西藏地区影响老年性白内障术后视力改善因素分析

Study of impact factors on visual acuity improvement for senile cataract surgery in Tibet

目的 分析影响西藏地区老年性白内障术后视力改善的因素.方法 对西藏地区接受白内障手术的老年性白内障278例,分析年龄、核分级、术式（超声乳化术和小切口白内障囊外摘除术）、人工晶状体度数、角膜水肿部位等对术后视力改善的影响.视力采用LogMAR视力.统计方法分别采用单因素和多因素线性回归方法.结果 （1）单因素分析：术式：超声乳化术组术后较术前视力改善（平均视力差） 0.92±0.48,小切口白内障囊外摘除术组平均视力差0.83±0.46,两种手术方式对视力改善的影响,差异没有统计学意义（P＞0.05）.年龄：70-、80-年龄组分别与40-、50-、60-年龄组差异有统计学意义（P＜0.05）.角膜水肿部位：弥漫性水肿（平均视力差0.52±0.42）较中央部位水肿（平均视力差0.70±0.44））对视力改善影响更大,差异有统计学意义（P＜0.05）.（2）多因素线性回归分析：年龄、角膜水肿部位均对视力改善有影响,差异有统计学意义（P＜0.05）.结论 （1）超声乳化术和小切口白内障囊外摘除术两种手术方式对视力提高程度无明显差异,因此在西藏地区可以根据当地条件,包括经济状况和医师具备的手术水平,来选择术式,以使患者获得最佳有用视力.（2）年龄为白内障术后视力改善的影响因素之一,随年龄增加视力改善减少,而西藏地区就医条件有限,故在西藏地区更应重视白内障的普查,强调早期发现和早期手术.（3）在角膜水肿分级无明显差异的基础上,弥漫性水肿较中央部水肿对视力改善影响更大,因此在术中应谨慎操作,尽量避免角膜内皮广泛的损伤.

Objective To analyze impact factors for visual acuity improvement of senile cataract surgery in Tibet prospectively. Methods Of 278 cases were included. To study relations of visual acuity improvement between pre- and post-cataract surgery with patient age, nucleus classification, small incision cataract surgery （SICS） or Phacoemulsification （PHACO） and corneal edema. LogMAR chart was used in visual acuity analysis. Results 1. Univariate analysis： There was no significant difference between PHACO group and SICS group on visual acuity improvement （PHACO 0.92± 0.48, SICS 0.83± 0.46, P 〉0.05）. Age group for 70- and 80- years-old had less improvement on visual acuity （P 〈0.05）. Diffuse corneal edema had much more influence than central corneal edema on visual acuity improvement （0.52± 0.42, 0.70± 0.44, diffuse vs central, respectively）. 2. Multivariate analysis： There were significant differences in age and location of corneal edema on visual acuity improvement （P 〈0.05）. Conclusions There is no significant difference on visual acuity improvement between PHACO and SICS. Ophthalmologist can choose either PHACO or SICS for better rehabilitation of visual acuity, depending on area economics, his own experience and so on in Tibet. Visual acuity improvement in cataract surgery is significantly affected by the age of the patients. Since medication is deficient in Tebit, screening of cataract in Tibet is very important for detecting and treating cataract as early as possible. Diffuse corneal edema has much more influence than central edema on visual acuity improvement when corneal edema degrees are not different. It＇s important to avoid corneal endothelium damage in cataract surgery.