视网膜色素变性合并白内障患者白内障摘出术后视功能评估

Visual outcomes of cataractous eyes with retinitis pigmentosa following cataract surgery

目的评估视网膜色素变性(RP)合并白内障患者行白内障手术后的视功能变化。方法采用系列病例观察研究方法,纳入2011年1月至2015年12月于汕头大学·香港中文大学联合汕头国际眼科中心行白内障超声乳化摘出联合后房型人工晶状体植入术的RP合并白内障患者67例111眼,采用国际标准视力表检测白内障患者术前、术后最佳矫正视力(BCVA),并将小数视力转换为最小分辨角对数视力(LogMAR)。根据光感受器内节椭圆体带(ISe)完整性将术前行光相干断层扫描(OCT)检查的19眼分为Ⅰ、Ⅱ和Ⅲ级,分析各等级ISe完整性与手术后BCVA的相关性。结果术后73.9%(82/111)的患眼视力较术前提高,26.1%(29/111)的患眼无明显变化,未见视力较术前下降者。术后患眼BCVA为0.40(0.22,0.70)LogMAR,较术前的0.82(0.60,1.40)LogMAR明显提高,差异有统计学意义(Z=-8.76,P<0.01)。术前视力>0.52 LogMAR的患眼占79.3%(88/111),术后降至38.7%(43/111);术前视力>1.3 LogMAR的患眼占28.8%(32/111),术后降至4.5%(5/111),差异均有统计学意义(χ^(2)=37.711、23.643,均P<0.01)。黄斑区ISe完整性分级与术后BCVA呈显著正相关(rs=0.959,P<0.01)。结论RP合并白内障患者行白内障超声乳化联合人工晶状体植入术可提高患者视力,ISe的完整性与术后BCVA相关。

Objective To evaluate the visual outcomes of cataract surgery in patients with retinitis pigmentosa(RP).Methods A serial case-observational study was conducted.One hundred and eleven eyes of 67 patients with RP and cataract who received phacoemulsification with posterior chamber intraocular lens implantation in Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong from January 2011 to December 2015 were included.Best corrected visual acuity(BCVA)was examined using standard visual chart before and after surgery and converted to logarithm of the minimal angle of resolution(LogMAR)units.Optical coherence tomography was employed to examine the retinas in 19 eyes before surgery and the eyes were graded into gradeⅠ,ⅡandⅢaccording to the integrity of inner segment ellipsoid zone(ISe).The correlation between the grading of ISe and postoperative BCVA was analyzed.This study complied with the Declaration of Helsinki,and study protocol was approved by an Ethics Committee of Joint Shantou International Eye Center(No.EC20170310(2)-P03).Written informed consent was obtained from each patient before operation.Results The vision was improved in 82 eyes(73.9%)and not obviously changed in 29 eyes(26.1%)after surgery.The median BCVA was improved from preoperative 0.82(0.60,1.40)LogMAR to postoperative 0.40(0.22,0.70)LogMAR,showing a significant difference between pre-operation and post-operation(Z=-8.76,P<0.01).The proportion of eyes with BCVA more than 0.52 LogMAR was significantly reduced from preoperative 79.3%(88/111)to postoperative 38.7%(43/111),and the proportion of eyes with BCVA more than 1.3 LogMAR was significantly reduced from preoperative 28.8%(32/111)to postoperative 4.5%(5/111)(χ^(2)=37.711,23.643;both at P<0.01).A positive correlation was found between the grading of ISe integrity and postoperative BCVA(rS=0.959,P<0.01).Conclusions Phacoemulsification with posterior chamber IOL implantation can improve the BCVA of RP patients.The integrity of the ISe can predict the postoperative BCVA in RP patients with cataract.