超声乳化吸除联合IOL植入术治疗高度近视合并白内障

Clinical evaluation on phacoemulsification and intraocular lens implantation in patients with high myopia and cataract

目的：分析超声乳化吸除联合IOL植入术治疗高度近视合并白内障患者的临床疗效。方法：回顾分析温州医科大学附属眼视光医院2011-01/12收治的73例128眼高度近视合并白内障患者的临床资料,对患者行超声乳化白内障吸除合并IOL植入术。术后随访4a,记录视力及并发症情况。结果：最佳矫正视力在术前、术后1wk,3mo,1、2、3a时分别为4.33±0.51、4.60±0.47、4.69±0.42、4.67±0.45、4.65±0.30、4.73±0.29;与术前比较,术后各时间段矫正视力均提高（P〈0.01）。与眼轴〉30mm组比较,26~30mm组在术后1wk,3mo,1a时的矫正视力均较好（P=0.012,0.003,0.002）。所有患者术中无并发症发生。术后黄斑囊样水肿2眼（1.6%）,予以激素治疗后恢复;高眼压4眼（3.1%）,予以降眼压药物治疗后恢复正常;后发性白内障57眼（44.5%）,其中6眼轻度,不影响视力,予以观察处理,51眼行Nd：YAG激光晶状体后囊截开术,视力恢复。术后随访期间无视网膜脱离。结论：超声乳化白内障吸除联合IOL植入术治疗高度近视合并白内障的临床疗效显著,长期视力稳定,手术安全可靠。

AIM ： To evaluate the therapeutic effect of phacoemulsification and intraocular lens implantation in patients with high myopia and cataract. METHODS： Seventy- three cases（ 128 eyes） with cataract and high myopia were collected fromJanuary2011 to December 2011 in the Eye Hospital of Wenzhou M edical University. Patients received phacoemulsification and intraocular lens implantation. The follow- up period was 4a. The Pre- and post- operative corrected vision and operative complications were recorded and analyzed.RESULTS： The best corrected visual acuity was 4. 33 ±0. 51 before operation and 4. 60 ± 0. 47,4. 69 ± 0. 42,4. 67 ±0. 45,4. 65 ± 0. 30,4. 73 ± 0. 29,at 1wk,3mo,1,2 and 3a after operation, respectively. Statistical difference of corrected vision was found between the before operation and each time period after operation（ P〈0. 01）. At 1wk,3mo and 1a after operation,patients with shorter axial length（ 26- 30 mm） all got a significant better corrected vision compared to patients with longer axial length（ 30mm; P = 0. 012,0. 003,0. 002）. No complication was seen during the operation. Cystoid macular edema was found in 2 eyes（ 1. 6%）, which were cured after glucocorticoid therapy; increased intraocular pressure（ IOP） in 4 eyes（ 3. 1%）,which returned to normal after IOP- lowering drugs; posterior capsular opacification was observed in 57 eyes（ 44. 5%）, in which 6 mild eyes without influence on vision were observed and 51 eyes were given Nd： YAG laser capsulectomy. The vision of the51 eyes recovered to normal after laser. No retinal or choroidal detachment was seen after surgery.CONCLUSION： It is effective and safe for high myopes with cataract to be treated with phacoemulsification and intraocular lens implantation and the long- termvisual outcome is stable.