超声乳化术治疗高度近视并发性白内障术后视力恢复的影响因素

Poor postoperative vision outcomes and its related factors in cataract patients with high myopia after phacoemulsification

目的分析超声乳化术治疗高度近视并发性白内障术后视力恢复的影响因素。方法对63例（87眼）高度近视并发性白内障患者行超声乳化联合人工晶状体植入术，术后随访3个月，分别测量患者视力、最佳矫正视力及眼底检查，术后最佳矫正视力分为〈0．3和／〉0．3两个等级，并用Logistic回归分析年龄、近视病史时间、术前眼轴长度、术前角膜散光度、术前角膜屈光度、玻璃体后脱离、后巩膜葡萄肿及黄斑病变多种因素对术后视力恢复的影响。结果术后2周视力：稞眼视力：〈0．3者45眼（51．72％），t〉0．3者42眼（48．28％）；最佳矫正视力：〈0．3者32眼（36．78％），≥0．3者55眼（63．22％）。术后3个月视力：裸眼视力：〈0．3者38眼（43．68％），≥0．3者49眼（56．32％）；最佳矫正视力：〈0．3者23眼（26．44％），≥0．3者64眼（73．56％）。术后最佳矫正视力〈0．3和≥0．3组比较，眼轴长度、角膜散光度、黄斑病变差异均有统计学意义（均为〈0．05）。黄斑病变（OR：8．06．95％C1：1．75∽37．07）、角膜散光度（OR：3．87，95％CI：1．20-12．48）和眼轴长度（OR：1．50，95％CI：1．09∽2．06）是术后矫正视力恢复的独立影响因素；有黄斑病变者术后矫正视力预后差；随着角膜散光度和眼轴长度的增加，术后矫正视力恢复差；其他因素尚不能认为是术后视力恢复的独立影响因素。结论超声乳化术治疗高度近视并发性白内障是安全有效地，伴随黄斑病变、角膜散光度过大和眼轴过长是超声乳化术治疗高度近视并发性白内障术后低视力的独立影响因素，影响强度：黄斑病变〉角膜散光度过大〉眼轴过长。

Objective TO analyze poor postoperative vision outcomes and its related factors in cataract patients with high myopia after phacoemulsification. Methods Sixty-three high myopic cataract patients （87 eyes ） were performed phacoemulsifica- tion and intraocular lens implantation, patients were followed up for 3 months, the visual acuity, best corrected visual acuity and fundus examination were observed, the post- operative best corrected visual acuity was divided into 〈 0.3 and I〉0.3, and the effects of ages, myopia history, preoperative axial length, preoperative corneal astigmatism, pre- operative cornea[ refractive power,posterior vitreous detachment,posterior staphyloma and maculopathy on the postoperative best corrected visual acuity were analyzed by Logistic regression. Results Visual acuity at postoperative 2 weeks： Uncorrected visual acuity： 〈 0.3 in 45 eyes（51.72% ） and 0.3 in 42 eyes（48.28% ） ;Best corrected visu- al acuity： 〈 0.3 in 32 eyes（36.78% ） and ≥ 0.3 in 55 eyes（63.22% ）. Visual acuity at postoperative 3 months,uncorrected visual acuity： 〈 0.3 in 38 eyes（43.68% ） and ≥ 0. 3 in 49 eyes（56.32 % ）;Best corrected visual acuity： 〈 0.3 in 23 eyes（26.44% ） and ≥0.3 in 64 eyes （ 73.56% ）. There were statistical difference in axis length, corneal a- stigmatism, maculopathy between the patients with best corrected visual acuity 〈 0.3 and ≥0.3 （ all P 〈 0.05 ）. The maculopathy （ OR： 8.06,95 % （31：1.75 - 37.07 ）, corneal astigmatism（ OR ：3.87,95% CI：1.20 - 12.48 ） and axis length （ OR： 1.50,95% C1：1.09 - 2. 06） were the independent influence factors of postoperative visual acuity recovery.Conclusion Phacoemulsiiication is safe and effective for cataract with high myopia, accompany with maculopathy and serious corneal and long axial length are the independent influence factors of postoperative poor visual acuity after phacoe- mulsification in cataract patients with high myopia achieving, influence intension： macuiopathy 〉 serious corneal astigmatism 〉 long axial length.