老年黄斑变性合并白内障患者行超声乳化术疗效分析

The clinical assessment ofphacoemulsification in patients with age-related macular degenaration

目的探讨老年黄斑变性合并白内障患者行超声乳化手术联合人工晶状体植入的临床效果及安全性、可行性。方法对40例52只眼老年黄斑变性合并白内障患者，行超声乳化联合人工晶状体植入术，其中干性老年黄斑变性者45只眼，湿性老年黄斑变性者7只眼。收集其资料进行回顾性分析，观察患者术后视力改善情况及有无并发症发生。结果术后3月时，90．38％患者视力不同程度提高，视力无明显提高甚至下降者5只眼，均为湿性黄斑变性患者。最佳矫正视力0．3—0．6者12只眼（其中达0．6者8只眼），0．1-0．3者35只眼，〈0．1者5只眼。4例术中后囊破裂，3例术后角膜雾状水肿。术后1年，7只眼湿性黄斑变性均有不同程度的加重，干性黄斑变性患者未发现眼底新生血管之类改变。结论超声乳化联合人工晶状体植入术可明显提高老年黄斑变性合并白内障患者术后视力，但对于湿性黄斑变性患者手术应慎重。

Objective To assess the clinical benefits and safety of cataract phacoemulsification and I- OL implantation in eyes with age-related macular degeneration （AMD）.Methods A retrospective case series of 40 patients （52 eyes）including 45 eyes with dry AMD and 7 eyes with exudative AMD undergoing phacoemulsifieation and IOL implantation was performed.Assessment included post-operative visual acuity and complications.Results The visual acuity improved respectively within 3 month post-operative.Five eyes with no improvement in visual acuity were all manifested exudative AMD.The corrected visual acuity of 0.3-0.6 was achieved in 12 eyes （among them, 8 eyes reach 0.6）, 35 eyes 0.1-0.3, 5 eyes below-0.1.There were 4 eyes occurred capsular rupture and 3 eyes presented corneal edema.Seven eyes with exudative AMD got worse after 1 year postoperative but there were no apparent changes in all eyes with dry AMD.Conclusions Visual acuity of patients with AMD can be improved after phacoemulsification and IOL implantation.It is justified in patients with dry AMD but there maybe increased risk of exudative AMD in eyes after cataract surgery.Surgeons will have to make practice decisions based on the sufficient clinical assessment pre-operative.