高度近视合并白内障超声乳化治疗观察(附86眼报告)

Clinical evaluation of phacoemulsification in cataract combined with high degree myopia(report of 86 eyes)

目的探讨高度近视合并白内障超声乳化治疗效果及影响因素。方法选择56例（86眼）高度近视合并白内障患者,按眼轴长度分为A组（26～29mm,54眼）和B组（〉29mm,32眼）。术前最佳矫正视力眼前手动-0.3,屈光度-10.00~23.00D。行超声乳化白内障吸除,植入折叠人工晶体于囊袋内,术后1d、1周、1个月、3个月、6个月行视力、裂隙灯、眼压检查,1个月行三面镜检查。结果术后3个月A组矫正视力≥0.5者37眼（69%）,≥0.3者52眼（96%）;B组矫正视力≥0.5者3眼（9%）,≥0.3者13眼（41%）。整体脱盲率为97%,脱残率为77%。结论超声乳化联合人工晶体植入术是治疗高度近视合并白内障的有效术式,术后视力主要与眼底病变有关。术前详细检查与评估,术中防止后囊破裂,使用合理人工晶体计算公式,术后视网膜变性的预防性光凝,有助于术后的视力提高。

Objective To investigate the effects and affecting factors of phacoemulsification in cataract patients with high degree myopia.Methods A total of 86 eyes with cataract and high degree myopia was included in this study.Eyes were divided into two groups according to axial length：group A（54 eyes,axial length=26～29 mm） and group B（32 eyes,axial length 29 mm）.The best spectacle-corrected visual acuity（BSCVA） ranged from hand motion to 0.3,and diopter was-10.00 D～-23.00 D.All patients underwent phacoemulsification and foldable IOL implantation,visual acuity,slit lamp biomicroscope,intraocular pressure were observed 1 day,1 week,1 month,3 months and 6 months postoperatively,and three-mirror contact lens examination were performed 1 month postoperatively.Results For group A,BSCVA≥ 0.5 in 37 eyes（69%）,and ≥0.3 in 52 eyes（96%） 3 months postoperatively.While for group B,BSCVA≥0.5 in 3 eyes（9%）,and ≥0.3 in 13 eyes（41%） 3 months postoperatively.The rate of recovery from blindness was 97%,and from low vision was 77%.Conclusions Phacoemulsification and IOL implantation is an effective surgical treatment for cataract combined with high degree myopia.Postoperative visual acuity is closely associated with fundus pathology.Careful examination and assessment before surgery,using suitable formula for IOL power calculation,avoiding posterior capsular rupture during the operation,and preventive laser photocoagulation for retinal degeneration after surgery,would contribute to the improvement of postoperative visual acuity.