白内障术眼低视力原因分析

Analysis of causes of low vision after cataract surgery

目的:探索白内障术眼低视力的原因。方法:对2011年10月至2013年3月在汕头国际眼科中心行白内障手术,术前无法窥清眼底,术后1周最佳矫正视力<0.3的患者进行视力、最佳矫正视力、眼压测量、裂隙灯检查、眼底镜检查、眼底照相及光学相干断层扫描(optical coherence tomography,OCT),若未发现任何视网膜器质性病变,再进行视觉诱发电位检查及视野检查。由2位医生对检查结果进行分析,对不同的眼底病变做出诊断,统计分析白内障术眼低视力的原因。结果:共纳入行白内障手术患者5 608例,术后1周最佳矫正视力<0.3的患者共49例(共49眼),其中男20例,女29例,右眼31只,左眼18只,年龄(69.11±12.05)岁。白内障术后低视力比例为0.87%。其中高度近视性脉络膜视网膜病变12例(24.5%),椭圆体带连续性破坏10例(20.4%),糖尿病性视网膜病变8例(16.3%),黄斑孔5例(10.2%),老年性黄斑变性4例(8.1%),黄斑前膜3例(6.1%),黄斑区视网膜厚度变薄1例(2.0%),视网膜色素变性1例(2.0%),视网膜劈裂症1例(2.0%),视网膜分支动脉阻塞1例(2.0%),白塞氏病1例(2.0%),缺血性视神经病变1例(2.0%),视网膜前膜1例(2.0%)。结论:在本组白内障术眼低视力的患者中,高度近视性脉络膜视网膜病变占主要部分,为24.5%,其次分别为椭圆体带连续性破坏、糖尿病性视网膜病变、黄斑孔、老年性黄斑变性和黄斑前膜。利用OCT可发现影响白内障术后视力的细微视网膜结构变化,对于白内障术前眼底可见的患者常规行OCT有利于判断手术预后,便于医患沟通,提高手术满意度。

Objective:To explore the causes of low vision after cataract surgery.Methods:Patients who underwent cataract surgery at Joint Shantou International Eye Center of Shantou University and the Chinese university of Hong Kong(JSIEC)from October 2011 to March 2013,whose fundus status could not be seen before surgery,and the best corrected visual acuity<0.3 in the first week after surgery,underwent a series of detailed ocular examinations,including visual acuity,best corrected visual acuity,intraocular pressure,slit-lamp examination,fundus examination,fundus photography and optical coherence tomography.If no organic lesions of the retina were found,then visual evoked potential examination and visual field examination were performed.Two doctors analyzed the examination results of the examination,made the diagnosis of different fundus diseases,and statistically analyzed the causes of low vision after cataract surgery.Results:A total of 5608 cataract surgeries were performed in our hospital from October 2011 to March 2013.A total of 49 patients(49 eyes)with best corrected visual acuity worse than 0.3 within postoperative 1 week 20 male and 29 female,31 right eyes and 18 left eyes,aged(69.11±12.05)years on average.The proportion of low vision after cataract surgery was 0.87%.12 cases(24.5%)of high myopic chorioretinopathy,10 cases(20.4%)of ellipsoidal band defect,8 cases(16.3%)of diabetic retinopathy,5 cases(10.2%)of macular holes,4 cases(8.1%)of age-related macular degeneration,3 cases(6.1%)of macular epiretinal membrane,1 case(2.0%)of thinning macular retinal thickness,1 case(2.0%)of retinitis pigmentosa,1 case of retinoschisis(2.0%),1 case of branch retinal artery occlusion(2.0%),1 case of Behcet’s disease(2.0%),and 1 case of ischemic optic neuropathy(2.0%),1 case of epiretinal membrane(2.0%).Conclusion:Among patients with low vision after cataract surgery,high myopic chorioretinopathy accounts for 24.5%,followed by ellipsoidal band defect,diabetic retinopathy,macular hole,age-related macular degeneration,and macular epiretinal membrane.The use of optical coherence tomography can detect subtle microscopic retinal structural changes that affect vision after cataract surgery.For patients with visible fundus before cataract surgery,routine optical coherence tomography contributes to evaluating the prognosis of the operation,facilitating doctorpatient communication,and improving the degree of surgical satisfaction.