老年人白内障摘除人工晶体植入术后的立体视觉异常原因探讨

Causes of stereoscopic function abnormality in elderly patients after the cataract extraction with intraocular lens implantation

目的探讨老年人白内障摘除后人工晶体植入术后立体视觉异常的原因及发病机制。方法随机抽取老年性白内障人工晶体植入术后患者150例,常规眼部检查并矫正屈光不正和老视,采用同视机检查双眼同时视功能和融合功能,采用颜少明《立体视觉检查图》检查立体视功能。对其中立体视功能未恢复或异常的患者97例进行分析。结果97例中,53例(54.6%)术前已患有影响视力和双眼单视的眼病,其中以眼底黄斑病变最常见(13只眼);27例(27.8%)手术合并角膜散光、后发白内障、眼肌麻痹性斜视、复视及黄斑水肿等;此外另一侧未手术眼的白内障17只眼(17.5%)和术后两眼屈光参差9例(9.3%)亦是影响立体视的常见原因;8例患者原因不明。结论老年白内障患者原有眼病、手术并发症、对侧未手术眼的白内障及两眼屈光参差均是影响视力康复和双眼立体视重建的主要因素。

Objective To analyze the reasons and mechanisms of stereoscopic function abnormality in elder patients after the cataract extraction with intraocular lens implantation. Methods 150 cases with artificial lens implantation were randomly selected. Routine eye examinations were carried out and the associated refractive error and presbyopia were corrected. Bilateral simultaneous visual perception and fusion function were examined. The stereoscopic function was tested using ＂the stereoscopic function examination diagram＇created by Yan Shao ming. Ninety-seven patients who were found to have unrecover-ed or abnormal stereoscopic function were enrolled for analysis. Results In these 97 cases, 53（54.6%）were found to have pre-existing eye disorders that could affect visual acuity and binocular single vision before the operation. Macular problem was the most prevalent problem in this group. Twenty-seven（27.8 %） patients had complicated with corneal astigmatism, after cataract, paralysing strabismus and diplopia as well as macular edema after the operation. In addition, the contralateral unoperated cataract in 17 （ 17.5 % ） patients and post-operative anisometropia in 9 （ 9.3 %） patients were also the causes of stereoscopic function abnormality. There was no reason could be identified in 8 cases. Conclusions The pre-existing eye disorders before lenses implantation, complications of the operation, contralateral unoperated cataract and anisometropia are all the major factors that affect visual acuity recovery and bilateral stereoscopic function rehabilitation.