 采用前瞻性队列研究设计,纳入2010年9月至2011年8月在北京大学人民医院眼科中心确诊为IMEM合并ARC的患者42例42眼为IMEM合并ARC组,行白内障超声乳化IOL植入术联合玻璃体切割术,同期纳入单纯ARC患者47例47眼为单纯ARC组,行白内障超声乳化IOL植入术.术前应用IOL Master光学生物测量仪测量术眼眼轴长度及角膜曲率,应用SRK-T公式计算出IOL植入后的预期屈光度.术后1个月、3个月进行眼科常规检查和医学验光,计算其等效球镜度数作为术后实际屈光度,并对术后实际屈光度与预期屈光度进行对比分析.对两个组间术眼手术前后屈光度的误差进行比较,对IMEM合并ARC患者术后屈光度误差与黄斑中心凹厚度变化的关系进行分析.结果 术前两个组间患者年龄、眼轴长度和角膜曲率的差异均无统计学意义(P=0.863、0.704、0.770).IMEM合并ARC组和单纯ARC组患者术后3个月视力较术前均明显改善,差异均有统计学意义(P=0.001、0.000).IMEM合并ARC组患者术后1个月和3个月的实际屈光度绝对值均明显高于术前预期屈光度绝对值,差异均有统计学意义(P<0.001);单纯ARC组患者术后1个月和3个月实际屈光度绝对值明显高于术前预期屈光度绝对值,差异均有统计学意义(p<0.O01);但IMEM合并ARC组与单纯ARC组间手术前后的屈光度值差异无统计学意义(F分组=0.417,P=0.520).IMEM合并ARC组术眼术后1个月、3个月的屈光度误差分别为(-0.727±0.666Background Idiopathic macular epiretinal membrane (IMEM) combined with age-related cataract (ARC)is a common eye disease and the primary managing approach is the combination of phacoemulsification,intraocular lens (IOL) implantation and vitrectomy.However,whether the ocular length measured by IOL Master is accurate for the calculation of IOL refraction in the eye with IMEM remains unclear.Objective The aim of this study was to evaluate the refractive outcomes of combination surgery of phacoemulsification,IOL implantation and vitrectomy in IMEM eyes.Methods A prospective cohort study was designed.Forty-two eyes of 42 patients with IMEM combined with ARC (IMEM+ARC group) were enrolled in Peking University People's Hospital and the combination of phacoemulsification,IOL implantation and vitrectomy was performed from September 2010 to August 2011,and 47 eyes of 47 patients with ARC were included for the phacoemulsification combined with IOL implantation in the corresponding period (ARC group) under the approval of Ethic Committee of Peking University People's Hospital and informed consent of the patients.Ocular length and corneal curvature were measured using IOL Master,and the expected IOL diopter was calculated with SRK-T formula.Regular eye examination and medical optometry were performed 1 month and 3 months after operation to obtain the actual diopter and the refractive error.The outcomes were compared between the two groups.The correlations of refractive error with change of fovea thickness were evaluated after operation in the IMEM+ARC group.Results There were no statistically significant differences in the age,ocular length and corneal curvature between the two groups before operation (P =0.863,0.704,0.770).The visual acuity was improved 3 months after operation in comparison with before operation in both groups (P=0.001,0.000).The negative diopters were obviously higher 1 month and 3 months after operation than those before operation in both groups (all at P〈0.

关 键 词:特发性黄斑前膜/手术 白内障/手术 白内障超声乳化联合人工晶状体植入术 玻璃体切割术 屈光度 眼轴 近视漂移 生物测量 

分 类 号:R779.6[医药卫生—眼科]

 

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