玻璃体切除眼白内障超声乳化术后黄斑厚度的变化

Changes of macular thickness after vitrectomy and phacoemulsification

目的探讨孔源性视网膜脱离行玻璃体切除术后,择期行白内障超声乳化联合人工晶体植入术后视力及黄斑厚度的变化。方法选择24例玻璃体切除术后白内障患者为研究组,同期选择单纯年龄相关性白内障37例为对照组。两组患者均实施白内障超声乳化联合人工晶状体植入术,采用光学相干断层成像技术分别测量术前1 d、术后1周及术后1个月的黄斑中心1 mm范围视网膜厚度。结果研究组术前1 d、术后1周及术后1个月的最佳矫正视力(BCVA)均显著低于对照组,差异具有统计学意义(P<0.01);两组患者术后1周及术后1个月的BCVA均显著高于术前1 d,差异具有统计学意义(P<0.01)。研究组术前1 d、术后1周视网膜厚度与对照组比较差异无统计学意义(P>0.05);研究组术后1个月视网膜厚度显著低于对照组,差异具有统计学意义(t=2.43,P=0.04<0.05)。对照组术后1周视网膜厚度较术前1 d增加明显,差异有统计学意义(P<0.05);术后1个月时视网膜厚度增加更为明显,与术前1 d和术后1周比较差异均有统计学意义(P<0.01)。研究组术后1周视网膜厚度与术前1 d比较差异无统计学意义(P>0.05);术后1个月视网膜厚度有所增加,与术前1 d和术后1周比较差异均有统计学意义(P<0.01)。两组患者术后均未见黄斑囊样水肿发生,仅对照组有1例术后1个月时视网膜厚度较术前增加>20%(为21.67%),但最佳矫正视力无受损。结论玻璃体切除术后择期实施白内障超声乳化术联合人工晶状体植入术可保持黄斑中心凹厚度相对稳定。使用前瞻性研究并增加样本量,是否还有相同的结论 ,尚需进一步研究。

Objective To investigate changes of postoperative vision and macular thickness after vitrectomy for rhegmatogenous retinal detachment, followed by phacoemulsification combined with intraocular lens implantation. Methods There were 24 patients with cataract after vitrectomy as research group, and 37 patients with age-related cataract at the same period as control group. Both groups received phacoemulsification combined with intraocular lens implantation. Their macular central retinal thickness in 1 mm range was detected by optical coherence tomography in 1 d before operation and in postoperative 1 week and 1 month. Results The research group had all lower best corrected visual acuity（BCVA） in 1 d before operation and in postoperative 1 week and 1 month than the control group, and their difference had statistical significance（P〈0.01）. Both groups had obviously higher BCVA in postoperative 1 week and 1 month than that in 1 d before operation, and the difference had statistical significance（P〈0.01）. There was no statistically significant difference of retinal thickness in 1 d before operation and in postoperative 1 week between the research group and the control group（P〉0.05）. The research group had obviously lower retinal thickness in postoperative 1 month than the control group, and the difference had statistical significance（t=2.43, P=0.040.05）. The control group had much higher retinal thickness in postoperative 1 week than that in 1 d before operation, and the difference had statistical significance（P〈0.05）. It also had much higher retinal thickness in postoperative 1 month, which had statistically significant difference with those in 1 d before operation and in postoperative 1 week（P〈0.01）. The research group had no statistically significant difference of retinal thickness in 1 d before operation and in postoperative 1 week（P〉0.05）. It had higher retinal thickness in postoperative 1 month, which had statistically significant difference with those in 1 d before operation and in postoperative 1 week（P〈0.01）. Both groups had no case with cystoid macular edema after operation. There was only 1 case in the control group with increased retinal thickness by 20%（21.67%） in postoperative 1 month and no damaged best corrected visual acuity. Conclusion Elective implement of phacoemulsification combined with intraocular lens implantation after vitrectomy can maintain stable macular central foveal thickness. Further research is required to verify outcome by prospective study and large sample number.