原发性闭角型青光眼合并年龄相关性白内障超声乳化术后屈光状态研究

Analysis of the refractive outcome after phacoemulsification in primary angle-closure glaucoma with age-related cataract

目的探讨原发性闭角型青光眼(PACG)合并年龄相关性白内障患者超声乳化白内障吸除联合人工晶状体植入(Phaco+IOL)术后屈光状态及其影响因素。方法选取2020年11月~2021年5月在华北理工大学附属医院行Phaco+IOL术的PACG合并年龄相关性白内障患者(PACG组)45例及年龄相关性白内障患者(单纯白内障组)47例。评估手术前后最佳矫正视力(BCVA)及视功能指数(VF-14)评分变化,测量眼轴长度(AL)、角膜曲率(K)、前房深度(ACD)及晶体拱高(LV),比较SRK/T、Hoffer Q及Holladay1三种不同公式平均绝对屈光误差值(MAE)的差异,并分析PACG组绝对屈光误差值(AE)与生物学参数的相关性。结果两组患者BCVA及VF-14评分较术前均明显提高,差异有统计学意义(P<0.05)。两组患者AL、ACD、LV比较,差异均有统计学意义(P<0.05),两组患者K比较,差异无统计学意义(P>0.05)。PACG组MAE大于单纯白内障组,差异有统计学意义(P<0.05)。单纯白内障组各公式MAE及MAE在0.50D误差范围内的百分比的差异均无统计学意义(P>0.05),而PACG组中Hoffer Q公式准确性最高。PACG组AE与AL、ACD呈负相关,AE与LV呈正相关,AE与K无明显相关性。结论PACG合并年龄相关性白内障患者Phaco+IOL术后更易发生屈光误差,与其术前较大晶体拱高、浅前房、短眼轴相关。在计算PACG合并年龄相关性白内障患者人工晶状体(IOL)屈光度时,Hoffer Q公式的准确性较高。

ObjectiveTo investigate the refractive outcome and its influencing factors of patients with primary angle-closure glaucoma(PACG)with age-related cataract after phacoemulsification combined with intraocular lens implantation(Phaco+IOL).MethodsPatients who were diagnosed as PACG with age-related cataract(the PACG group)underwent Phaco+IOL(n=45)and age-related cataract(the simple cataract group)(n=47)at the Affiliated Hospital of North China University of Science and Technology from November 2020 to May 2021 were enrolled.This study evaluated the changes of best corrected visual acuity(BCVA)and the score of visual function index-14(VF-14)before and after surgery.Axial length(AL),corneal curvature(K),anterior chamber depth(ACD),and lens vault(LV)were measured.Comparing the difference in mean absolute error(MAE)of SRK/T,Hoffer Q and Holladay1 formulas.The correlation between the biological parameters of the eye and absolute refractive error(AE)in the PACG group was analyzed.Results The level of BCVA and the scores of VF-14 after surgery were significantly better than before surgery in two groups(P<0.05).There were statistically significant difference in AL,ACD and LV in two groups(P<0.05),and no statistically significant difference in K(P>0.05).The MAE in the PACG group was significantly larger than the MAE in the simple cataract(all P<0.05).There were no significant difference in MAE and the percentage of MAE within 0.50 D among three formulas in the simple cataract group(P>0.05).In the PACG group,the Hoffer Q formula has the highest accuracy among the formulas.AE was negatively correlated with AL and ACD in the PACG group and AE was positively correlated with LV.There was no significant correlation between AE and K.ConclusionPatients with PACG with age-related cataract are more likely to have refractive error than patients with age-related cataract after Phaco+IOL,which is related to their preoperative larger lens vault,shallower anterior chamber depth,shorter axial length.The Hoffer Q formula has the highest accuracy among the formulas in calculating intraocular lens(IOL)power in patients with PACG with age-related cataract.