特发性黄斑裂孔手术后屈光状态临床观察

Clinical observation of refractive outcome after surgery of idiopathic macular hole

目的观察特发性黄斑裂孔(IMH)患眼玻璃体切割联合白内障超声乳化IOL植入手术(联合手术)后屈光状态的变化。方法回顾性临床研究。2016年1月至2019年6月于天津医科大学眼科医院行联合手术的IMH患者51例56只眼纳入研究。其中,男性17例,女性34例;平均年龄(66.79±4.33)岁。所有患眼均行BCVA、检影验光以及眼轴长度(AL)测量。根据SRK-T公式计算IOL度数,预测屈光度(预测值)。患眼平均BCVA为0.20±0.13;平均前房深度为(2.89±0.28)mm;平均△角膜散光度(0.73±0.43)D;平均AL为(22.92±0.70)mm;平均屈光度预测值为(0.10±0.66)D。所有患眼均行标准经睫状体平坦部三通道25G联合手术。手术后6个月,采用与手术前相同的设备和方法测量手术后屈光度实际值(实际值)。预测值与实际值差异比较采用配对t检验。结果手术后6个月,患眼平均屈光度实际值为(-0.19±0.64)D;与手术前屈光度预测值比较,差异无统计学意义(t=1.665,P=0.102);实际值与预测值差值为(-0.33±0.81)D。结论IMH患眼联合手术后屈光状态发生近视漂移;手术前IOL度数预算时可适当预留+0.3 D左右远视。

Objective To observe the changes in refractive status of eyes with idiopathic macular hole (IMH) after vitrectomy and phacoemulsification and IOL implantation (combined surgery).Methods A retrospective clinical study. From January 2016 to June 2019, 51patients (56 eyes) of IMH who underwent combined surgery at the Tianjin Medical University Eye Hospital. were included in the study. Among them, there were 17 males and 34 females with the average age of 66.79±4.33 years. All the affected eyes underwent BCVA, retinoscopy and axial length (AL) measurement. The IOL power was calculated according to the SRK-T formula and the refractive power (predicted value) was predicted. The average BCVA of the affected eye was 0.20±0.13. The average anterior chamber depth was 2.89±0.28 mm. The average △corneal astigmatism was 0.73±0.43 D, the average AL was 22.92±0.70 mm, the average predicted refractive power was 0.10±0.66 D. All the affected eyes underwent standard transciliary flat part three-channel 25G combined surgery. Six months after the operation, the actual value (actual value) of the diopter after the operation was measured with the same equipment and method before the operation. Paired t test was used to compare the difference between the predicted value and the actual value.Results Six months after the operation, the actual value of the refractive power was -0.19±0.64 D. Compared with the pre-operative refractive power, the difference was not statistically significant (t=1.665, P=0.102). The difference between the actual value and the predicted value was -0.33± 0.81 D.Conclusions The refractive status of the IMH eye undergoes myopia drift after combined surgery. The preoperative IOL power budget can be appropriately reserved for +0.3 D hyperopia.