白内障超声乳化术后黄斑部的光学相干断层扫描

Optical coherence tomography of macula area after cataract phacoemulsification

目的观察白内障顺利进行超声乳化术后黄斑部的变化.方法应用光学相干断层扫描仪分析50眼单纯年龄相关性白内障及33眼合并糖尿病或葡萄膜炎或高度近视的年龄相关性白内障超声乳化吸出术后2、4、6、8周及3个月的黄斑部变化及60只正常眼的黄斑部.结果正常人中心注视点厚度为(151.5±11.1)μm,白内障超声乳化术后中心注视点厚度增加,但单纯白内障组仅于术后4～6周有显著性差异;单纯白内障组10眼(20%)出现术后黄斑水肿,均发生于术后2～6周,包括8眼中心凹增厚及2眼黄斑囊样水肿,其中9眼(90%)于6个月内自愈;合并症组13眼(43.3%)出现术后黄斑水肿且消退缓慢;术后各期中心凹厚度与视力呈负相关.结论白内障超声乳化术后黄斑部呈现厚度增加的趋势,造成一定程度的视力下降,尤其是糖尿病、高度近视等易患黄斑水肿者,少数人会出现黄斑囊样水肿,但绝大多数人可自愈,预后良好.

Objective To investigate changes of macular area after uneventful cataract phacoemulsification. Methods Optical coherence tomography（OCT） was detected to analyze the macular area changes at 2,4,6,8 weeks and 3 months following uneventful cataract phacoemulsification in 50 simple age-related cataract patients and 33 patients associated with diabetes or high myopia or uveitis in PHACO group,and 60 normal subjects were examined using the same protocol as control. Results The measured value of central fovea thickness was 151.5±11.1μm in normal subjects. The central fovea thickness value was gradually increased after phacoemulsification with a significant difference at the 4th-6th week in simple cataract group in comparison with that before surgery （ q=4.71 , 3.90, P=0.013,0. 026 ）. The fovea appeared to be abnormally thickened in 10 eyes（20% ） of simple group,including 8 eyes of single fovea thickening in 2 -6 weeks following surgery and 9 eyes of them were resolved till 6 months postoperatively. In complication group, 13 eyes（ 43.3% ） displayed macular edema. A statistical difference was noted in the incidenee of fovea edema between simple cataract group and complication group（x^2=6.75 ,P 〈0. 05 ）. The mean macular thickness in the central fovea showed a negative correlation with visual acuity at all stages of postoperation（ r=-0.46--0.76,P〈0.05 ）. Conclusion Macula thickness is increased after phacoemulaification, and this results in visual acuity reduction especially for the patients with diabetes and high myopia. In a few of patients received phacoemulsification, cystoid macular edema is found. Optical coherence tomography can provide important evidence to early clinical diagnosis and treatment after cataract surgery.