超声乳化白内障吸除术对高度近视黄斑劈裂进展影响的临床观察

Clinical observation of the effect of phacoemulsification on the progression of myopic foveoschisis in high myopia

目的:评估白内障手术是否影响高度近视黄斑劈裂的进展,为高度近视黄斑劈裂合并白内障患者先行白内障手术改善视觉质量可行性提供依据。方法:选取2018年4月至2021年1月在上海市第十人民医院眼科确诊为高度近视黄斑劈裂患者共36例36眼纳入研究。根据是否行白内障手术分为实验组:男10例10眼,女8例8眼;对照组:男9例9眼,女9例9眼。比较两组初诊及1个月、3个月、6个月、12个月后黄斑中心区视网膜厚度(central subfield thickness,CST)、黄斑区视网膜容积(macular volume,MV)、视网膜平均厚度(average macular thickness,AMT)、最佳矫正视力(best corrected visual acuity,BCVA)、黄斑劈裂形态学进展率情况。结果:两组CST、MV、AMT时间和组别交互效应差异无统计学意义(F=0.825,P=0.370;F=1.266,P=0.268;F=0.612,P=0.657),两组间差异无统计学意义(F=2.519,P=0.122;F=3.318,P=0.077;F=1.378,P=0.249)。两组BCVA时间和组别交互效应差异有统计学意义(P<0.001);做简单效应分析实验组术后1、3、6及12个月BCVA较初诊差异均有统计学意义(均P<0.001);两组1、3、6、12个月BCVA较初诊BCVA的增量差异均有统计学意义(均P<0.001)。两组黄斑劈裂形态进展率差异无统计学意义(P=1.0)。结论:白内障超声乳化吸除术在短期内不影响高度近视黄斑劈裂的进展,且可以提高高度近视黄斑劈裂合并白内障患者的视力。

Objective:To assess whether cataract surgery can affect the progression of myopic foveoschisis,so as to provide evidence for the feasibility of cataract surgery to improve visual quality in patients with myopia foveoschisis accompanied by cataract.Methods:A total of 36 patients(36 eyes) diagnosed with high myopia foveoschisis at the Department of Ophthalmology,Shanghai Tenth People’s Hospital from April 2018 to January 2021 were enrolled in the study.The patients were divided into an experimental group(10 males with 10 eyes,and 8 females with 8 eyes) and an observation group(9 males with 9 eyes,and 9 females with 9 eyes) according to whether cataract surgery was performed.The central subfield thickness(CST),macular volume(MV),average macular thickness(AMT),best corrected visual acuity(BCVA),and the progression rate of foveoschis morphology were compared between the two groups at the initial diagnosis and 1 month,3 months,6 months,and12 months after the surgery.Results:In terms of CST,MV,and AMT in the central macular area,no significant difference was found between the two groups(F=2.519,P=0.122;F=3.318,P=0.077;F=1.378,P=0.249),and there was no significant difference in time and group interaction effects between the two groups(F=0.825,P=0.370;F=1.266,P=0.268;F=0.612,P=0.657).In terms of BCVA,there was significant difference in time and group interaction effects between the two groups(P<0.001).The simple effect analysis showed that,compared with initial diagnosis,the BCVA in the experimental group was statistically significant at 1,3,6 and 12 months after the surgery(all P<0.001).In addition,there was a significant difference in the increments of BCVA between the two groups at 1,3,6,and 12 months after the surgery when compared with the initial diagnosis(all P<0.001).However,there was no significant difference in the morphological progression between the two groups(P=1.0).Conclusion:Phacoemulsification will not affect the progression of myopic foveoschisis in a short period,and can improve the vision of patients with myopic foveoschisis accompanied by cataract.