光学相干断层扫描观察高度近视眼白内障超声乳化术后黄斑区变化

Changes of macular area in highly myopic eyes after phacoemulsification evaluated by optic coherence tomography

目的观察高度近视眼白内障超声乳化术后黄斑区视网膜的变化及术后视力恢复情况。方法 105例(150眼)白内障患者分为高度近视眼白内障组(A组,56例,80眼)和非高度近视眼白内障组(B组,49例,70眼),分别行超声乳化联合人工晶体植入术。分别于术前和术后1周、1个月和3个月测量患者裸眼视力(UCVA)和最佳矫正视力(BCVA);行光学相干断层扫描,测量黄斑中心凹视网膜神经上皮层厚度(MFT)和黄斑中心凹直径6 mm范围内的黄斑区容积(TMV);计算高、低累积能量复合参数(AECP)。结果 A组和B组术后各时间点UCVA、BCVA和TMV均显著高于术前(P<0.01),而术后各时间点MFT与术前比较差异均无统计学意义(P>0.05)。A组和B组中,高、低AECP患者术后各时间点MFT与术前比较差异均无统计学意义(P>0.05);高、低AECP患者术后各时间点TMV均显著高于术前(P<0.01);高AECP患者术后各时间点MFT和TMV与术前的差值与低AECP患者比较差异均无统计学意义(P>0.05)。术后A组中1眼黄斑区鼻下方发生视网膜神经上皮层浅脱离,A组中3眼、B组中1眼黄斑区中心凹发生微囊样改变。结论高度近视眼白内障行超声乳化术,复明效果较好,术后无黄斑水肿发生,MFT无明显变化,但TMV增加,超声能量对黄斑区视网膜无明显影响。

Objective To evaluate the macular changes and recovery of visual acuity in highly myopic patients after phacoemulsification. Methods One hundred and five patients(150 eyes) with cataract were divided into highly myopic group(group A,56 patients,80 eyes) and non-highly myopic group(group B,49 patiens,70 eyes),and phacoemulsification and intracapsular implantation of foldable intraocular lens were performed.In all patients,uncorrected visual acuity(UCVA) and best-corrected visual acuity(BCVA) were measured,minimal foveal thickness(MFT) and total macular volume(TMV) were determined with optical coherence tomograghy before operation and 1 week,1 month and 3 months after operation,and accumulated energy complex parameter(AECP) was also calculated. Results UCVA,BCVA and TMV at different time points after operation were significantly higher than those before operation in group A and group B(P<0.01),while there was no significant difference between MFT before operation and those at different time points after operation in two groups(P>0.05).There was no significant difference between MFT before operation and those at different time points after operation in patients with high AECP and those with low AECP in group A and group B(P>0.05),TMV at different time points after operation were significantly higher than that before operation in patients with high AECP and those with low AECP in group A and group B(P<0.01),and there was no significant difference in the changes of MFT or TMV between patients with high AECP and those with low AECP at the time points of 1 week,1 month and 3 months after operation in group A and group B(P>0.05).One eye had a shallow detachment of the neuroretina from retinal pigment epithelium in nasally inferior part of the macular area in group A,and 3 eyes in group A and 1 eye in group B had subtle intraretinal cystoid abnormalities. Conclusion Highly myopic patients may have a good recovery of visual acuity after phacoemulsification,with no macular edema,no significant change in MFT,and an increase in TMV after operation.The actual phaco power has no significant influence on macular area in highly myopic patients.