光学相干断层扫描(OCT)在视网膜色素变性患者白内障手术视力预后判断中的应用

Effects of optical coherence tomography on the visual outcomes of cataract surgery in patients with retinitis pigmentosa

目的利用光学相干断层扫描(optical coherence tomography,OCT)判断视网膜色素变性(retinitis pigmentosa,RP)患者白内障手术后视力预后情况。方法回顾性分析16例(24眼)RP合并白内障患者行白内障超声乳化吸出联合人工晶状体植入术的临床结果。观察患者术前合并黄斑病变和术后发生后囊膜混浊情况,分析白内障手术前后最佳矫正视力(best corrected visual acuity,BCVA)的变化和相关性。根据OCT的椭圆体带(ellipsoidal zone,EZ)结构完整性将RP患者分为EZ结构完全缺失组(Grade1组)、EZ结构异常或部分缺失组(Grade2组)和EZ结构基本正常组(Grade3组),观察各组术后BVCA。结果术前有11眼RP患者合并有黄斑病变,其中黄斑囊样水肿2眼、黄斑前膜5眼、玻璃体黄斑牵拉4眼;术后发生后囊膜混浊5眼。患者术前及术后1周、1个月、3个月BCVA分别为(1.529±0.535)logMAR、(1.232±0.656)logMAR、(1.056±0.498)logMAR、(1.013±0.565)logMAR,术后最终BCVA较术前BCVA显著提高(t=3.252,P=0.002),其中19眼术后视力得到提高。术前BCVA与术后最终BCVA显著相关(r=0.683,P<0.01)。Grade1组、Grade2组、Grade3组术后最终BCVA分别为(1.331±0.545)logMAR、(0.617±0.256)logMAR、(0.660±0.378)logMAR,Grade2组和Grade3组术后最终视力均好于Grade1组(F=6.764,P=0.005),Grade2组和Grade3组术后BCVA差异无统计学意义(P=0.878)。结论大部分RP合并白内障患者在白内障手术后视力可得到改善,OCT可以判断RP患者白内障手术后视力预后,尤其是EZ结构完整性。

Objective To evaluate the visual outcomes of patients with retinitis pigmentosa(RP)after cataract surgery using optical coherence tomography(OCT).Methods The clinical results of 16 patients(24 eyes)with RP in complicated with cataract after phacoemulsification combined with intraocular lens implantation were retrospectively analyzed.The prevalence of preoperative macular degeneration and postoperative capsule complications were observed,and the changes and correlations of logMAR best corrected visual acuity(BCVA)before and after cataract surgery were analyzed.According to the structural integrity of the ellipsoidal zone(EZ),patients were divided into three groups:Grade1 group,in which EZ was completely missing,Grade2 group,in which EZ was abnormalities or partially missing and Grade3 group,in which EZ is basic normal,and then the BVCA after surgery was observed in the 3 groups.Results Among the RP patients,11 eyes had macular complications before surgery,in which 2 eyes had cystoid macular edema,5 eyes had epiretinal membrane,and 4 eyes had vitreomacular traction.Postoperative posterior capsular opacity occurred in 5 eyes.The BCVA were(1.529±0.535)logMAR,(1.232±0.656)logMAR,(1.056±0.498)logMAR and(1.013±0.565)logMAR,respectively,before surgery,1 week,1 month and 3 months after surgery.Postoperative final BCVA was higher than the preoperative BCVA(t=3.252,P=0.002),and 19 eyes got visual acuity improved.Preoperative BCVA was significantly correlated with postoperative final BCVA(r=0.683,P<0.01).The postoperative final BCVA of Grade1 group,Grade2 group and Grade3 group were(1.331±0.545)logMAR,(0.617±0.256)logMAR,(0.660±0.378)logMAR.Grade2 group and Grade3 group had better visual acuity than Grade1 group(F=6.764,P=0.005),and there was no statistically significant difference in BCVA between Grade2 group and Grade3 group(P=0.878).Conclusion The visual acuity of most RP patients with cataract can improve after cataract surgery,and OCT can be used to evaluate the visual prognosis of RP patients after cataract surgery,especially the structural integrity of EZ.