前置镜检查在白内障术前检查中的应用

Application of fundus pre-set lens examination in preoperative examination of cataract

目的:观察裂隙灯显微镜下前置镜检查在白内障术前眼底检查及预测术后最佳矫正视力(BCVA)中的应用价值。方法:观察671例874眼白内障超声乳化手术患者,根据白内障混浊(C,N,P)级别相加分为三组,A组:3级及以下;B组:4级;C组:5级。术前分别采用直接检眼镜及前置镜(+90D)检查眼底,结合晶状体混浊程度与术前BCVA匹配性分析预测术后BCVA,术后2wk再次检查眼底、BCVA。比较直接检眼镜检查和前置镜检查的眼底病变术前检出率及术后BCVA预测符合率,采用Pearson卡方检验(非校正法)。结果:直接检眼镜检查方法眼底病变术前检出率分别为A组:96.8%(30/31);B组:69.5%(66/95);C组:35.3%(18/51),术后BCVA预测符合率分别为A组:94.8%(163/172);B组:87.4%(416/476);C组:60.6%(137/226)。前置镜检查方法眼底病变术前检出率分别为A组:100%(31/31);B组:93.7%(89/95);C组:84.3%(43/51),术后BCVA预测符合率分别为A组:95.9%(165/172);B组:92.0%(438/476);C组:76.1%(172/226)。B组及C组前置镜检查眼底病变术前检出率、术后BCVA预测符合率明显优于直接检眼镜检查,差异有显著性(P<0.01)。前置镜组总体眼底病变术前检出率92.1%,术后BCVA预测符合率88.7%。结论:裂隙灯显微镜下前置镜检查在白内障术前检查中眼底病变检出率明显优于直接检眼镜,结合晶状体混浊程度与术前BCVA匹配性分析可以粗略预测非成熟期白内障患者术后BCVA。

AIM ： To observe the application value of fundus pre-set lens examination in preoperative fundus examination and predicting postoperative best-corrected visual acuity （BCVA） of cataract. METHODS： A total of 671 patients 874 eyes with cataract were observed and all the eyes were divided into 3 groups according to lens opacities degree： group A： grade 3 or lower; group B： grade 4; group C： grade 5. Before phacoemulsification, ocular fundus was observed respectively by direct ophthalmoscope and fundus pre-set lens（ ＋ 90D）. We tried to forecast the postoperative BCVA by fundus examination combining lens opacities degree and preoperative BCVA analysis. Ocular fundus and BCVA were reexamined in two weeks after phacoemulsification. Compare the detection rate of preoperative ocular fundus diseases and coincidence rate of predictive postoperative BCVA by direct ophthalmoscope and fundus pre-set lens. Pearson＇s chi-square test was used in the data statistics. RESULTS： The detection rate of preoperative ocular fundus diseases by direct ophthalmoscope： group A： 96. 8%（30/31 ） ; group B：69.5% （66/95） ; group C：35.3% （18/51）, coincidence rate of predictive postoperative BCVA by direct ophthalmoscope： group A： 94.8% （163/ 172） ;group B：87.4% （416/476） ;group C：60.6% （137/226）. The detection rate of preoperative ocular fundus diseases by fundus pre-set lens： group A：100% （31/31）;group B：93.7% （89/95） ;group C：84.3% （43/51） ,coincidence rate of predictive postoperative BCVA by fundus pre-set lens： group A：95.9% （165/172） ;group B：92.0% （438/476） ;group C：76.1%（172/226）. The detection rate of preoperative ocular fundus diseases and coincidence rate of predictive postoperative BCVA by fundus pre-set lens were significantly higher than by direct ophthalmoscope in group B and group C. The total detection rate of preoperative ocular fundus diseases by fundus pre-set lens was 92.1% while the coincidence rate of predictive postoperative BCVA was 88.7%. CONCLUSION ：The detection rate of preoperative ocular fundus diseases by fundus pre-set lens examination in preoperative examination of cataract is higher than by direct ophthalmoscope. Combined with lens opacities degree and preoperative BCVA analysis, fundus pre-set lens examination can roughly predict post-operative BCVA in patients with cataract in immature stage.