不同IOL计算公式对超声乳化人工晶状体植入联合玻璃体切割术治疗特发性黄斑前膜合并白内障患者术后屈光度预测准确性的研究

Research on accuracy of different IOL power calculation following the combination of phacoemulsification and vitrectomy in eyes with idiopathic macular epiretinal membrane

目的评估不同人工晶状体（IOL）计算公式预测超声乳化IOL植入联合玻璃体切割术（前后联合术）治疗年龄相关性白内障（ARC）合并特发性黄斑前膜（IMEM）患者屈光度的准确性。方法采用前瞻性病例对照临床研究设计。选取2013年3月至2015年7月在温州医科大学眼视光医院杭州院区拟行前后联合术的ARC合并IMEM患者（ARC＋IMEM组）共30例30眼，ARC患者（ARC组）共32例32眼，术中均植入Adapt-AO IOL。IOL度数使用IOL-Master以SRK-T公式及Haigis公式计算所得。使用光相干断层扫描（OCT）测量术前及术后黄斑中心凹的厚度。计算各组不同公式计算IOL度数的术后平均屈光预测误差（ME）和平均绝对屈光预测误差（MAE）；分析术后各公式屈光误差与黄斑厚度变化值的相关性。结果ARC＋IMEM组患者术后Haigis公式ME和MAE分别为（－0.47±0.66）D、（0.63±0.44）D，SRK-T公式ME和MAE分别为（－0.60±0.59）D和（0.73±0.41）D；ARC组患者术后Haigis公式ME和MAE分别为（－0.18±0.74）D和（0.68±0.65）D；SRK-T公式ME和MAE分别为（－0.23±0.85）D和（0.75±0.69）D；各组间ME总体比较，差异有统计学意义（F组间＝5.093，P＝0.026），不同公式间ME和MAE总体比较差异无统计学意义（ME：F公式＝0.393，P＝0.532；MAE：F公式＝0.695，P＝0.406）。ARC＋IMEM组术后Haigis公式MAE≤0.25 D、≤0.5 D及≤1.0 D的患者比例与ARC组比较，差异均无统计学意义（均P〉0.05）。ARC＋IMEM组患者术后SRK-T公式MAE≤0.25 D的患者比例较ARC组明显升高，差异有统计学意义（χ2＝7.114，P＝0.007）。ARC＋IMEM组术后3个月黄斑中心凹厚度变化值为（－97.4±115.3）μm，与Haigis公式和SRK-T公式术后ME均呈正相关（r＝0.369，P＝0.045；r＝0.421，P＝0.021）。结论在参数未优化条件下，ARC＋IMEM患者Haigis公式计算IOL度数测量ME值略小于SRK-T公式。近视漂移程度可能与黄斑厚度的变化值相关。

ObjectiveTo evaluate the accuracy of intraocular lens （IOL） power calculation using IOL-Master in patients underwent phacoemulsification and vitrectomy for idiopathic macular epiretinal membrane （IMEM） concurrent with age-related cataract （ARC）. MethodsA prospective study was designed.A total of 32 patients （32 eyes） with ARC （ARC group） and 30 patients （30 eyes） with ARC and IMEM （ARC＋ IMEM group） were enrolled from March 2013 to July 2015 in the Hangzhou District of Eye Hospital of Wenzhou Medical University.All the surgeries were performed by the same experienced surgeon and the same IOL （Adapt-AO） was implanted.IOL power was calculated by both SRK-T and Haigis formulas.The central macular thickness was measured by OCT preoperatively and postoperatively.The mean postoperative refractive prediction error （ME）, mean absolute postoperative prediction error （MAE） and percentage of eyes achieved target refraction within ±0.25, ±0.50 and ±1.00 D were compared between the 2 groups.The correlation between the refractive error and macular thickness change was evaluated.ResultsThe ME and MAE calculated by Haigis were （-0.47±0.66）D and （0.63±0.44）D in ARC＋ IMEM group, and （-0.18±0.74）D and （0.68±0.65）D in ARC group.The ME and MAE calculated by SRK-T were （-0.60±0.59）D and （0.73±0.41）D in ARC＋ IMEM group, and （-0.23±0.85）D and （0.75±0.69）D in ARC group.No significant differences were found between the two groups in each formula （all at P〉0.05）. There was no significant difference of MAE distribution between the two groups in Haigis formula.In SRK-T formula, the percentage of MAE≤0.25 D in the ARC＋ IMEM group was significantly higher than that in the ARC group （χ2=7.114, P=0.007）. In the ARC＋ IMEM group, the change of the macular thickness was （-97.4±115.3）μm, which was statistically correlated with the ME of Haigis and SRK-T formulas （r=0.369, P=0.045; r=0.421, P=0.021）. ConclusionsThere is a tendency toward myopia shift in patients underwent phacoemulsification and vitrectomy compared with conventional phacoemulsification.The myopia shift shows a significant correlation with macular thickness changes.Haigis formula performs better than SRK-T formula with the condition of un-optimized parameters.