双眼白内障超声乳化人工晶状体植入术后主视眼转变及对视觉质量的影响

Effect of binocular cataract phacoemulsification and intraocular lens implantation surgery on ocular dominance and visual quality

目的观察分析双眼白内障超声乳化人工晶状体植入手术患者主视眼的转变及对视觉质量的影响。方法选取符合入选标准的双眼行白内障手术患者46例,年龄(65.8±1.3)岁。按术前屈光度分为:A组(27例),双眼等效球镜度数差异<2D;B组(19例),双眼等效球镜度数差异≥2D。所有患者均行术前及术后3个月屈光度检查,使用盲法行术前及术后1、3个月主视眼测量检查,术后3个月行对比敏感度检查和视觉满意度问卷调查。结果术后1个月13例(28.3%)发生主视眼转变,A组9例,转变率33.3%,B组4例,转变率21.1%,2组间转变率差异无统计学意义(P>0.05)。术后3个月11例(23.9%)患者发生主视眼转变,A组7例,转变率25.9%,B组4例,转变率为21.1%,主视眼转变率组间差异无统计学意义(P>0.05)。术前主视眼较非主视眼近视屈光度低(P=0.01),术后主视眼与非主视眼屈光度差异无统计学意义(P>0.05)。术后主视眼发生转变与未发生转变的患者对比敏感度及视觉满意度问卷调查差异均无统计学意义(P>0.05)。结论白内障术后存在主视眼转变,但主视眼转变对视觉质量无影响。不同程度的屈光参差患者白内障术后主视眼转变无明显差异。

Objective To investigate the ocular dominance change after binocular cataract phacoemulsification and intraocular lens implantation surgery and its impact on visual quality. Methods Totally 46 patients （mean age 65.8±1.3 years） receiving binocular cataract phacoemulsification and intraocular lens implantation surgery in our department from February to May 2013 were prospectively enrolled in this study. According to the degree of refraction, they were divided into 2 groups, group A with the discrepancy of 2 eyes less than 2 diopter （n=27） and group B with the discrepancy greater than 2 diopter （n=19）. All patients were received ocular dominance tests preoperatively and 1 and 3 months postoperatively. Refraction test was carried out before and in 3 months postoperatively. Each patient was recorded contrast sensitivity and accepted the survey on visual quality satisfaction in postoperative 3 months. Results Ocular dominance change was found in 13 patients （28.3%） in 1 month after surgery, including 9 patients from group A （33.3%） and 4 from group B （21.1%）, and in another 11 patients （23.9%） in 3 months after surgery, containing 7 out of group A （25.9%） and 4 out of group B （21.1%）. There was no statistic difference in ocular dominance change between the 2 groups at the 2 time points（P〉0.05）. The myopia diopter was significantly lower in the dominant eyes than non-dominant eyes before surgery （P=0.01）, while no statistic difference was seen after surgery （P〉0.05）. The contrast sensitivity and visual quality satisfaction had no statistic difference between patients having ocular dominance change or not after surgery（P〉0.05）. Conclusion Ocular dominance will change after cataract surgery, but it has no effect on refraction and visual quality. There is no difference between patients of different extent of anisometropia in the change of ocular dominance after cataract surgery.