超声乳化白内障吸除联合负度数人工晶状体植入术治疗高度近视眼合并白内障的临床观察

Clinical observation on phacoemulsification and implantation of negative-power intraocular lens in patients with high myopia and cataract

目的：观察超声乳化白内障吸除联合负度数人工晶状体植入术治疗高度近视眼合并白内障患者的临床疗效。方法回顾性分析辽宁省本溪市本钢总医院眼科2010年9月至2013年9月间收治的77例（106只眼）高度近视眼合并白内障患者的临床资料，对患者实施超声乳化白内障吸除联合负度数人工晶状体植入术，术后半年内对患者进行随访，比较患者的并发症发生情况、裸眼视力及矫正视力，并对患者进行跟踪复查对比，手术前后眼轴长度及视力比较情况以均数±标准差（ x珋±s）的形式表示，患者手术前后裸眼视力及最佳矫正视力的比较进行卡方检验，采用t检验的方法比较不同眼轴长度矫正视力差异是否有统计学意义。结果术后1周裸眼视力＜0．1者0只眼，视力0．1～0．4者12只眼（11．3％），视力0．5～1．0者77只眼（72．6％），视力＞1．0者17只眼（16．1％）；半年后裸眼视力＜0．1者0只眼，视力0．1～0．4者22只眼（20．8％），视力0．5～1．0者71只眼（66．9％），视力＞1．0者13只眼（12．3％）；术前与术后1周、1个月、3个月和半年相比，视力恢复情况较好，差异均有统计学意义（χ2＝0．769，1．597，2．348，3．101；P＜0．05）；术后1周矫正视力＜0．1者0只眼，视力0．1～0．4者12只眼（11．3％），视力0．5～1．0者77只眼（72．6％），视力＞1．0者17只眼（16．1％）；半年后矫正视力＜0．1者0只眼，视力0．1～0．4者22只眼（20．8％），视力0．5～1．0者71只眼（66．9％），视力＞1．0者13只眼（12．3％）；术前与术后1周、1个月、3个月和半年相比，矫正视力恢复情况较好，差异有统计学意义（χ2＝0．923，1．908，3．511，3．747；P＜0．05）。术后各点患者眼轴长度＞30 mm视力矫正效果显著，差异有统计学意义（t＝0．833，1．563，3．548，4．229；P＜0．05）。术后发生黄斑囊样水肿者2只眼（1．9％），发生后发性白内障者1只眼（0．9％），分别注射地塞米松，实施后囊切开术进行治疗，均得到好转，视力恢复。并发症以黄斑囊样水肿、后发性白内障为主，治疗后视力恢复正常。结论超声乳化白内障吸除联合负度数人工晶状体植入术治疗高度近视眼合并白内障临床效果显著，视力恢复和矫正效果好，安全可靠。

Objective To observe the therapeutic effect of phacoemulsification and implantation of negative-power intraocular lens in patients with high myopia and cataract.Methods It was retrospective case study.Seventy-seven cases(106 eyes) with high myopia and cataract were collected from Sep.2010 to Sep. 2013 in department of Ophthalmology,General Hospital of Benxi Iron&Steel Co-and patients were performed with phacoemulsification and negative-power intraocular lens implantation.Pre-and post-operative vision and corrected vision were observed and analyzed.Post-operative corrected vision in different patients with different axial lengths was compared and operative complications were observed as well.Patients were followed up for six months.Chi-square test was used to compare the pre-and post-operative vision and corrected vision.t-test was performed to evaluate the post-operative corrected vision in different patients with different axial lengths. Resuluts One week after operation no eye′s vision was less than 0.1,the vision of 12 eyes (11.3%) was 0.1-0.4,77 eyes (72.6%) was 0.5-1.0 and 17 eyes (16.1%) was greater than 1.0.Six monthes after operation,no eye′s vision was less than 0.1,the vision of 22 eyes (20.8%) was 0.1-0.4,71 eyes (66.9%) was 0.5-1.0,13 eyes (12.3%) was greater than 1.0.There was a significant difference between the vision before operation and the vision one week,one month,three monthes and six monthes after operation(χ2=0.769,1.597,2.348, 3.101;P<0.05).One week after operation, no eye′s corrected vision was less than 0.1,the corrected vision of 12 eyes (11.3%) was 0.1-0.4,77 eyes (72.6%) was 0.5-1.0 and 17 eyes (16.1%) was greater than 1.0.Six monthes after operation, no eye′s corrected vision was less than 0.1,the corrected vision of 22 eyes (20.8%) was 0.1-0.4,71 eyes (66.9%) was 0.5-1.0,13 eyes (12.3%) was greater than 1.0.There was a significant difference between the corrected vision before operation and the corrected vision one week,one month,three monthes and six monthes,after operation (χ2=0.923,1.908, 3.511,3.747;P<0.05).Compared to patients with shorter axial length, those whose axial length was greater than 30 mm got a significant better corrected vision one week,one month,three monthes and six monthes after operation (t=0.833,1.563,3.548,4.229;P<0.05).After surgery,cystoid macular edema was observed in two eyes (1.9%) and posterior capsular opacification was observed in one eye (0.9%).All these complications were treated till the vision returned to normal.Conclusions Phacoemulsification and implantation of negative-power intraocular lens in treating patients with high myopia and cataract is safe and effective.