玻璃体切割联合白内障手术后屈光状态的临床观察

Refractive shift after simultaneous vitrectomy and cataract surgery

目的 观察玻璃体切割联合白内障手术后屈光状态的变化规律.方法 回顾性分析单纯白内障手术（单纯组）患者30例50只眼和玻璃体切割联合白内障手术（联合组）患者44例48只眼的临床资料.联合组又根据手术中使用玻璃体腔填充物的不同,分为平衡盐溶液组和气体组.两组患者手术前均测量眼轴长度和角膜曲率,并根据其计算植入人工晶状体度数和手术前预测的等效球镜度数（预测值）.手术后6个月同样方法测量眼轴长度、角膜曲率,实际的等效球镜度数（实际值）.对比分析两组患者预测值与实际值差异以及联合组与单纯组、平衡盐溶液组和气体组之间的屈光状态变化（实际值与预测值之差）.结果 联合组手术前平均预测值为（-0.10±0.42）D,手术后6个月时平均实际值为（-1.00±1.10）D,两者比较,差异具有统计学意义（t=6.687,P＜0.05） 单纯组和联合组手术后屈光状态平均变化值分别为（0.13±0.53）、（-0.93±0.92）D,两者比较,差异具有统计学意义（t=-3.792,P＜0.05） 平衡盐溶液组和气体组之间屈光状态平均变化值分别为（-0.76±0.89）、（-1.19±0.94）D,两组比较,差异无统计学意义（t=-1.530,P＞0.05）.结论 玻璃体切割联合白内障手术后患者屈光状态变化趋于向近视偏移.

Objective To investigate the refractive shift after combined surgery （phacoemulsification,intraocular lens implantation and vitrectomy） by comparing the difference between the predictive and postoperative refractive power. Methods The clinical data of 44 patients （48 eyes） underwent combined surgery （combined group） and 30 patients （50 eyes） underwent cataract surgery （cataract group） were retrospective analyzed. Combined group was further divided into two sub-groups by the kind of tamponade：balanced salt solution group and gas group. Before surgery, axial length and corneal curvature were measured, and the predictive spherical equivalent （PSE） was calculated. Axial length, corneal curvature and actual spherical equivalent （ASE） were measured in six months after surgery. The differences between PSE and ASE were compared between combined group and cataract group, balanced salt solution group and gas group. Results In combined group, the mean PSE was （-0.10±0.42） D and ASE was （- 1.00± 1.10） D,and the difference was significant （t= 6.687, P〈0.05）. Patients underwent combined surgery showed a statistically significant myopic shift compared with those underwent simple cataract surgery （t= -3.792,P〈0. 05）, the refractive shift of balanced salt solution group and gas group were （-0. 76± 0. 89） and （- 1.19±0.94） D respectively, and there was no significant difference （t= -1.530, P〉0. 05）. Conclusion Combined surgery of phacoemulsification and vitrectomy tends to shift the actual refractive status to myopia.