晶状体囊前超声乳化术治疗高度近视硬核白内障的效果及影响因素分析  

Efficacy of precapsular phacoemulsification for patients with high myopia hard nucleus cataract and analysis of the influencing factors to postoperative visual acuity

作　　者：卢魁 姜海烽 刘洪威 Lu Kui;Jiang Haifeng;Liu Hongwei(Department of Cataract,Aier Eye Hospital in Zhoukou,Zhoukou 466000,China)

机构地区：[1]周口爱尔眼科医院白内障科,周口466000

出　　处：《中华眼外伤职业眼病杂志》2024年第12期911-918,共8页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的观察晶状体囊前超声乳化术治疗高度近视硬核白内障患者的效果及术后视力的影响因素。方法前瞻性随机对照研究。纳入周口爱尔眼科医院白内障科2022年3月至2024年3月高度近视硬核白内障150例(150眼)作为研究对象,按随机数字表法分为对照组(囊袋内超声乳化治疗)和试验组(囊前超声乳化治疗),每组各75例。术后随访3个月,对比两组裸眼视力(UCVA)、最佳矫正视力(BCVA)、角膜内皮细胞密度(ECD)及并发症,分析影响超声乳化术后视力的相关因素。结果试验组术中超声乳化能量为(15.47±3.49)%、超声乳化时间为(58.33±8.81)s,均低于对照组的(25.46±5.17)%及(105.36±12.69)s,差异均有统计学意义(t=13.87、26.37,均P<0.001)。术后试验组的UCVA(logMAR)为0.49±0.21,BCVA(logMAR)为0.34±0.10,ECD为(2187.27±118.73)个/mm^(2),与对照组的0.51±0.30、0.35±0.12及(2216.33±104.62)个/mm^(2),差异均无统计学意义(均P>0.05)。试验组并发症发生率为6.67%(5/75),低于对照组的18.67%(14/75)(χ^(2)=4.88,P=0.027)。年龄(OR=1.08,95%CI=1.009~1.152,P=0.027)、眼轴长度(OR=1.54,95%CI=1.136~2.077,P=0.005)、角膜散光度(OR=1.08,95%CI=1.027~1.128,P=0.002)、核硬度(OR=2.07,95%CI=1.106~3.863,P=0.023)、黄斑病变(OR=1.09,95%CI=1.029~1.161,P=0.004)、后巩膜葡萄肿(OR=1.24,95%CI=1.054~1.465,P=0.010)均与术后视力恢复相关。结论囊袋内超声乳化术与囊前超声乳化术均可有效治疗高度近视硬核白内障患者,但囊前超声乳化术的并发症较低。年龄、眼轴长度、角膜散光度、核硬度、黄斑病变、后巩膜葡萄肿均为影响术后视力恢复的因素。Objective To observe the efficacy of precapsular phacoemulsification for patients with high myopia hard nucleus cataract and the influencing factors to postoperative visual acuity.Methods This was a prospective randomized controlled study.A total of 150 eyes of 150 patients with high myopia hard nucleus cataract admitted to the cataract department of Aier Eye Hospital in Zhoukou from March 2022 to March 2024 were selected as the study subjects,and were randomly divided into a control group(intracapsular phacoemulsification treatment)and a trial group(precapsular phacoemulsification treatment)with 75 cases each by random number table method.Those patients were followed-up for 3 months after operation.Uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),corneal endothelial cell density(ECD),and complications of the two groups were compared,and the related factors affecting visual acuity after phacoemulsification were analyzed.Results Intraoperative phacoemulsification energy in the trial group was(15.47±3.49)%,and phacoemulsification time was(58.33±8.81)seconds,both of which were lower than those in the control group[(25.46±5.17)%and(105.36±12.69)seconds,respectively].The differences were statistically significant(t=13.87,26.37;all P<0.001).Postoperatively,UCVA(logMAR)in the trial group was 0.49±0.21,BCVA(logMAR)was 0.34±0.10,and ECD was(2187.27±118.73)cells/mm^(2),which were similar to those in the control group[0.51±0.30,0.35±0.12,and(2216.33±104.62)cells/mm^(2)(all P>0.05)].Complication rate in the trial group was 6.67%(5/75),which was lower than that in the control group[18.67%(14/75)(χ^(2)=4.88,P=0.027)].Age(OR=1.08,95%CI=1.009-1.152,P=0.027),axial length(OR=1.54,95%CI=1.136-2.077,P=0.005),corneal astigmatism(OR=1.08,95%CI=1.027-1.128,P=0.002),emery nuclear hardness grading(OR=2.07,95%CI=1.106-3.863,P=0.023),maculopathy(OR=1.09,95%CI=1.029-1.161,P=0.004),and posterior scleral staphyloma(OR=1.24,95%CI=1.054-1.465,P=0.010)were all associated with postoperative visual acuity recovery.Conc

关 键 词：超声乳化白内障吸除术 囊前 近视 高度 白内障 硬核 视力 术后 

分 类 号：R47[医药卫生—护理学]