影响高度近视白内障患者疗效的相关因素分析

Related factors influencing the curative effect for cataract patients with high myopia

目的:分析白内障摘除手术治疗高度近视白内障患者疗效的影响因素。方法:回顾性研究。纳入高度近视合并白内障患者行白内障摘除术86例118眼,所有患者均完成术后6mo随访调查且临床资料完整,记录所有患者术后6mo最佳矫正视力(best correct visual acuity,BCVA),以0.3为分界将患者分为低视力组(视力<0.3)与视力正常组(视力≥0.3),回顾性分析两组患者临床资料,对年龄、性别、病程、BCVA、角膜屈光度、眼轴长度、角膜散光、巩膜、眼底病变程度、术后并发症、玻璃体脱离、黄斑病变等因素进行统计,采用单因素及多元Logistic回归分析法筛选影响白内障摘除手术治疗高度近视白内障患者疗效的相关因素。结果:所有患者中低视力34眼(29%),视力正常84眼(71%);低视力组眼轴长度、角膜散光度、合并黄斑病变所占比例、合并后巩膜葡萄肿所占比例、晶状体核硬度分级、眼底病变程度与视力正常组对比差异有统计学意义(P<0.05);眼轴长度(OR:1.567,95%CI:1.129~2.224)、黄斑病变(OR:8.054,95%CI:1.741~37.541)、晶状体核硬度分级(OR:3.642,95%CI:2.512~18.787)、眼底病变程度(OR:7.964,95%CI:1.254~28.415)均与高度近视白内障疗效相关(P<0.05);随访6mo,晶状体后囊膜混浊5眼,无继发性青光眼、人工晶状体移位、角膜失代偿及视网膜脱离并发症发生。结论:眼轴长度、黄斑病变、晶状体核硬度分级、眼底病变程度均为影响白内障摘除手术治疗高度近视白内障患者术后视力恢复的独立危险因素,为促进患者术后视力恢复,必须积极控制危险因素,重视术中精细操作。

AIM：To analyze the influencing factors of the curative effect of cataract extraction in cataract patients with high myopia. METHODS： A total of 86 patients （118 eyes） with high myopia and undergoing cataract extraction were enrolled in the retrospective study. All patients completed followup in 6mo after surgery and the clinical data were complete. The best corrected visual acuity （BCVA） was recorded in 6too after surgery. With 0.3 as the dividing line, the patients were divided into the low visual acuity group （the visual acuity 〈0.3） and the normal visual acuity group （the visual acuity ≥0.3）. The clinical data of the two groups were retrospectively analyzed. Age, gender, course of disease, BCVA, corneal diopter, axial length, corneal astigmatism, sclera, degree of fundus lesions, postoperative complications, vitreous detachment, maculopathy and other factors were statistically analyzed. Univariate and multivariate Logistic regression analyses were performed to screen the related factors influencing the curative effect in the treatment of patients with high myopia and undergoing cataract extraction. RESULTS： Among all patients, there were 34 eyes （29%） with low visual acuity and 84 eyes （71%） with normal visual acuity. The axial length, corneal astigmatism, proportion of with macular lesions, proportion of with posterior sclerotic staphyloma, the hardness of the lens nucleus and degree of fundus lesions showed statistically significant differences between the low visual acuity group and the normal visual acuity group （P〈0. 05）. The axial length （ OR： 1. 567, 95% CI： 1. 129-2. 224）, macular lesions （ OR.8. 054, 95%C1：1.741-37.541）, the hardness of the lens nucleus （OR：3.642, 95%C1：2.512-18.787） and the degree of fundus lesions （ OR：7.964, 95% C1：1. 254-28. 415） were associated with the curative effect in patients with cataract and high myopia （P〈0. 05）. During 6mo of follow-up, there were 5 eyes with posterior capsular opacification, no secondary glaucoma, artificial lens shift, corneal decompensation and complications of retinal detachment. CONCLUSION： The axial length, macular lesions, hardness of the lens nucleus and degree of fundus lesions are the independent risk factors for visual acuity recovery in cataract patients with high myopia after surgery. To improve the visual recovery after surgery, the risk factors must be controlled actively and attention should be paid to fine surgery.