不同手术方式对高度近视合并白内障患者中央角膜厚度及视觉质量的影响

Effects of different surgical approaches on central corneal thickness and visual quality in patients with high myopia and cataract

目的观察比较白内障囊外摘出人工晶状体植入术与超声乳化白内障摘出人工晶状体植入术对高度近视合并白内障患者中央角膜厚度(central corneal thickness,CCT)及视觉质量的影响。方法选择2009年1月至2011年12月我院高度近视合并白内障患者50例(75眼),根据手术方式不同分为2组,其中A组行白内障囊外摘出人工晶状体植入术,B组行超声乳化白内障摘出人工晶状体植入术,术后1 d、1周、1个月、3个月采用国际标准视力表检查最佳矫正视力(best corrected visual acuity,BCVA),采用角膜内皮计观察角膜内皮并进行角膜内皮细胞(corneal endothelial cell,CEC)计数,同时采用OCT检查术眼CCT。结果与术前比较,两组患者术后BCVA均显著提高,差异均有统计学意义(均为P<0.05);两组间比较,术前差异无统计学意义(P>0.05),术后1 d、1周差异也均无统计学意义(均为P>0.05),但术后1个月、3个月差异均有统计学意义(均为P<0.05),B组BCVA好于A组。与术前相比,两组术后CEC数量均下降,差异均有统计学意义(均为P<0.05);两组术前CEC计数比较,差异无统计学意义(P>0.05),但B组术后1周、1个月、3个月的CEC计数均高于A组,差异均有统计学意义(均为P<0.05)。与术前相比,术后1周、1个月、3个月两组CCT均明显增加,差异均有统计学意义(均为P<0.05);术后1 d A组CCT低于B组,差异有统计学意义(P<0.05);术后1周、1个月、3个月两组CCT差异均无统计学意义(均为P>0.05)。结论对于高度近视合并白内障患者,行超声乳化人工晶状体植入术治疗较白内障囊外摘出人工晶状体植入术更有利于术后视功能的恢复,更符合眼部生理功能重建。

Objective To observe and compare the effects of phacoemusification and extracapsular extraction on the central corneal thickness （CCT） and visual quality in high myopia with cataract patients. Methods Fifty patients, who were high myopia with cataract from January 2009 to December 2011 in the hospital, were selected and di- vided into two groups according to the different methods. Group A was treated with phac- oemusification,while group B with extracapsular extraction. The best corrected visual a- cuity of both group A and B were checked with standard visual acuity chart, corneal en- dothelium was observed with corneal endothelial meter and corneal endothelial cell （CEC） was counted after 1 day, 1 week, 1 month and 3 months respectively. Meanwhile, optical coherence tomography （OCT） was used to check the central corneal thickness. Results Compared with the preoperative, BCVA of the two groups dramatically in-creased after the operation and differences were statistically significant （ all P 〈 0.05 ）. Comparison between the two groups in- dicated that pre-operative differences didn＇ t show any statistical significance and neither did the post-operative differences af- ter 1 day and 1 week（P 〉 0.05 ）. However, differences after 1 month and 3 months showed statistical significance （P 〈 0. 05 ）. BCVA in group B was better than that in group A. The postoperative number of CEC decreased in both groups with statistical- ly-significant differences （ all P 〈 0. 05 ）. Preoperative comparison on CEC number between groups indicated no statistically- significant differences（ all P 〉 0.05 ）, but the post-operative CEC after 1 week, 1 month and 3 months in group B was higher than in group A and the differences were of statistical significance （P 〈 0.05 ）. Compared with the preoperative situation, CCT in both group obviously increased in 1 week, 1 month and 3 months after the operation; postoperative CCT in group A was lower than that in group B with statistically-significant differences. And postoperative CCT differences in two groups showed no statistical significance （ all P 〉 0.05 ） at 1 week, 1 month and 3 months after operation. Conclusion For patients of high myopia with cataract ,phacoemusification is a better choice than extracapsular extraction, for it can bitterly help the postoper- ative recovery of visual function and the ocular reconstruction of physiological function.