西北地区眼科单中心1009例单眼盲患者致盲病因和手术疗效分析

Causes of blindness and surgical efficacy of 1009 patients with monocular blindness in northwest China:a ophthalmic single-center study

目的分析我国西北地区眼科单中心行白内障手术的单眼盲患者致盲病因和手术效果,为提高防治提供参考。方法回顾性系列病例研究。纳入2016年7月至2020年11月陕西省眼科医院(西安市第四医院)收治的对侧眼行白内障手术的单眼盲(单眼裸眼视力<0.05)患者1009例。采用χ2检验及logistic回归分析对患者致盲病因和白内障手术效果进行分析。结果1009例单眼盲患者中,男465例(46.1%),女544例(53.9%),年龄(67.7±11.9)岁。前6种致盲病因分别为青光眼29.7%(300例)、视网膜脱离15.3%(154例)、眼外伤14.4%(145例)、角膜病6.4%(65例)、高度近视6.1%(62例)、白内障5.7%(58例)。对侧眼手术前、后视力完整者989例,术后视力提高者占90.2%(892例),未提高者占9.8%(97例);386例单纯白内障患者术后视力均提高,余603例术后视力提高者与未提高者间差异具有统计学意义的相关因素为眼部合并其他疾病及其治疗史(均为P<0.05),进行logistic回归分析后,有意义的独立因素包括青光眼和眼部合并其他疾病治疗史(均为P<0.05),其中眼部合并其他疾病治疗史回归系数为-2.016,影响最大。结论青光眼是我国西北地区行白内障手术的单眼盲患者中最常见的致盲病因,且女性多见。单眼盲对侧眼单纯白内障患者在无禁忌证时应尽早行白内障手术。眼部合并疾病尤其青光眼的及时诊治对白内障手术有积极作用。

Objective To analyze the causes of blindness and the surgical efficacy of cataract surgery in patients with monocular blindness of northwestern China based on a ophthalmic single-center study,thus providing references for improving the prevention and therapeutic efficacy.Methods This was a retrospective study involving 1009 patients with monocular blindness(monocular uncorrected vision<0.05)who received cataract surgery of the fellow eyes in Shaanxi Eye Hospital(Xi’an Fourth Hospital)from July 2016 to November 2020.Chi-square test and logistic regression were used to analyze the causes of blindness and the surgical efficacy of cataract surgery.Results Among 1009 patients with monocular blindness,there were 465(46.1%)male cases and 544(53.9%)females,with an average age of(67.7±11.9)years.The top 6 cases of blindness were glaucoma(300 cases,29.7%),retinal detachment(154 cases,15.3%),ocular trauma(145 cases,14.4%),corneal disease(65 cases,6.4%),high myopia(62 cases,6.1%),and cataracts(58 cases,5.7%).There were 989 cases with complete vision of the contralateral eye before and after surgery,and among them,90.2%(892 cases)of them had improved vision after surgery,and 9.8%(97 cases)did not have any improvement.The visual acuity was improved in 386 cases after simple cataract.In the remaining 603 cases and those without improvement of vision,there were significant difference in ocular complication and treatment history(P<0.05).logistic regression analysis revealed that glaucoma and treatment history were independent factors influencing the postoperative vision improvement,and notably,treatment history of combined ocular disease had the most significant influence(regression coefficient=-2.016).Conclusion Glaucoma is the most common cause of blindness among monocular blind patients undergoing cataract surgery in the Northwest of China,which more frequently affects women.Patients with single blindness and simple cataract in the contralateral eye should undergo cataract surgery as soon as possible if there are no contraindications.The timely diagnosis and treatment of combined ocular diseases,especially glaucoma,have positive effects on the therapeutic efficacy of cataract surgery.