高度近视白内障双眼术后视功能和生存质量早期变化

Analysis of Changes of Visual Function and Quality of Life after the Delayed Sequential Bilateral Cataract Surgery in the Early Postoperative Period for High Myopia Patients

目的:比较高度近视白内障患者第1眼和第2眼手术前后早期视功能和生存质量的变化,为短期内第2眼手术的意义提供一定的依据。方法:前瞻性临床研究。收集2019年6月至2020年6月于西安市人民医院(西安市第四医院)白内障中心手术的高度近视白内障患者48例(96眼),患者眼轴长度≥27.0 mm,近视屈光度<-6.0 D。视力较差眼先手术,间隔2~4周行第2眼手术。观察术前、术后1周及术后3个月的裸眼视力(UCVA)和最佳矫正视力(BCVA);采用主观视功能(VF)和生存质量(QOL)问卷调查量表评估手术前后VF和QOL变化;采用双通道视觉质量分析系统(OQAS-II)比较术前和术后的客观散射指数值(OSI)以及调制传递函数截止频率(MTF cutoff)。采用独立样本t检验比较第1眼和第2眼各数据间的差异。结果:第1眼术后1周BCVA(LogMAR)为0.20±0.35,等效球镜度(SE)为(-2.42±0.84)D,第2眼BCVA(LogMAR)为0.57±0.29,SE为(-19.30±4.65)D;VF问卷调查显示第1眼术后1周患者主观视觉质量、周边视野、视觉适应及立体视功能均较术前明显提高(t=-16.16、-18.65、-9.79、-9.94,均P<0.001);第2眼术后1周这4项功能均较第1眼术后1周进一步提高(t=-34.32、-14.87、-15.95、-21.36,均P<0.001);双眼术后3个月与第2眼术后1周仅周边视野和立体视功能进一步提高(t=-2.27,P=0.030;t=2.37,P=0.020)。QOL问卷显示第1眼术后1周患者在自理能力、活动能力、社交能力及心理状况量表分值均较术前明显提高(t=-31.52、-21.79、-19.68、-14.16,均P<0.001);第2眼术后1周心理状况量表分值较第1眼术后明显提高(t=-12.50,P<0.001)。OQAS-II检查显示第1眼和第2眼术后1周和3个月OSI均较其术前明显降低(t=17.15、-19.54、9.61、10.18,均P<0.001),MTF cutoff均较术前提高(t=10.58、-11.65、-8.23、-9.15,均P<0.001)。结论:高度近视白内障患者第1眼手术可明显改善患者的生存质量,第2眼手术可进一步改善视功能并提升心理健康状况。

Objective:To analyze the changes of visual function and quality of life in the first eyes versus the second eyes with high myopia before and after cataract surgery,to provide a theoretical basis for cataract surgery for the second eyes with good vision.Methods:In this prospective clinical study,48 bilateral highly myopic patients(axial length≥27.0 mm,myopia exceeding-6.00 diopters)who underwent uneventful sequential cataract surgery(the eyes with worse visual acuity operated first)in Xi'an People's Hospital(Xi'an Fourth Hospital)from June 2019 to June 2020 were collected,the time interval between the first eyes and second eyes was 2-4 weeks.The visual acuity,visual function(VF)and quality of life(QOL)questionnaire was completed before the surgery,1 week and 3 months after surgery,respectively.Objective scattering index(OSI)and modulation transfer function cutoff frequency(MTF cutoff)were compared by double-pass optical quality analysis system(OQAS-II)at each time point.Differences in the parameters were compared between the first and second eyes using independent t test.Results:The first eyes'postoperative BCVA logMAR was 0.20±0.35,the spherical equivalent(SE)was-2.42±0.84 D and the second eyes preoperative SE was-19.30±4.65 D,BCVA logMAR was 0.57±0.29.VF questionnaire showed that the subjective visual quality,peripheral visual field,visual adaptation and stereoscopic function scores were significantly improved after the first eyes'surgery(t=-16.16,-18.65,-9.79,-9.94,all P<0.001),and these four functions were further improved after the second eyes'surgery(t=-34.32,-14.87,-15.95,-21.36,all P<0.001),the peripheral visual field and stereopsis function were further improved after 3 months of the surgery for both eyes compared with 1 week after surgery of the second eyes(t=-2.27,P=0.030;t=2.37,P=0.020).QOL questionnaire showed that the patients'scores of self-care ability,activity ability,social ability and psychological status scale were significantly improved after the first-eye surgery compared with those before surgery(t=-31.52,-21.79,-19.68,-14.16,all P<0.001).Only the score of psychological status was improved significantly after the second-eyes cataract surgery compared with that after the first-eyes'surgery(t=-12.50,P<0.001).OQAS-II showed that the OSI values of the first and the second eyes were significantly lower at 1 week and 3 months postoperatively when compared with the preoperative values(t=17.15,-19.54,9.61,10.18,all P<0.001)and MTF cutoff value was significantly higher than that before surgery at 1 week and 3 months postoperatively(t=10.58,-11.65,-8.23,-9.15,all P<0.001).Conclusions:Cataract surgery of the first eyes can significantly improve the quality of life for the patients with high myopia,while second eyes surgery may significantly further improve visual function and quality of life especially the psychological status for cataract patients with high myopia.