原发性闭角型青光眼白内障术后发生屈光漂移的分析

Refractive shift after cataract surgery in patients with primary angle-closure glaucoma

目的探讨原发性闭角型青光眼(PACG)患者行白内障超声乳化手术后屈光漂移产生相关的影响因素。方法选取2017年4月至2018年11月在我院行白内障超声乳化摘除联合人工晶状体植入手术的PACG患者31例(40只眼),正常眼轴白内障患者37例(48只眼)。利用IOL Master测量并预估两组术后屈光度,术后1 d、1周、2个月分别验光获得实际术后屈光度,实际术后屈光度与术前预估屈光度之间的差值,为屈光误差(RE),RE<0为近视漂移,RE>0为远视漂移。比较两组术后不同时间点的屈光误差绝对值(ARE)及术后2个月屈光漂移构成的差异。术前测量PACG患者的眼压、前房深度、晶状体厚度及眼轴长度,并分析以上参数与白内障术后2个月的ARE的相关性。结果术后1 d、1周、2个月PACG组的ARE均大于正常眼轴白内障组(均P<0.05),且术后2个月远视漂移发生率明显高于正常眼轴白内障组(P<0.05)。PACG白内障术后2个月的ARE与术前眼压、晶状体厚度呈正相关(r=0.758、0.615,均P<0.01),与前房深度、眼轴长度呈负相关(r=-0.832、-0.831,均P<0.01)。多元线性回归结果表明,ARE与眼压、前房深度、眼轴长度相关,Y=3.650+0.013 X 1-0.609 X 3-0.098 X 4(R 2=0.847,F=66.562,P<0.05)。结论PACG组白内障术后RE明显大于正常眼轴组,多为远视漂移,与术前高眼压、浅前房和短眼轴相关。

Objective To investigate factors affecting the refractive shift after phacoemulsification in patients with primary angle-closure glaucoma(PACG).Methods Thirty-one PACG patients(40 eyes)and 37 cataract patients with normal axial length(48 eyes)who underwent phacoemulsification in our hospital were enrolled from April 2017 to November 2018.IOL Master was used to measure and predict the postoperative refraction status.Postoperative refraction was measured at 1 day,1 week and 2 months postoperatively.Refractive error(RE)was calculated by subtracting preoperative refraction from the postoperative refraction.RE<0 was defined as myopia shift,while RE>0 was defined as hyperopia shift.The differences of absolute refractive error(ARE)and refractive shift at 2 months after the surgery between two groups were compared.Intraocular pressure(IOP),anterior chamber depth(ACD),lens thickness and axial length(AL)were measured preoperatively to analyze the correlation between these parameters and ARE at 2 months after the surgery.Results The ARE in the PACG group was significantly larger than the cataract group at all study visits(all with P<0.05).Rate of hyperopia shift at 2 month postoperatively was also higher in the PACG group(P<0.05).Preoperative IOP and lens thickness were positively correlated with ARE at 2 month postoperatively in the PACG group(r=0.758,r=0.615 respectively,P<0.05),while ACD and AL were negatively correlated with ARE(r=-0.832,r=-0.831 respectively,P<0.05).Multiple linear regression analysis showed that ARE was related to IOP,ACD and AL,the equation was Y(ARE)=3.650+0.013 X 1(IOP)-0.609 X 3(ACD)-0.098 X 4(AL)(R 2=0.847,F=66.562,P<0.05).Conclusions The refractive shift after phacoemulsification in the PACG group is mostly hyperopia shift,and is larger than the cataract group.High IOP,Shallow anterior chamber and short AL are risk factors of refractive shift for patients with PACG after phacoemulsification.