白内障合并年龄相关性黄斑变性患者行超声乳化晶状体吸出术临床疗效

Clinical efficacy of phacoemulsification in cataract patients with age-related macular degeneration

目的探讨超声乳化晶状体吸出术治疗白内障合并年龄相关性黄斑变性(age-related macular degeneration,AMD)患者的疗效及对黄斑中心凹视网膜厚度的影响。方法回顾分析我院行超声乳化晶状体吸出术的白内障患者72例(80眼),其中单纯白内障患者40例(44眼),合并AMD患者32例(36眼);于我院门诊就诊确诊近期不行手术合并AMD的白内障患者30例(32眼)。分别于术前,术后1d、1周、4周、3个月检测患者的最佳矫正视力、黄斑中心凹视网膜厚度及黄斑区组织变化情况,并作比较。结果单纯白内障组和合并AMD组分别有43眼(97.73%)和25眼(69.44%)术后视力较术前有不同程度提高;AMD未手术组12眼(37.50%)视力有不同程度下降,未发现视力提高者。单纯白内障组和合并AMD组术后黄斑中心凹视网膜厚度均较术前增加,但仅在术后4周与术前比较差异有统计学意义(t=2.567,P=0.012;t=3.076,P=0.003),且与单纯白内障组相比,合并AMD组术后4周时黄斑中心凹视网膜厚度增加更为明显,差异有统计学意义(t=2.044,P=0.044);AMD未手术组术后黄斑中心凹视网膜厚度与术前比较,差异无统计学意义(P>0.05)。单纯白内障组有5眼视网膜厚度明显增加,1眼于术后4周出现黄斑囊样水肿;合并AMD组有8眼视网膜厚度明显增加,2眼出现黄斑囊样水肿,未发现脉络膜新生血管产生者;AMD未手术组观察期内未发现黄斑区明显改变者。结论合并AMD的白内障患者经超声乳化晶状体吸出术后视力可有不同程度提高,手术本身并不诱导脉络膜新生血管的产生。超声乳化晶状体吸出术对于合并AMD的白内障患者是一种相对安全的手术方法。

Objective To analyze the clinical efficacy of phacoemulsification in cataract patients with age-related macular degeneration（AMD）,and assess its effect on the retinal thickness of central macular fovea.Methods A retrospective case-control study was carried out in 72 cataract patients（80 eyes）,all patients received phacoemulsification,in which 40 patients（44 eyes）without AMD and 32 patients（36 eyes）with AMD;And there were 30 cataract patients（32 eyes）with AMD,but did not take surgery.The best corrected visual acuity,retinal thickness of central macular fovea and macular histological changes were detected at pre-operation and postoperative 1 day,1 week,4 weeks and 3 months.Results The postoperative best corrected visual acuity in 43 eyes（97.73%）in single cataract group and 25 eyes（69.44%）in AMD and surgery group were improved,respectively;The postoperative best corrected visual acuity in 12 eyes（37.50%）in without surgery group were decreased with no improvement.The postoperative retinal thickness of central macular fovea in single cataract group and with AMD and surgery group were increased,but there were significant differences only at postoperative 4 weeks compared with pre-operation（t=2.567,P=0.012;t=3.076,P=0.003）.The postoperative retinal thickness of central macular fovea in AMD and surgery group was higher than that of single cataract group,there was significant difference（t=2.044,P=0.044）;There was no significant difference in the each period of the without surgery group（P0.05）.The retinal thickness in single cataract group and in AMD and surgery group increased significantly with 5 eyes and 8 eyes,the cystoid macular edema in single cataract group and in AMD and surgery group appeared in 1 eye and 2 eyes at postoperative 4 weeks,respectively.No eye with mild or moderate AMD developed neovascular AMD.No significant macular tissue changes were found in without surgery group.Conclusions The visual acuity is improved at different levels after phacoemulsification in cataract patients with AMD,the surgery itself don＇t induce the occurrence of the neovascularization,and phacoemulsification is a relative safe method to the cataract patients with AMD.