玻璃体切除术对晶状体悬韧带及前房深度的影响分析

Influence of pars plana vitrectomy on the length of lens zonules and anterior chamber depth

目的:定量分析玻璃体切除手术(pars plana vitrectomy,PPV)对晶状体悬韧带及前房深度(anterior chamber depth,ACD)的影响。方法:回顾性分析拟行白内障摘除术患者87例88眼的术前资料,根据有无PPV手术史分为研究组(有PPV手术史,43例44眼)和对照组(无PPV手术史,44例44眼)。采用全景超声生物显微镜(ultrasonic biomicroscopy,UBM)测量晶状体悬韧带,眼科光学生物测量仪(IOL Master)测量ACD,比较两组患者晶状体悬韧带和ACD的差异及二者的相关性。结果:研究组和对照组患者的平均悬韧带长度分别为1.09±0.24mm和0.78±0.22mm,ACD分别为3.25±0.39mm和3.44±0.48mm,差异均有统计学意义(P<0.05)。对照组平均悬韧带长度与ACD呈正相关(r=0.468,P=0.001),研究组平均悬韧带长度与ACD无明显线性相关关系(r=0.173,P=0.263)。结论:PPV术可使晶状体悬韧带长度增加,在眼轴长度(axial length,AL)<29mm的患者中尤为明显,且PPV术后晚期,ACD改变与悬韧带变化并不相符,故白内障术前应充分了解悬韧带及前房情况,以避免或减少相关手术并发症,提高手术的安全性和有效性。

AIM： To quantitatively assess the influence of pars plana vitrectomy（PPV）on the length of lens zonules and anterior chamber depth（ACD）. METHODS： The medical records of 87 cataract patients（88 eyes）were retrospectively reviewed. Forty-three patients（44 eyes）with previous PPV were included in the study group, and 44 patients（44 eyes）without a history of PPV were served as control group. Length of zonules and anterior chamber depth（ACD）were quantitative analyzed based on the data from ultrasonic biomicroscopy（UBM）and IOL Master examinations respectively. RESULTS： The average length of zonules in study and control group were 1.09±0.24mm and 0.78±0.22mm, respectively, and the difference was statistically significant（P〈0.05）. The ACD of the two groups were 3.25±0.39mm and 3.44±0.48mm, respectively, and a statistical difference was observed（P〈0.05）. The length of zonules in the control group was positively correlated with the ACD（r=0.468, P=0.001）, however, this was not the case in the study group（r=0.173, P=0.263）. CONCLUSION： Previous vitrectomy may cause changes in zonular length, which may imply a possibly weakened zonules, especially for patients with the axial length less than 29mm. The change in anterior chamber depth in patients with previous PPV may not be correspondent to that in the length of zonules. The findings of our study suggest that preoperative conditions of zonules and anterior chamber should be fully understood to reduce the related complications and to improve the safety and efficiency of cataract surgery after pars plana vitrectomy.