不同时机人工晶状体植入术治疗外伤性白内障的疗效及术后视力相关分析

Efficacy of intraocular lens implantation at different times for traumatic cataract and correlation analysis of postoperativevisual acuity

目的探讨不同时机人工晶状体(IOL)植入术治疗外伤性白内障的疗效及术后视力相关分析。方法回顾性病例对照研究。选取河南中医药大学第五临床医学院2019年8月至2021年6月诊治的外伤性白内障104例(104眼)作为研究对象, 入选患者在符合手术适应证的前提下采用1∶1配对的方式分为Ⅰ期组(予以IOL Ⅰ期植入术)和Ⅱ期组(予以IOL Ⅱ期植入术), 每组各52例(52眼), 对比手术时间、术中出血量、住院时间、视力优良率;并根据术后6个月视力恢复情况分为视力恢复良好组(n=81)与视力恢复不良组(n=23), 采用二元Logistic回归分析影响视力恢复的危险因素。结果Ⅰ期组与Ⅱ期组的手术时间、术中出血量、住院时间相比, 差异均无统计学意义(均P>0.05)。术后, 两组视力优良率比较, 差异无统计学意义(P>0.05)。视力恢复不良组与良好组在性别、年龄、术前视力、就诊时间、损伤原因等基线资料比较中, 差异均无统计学意义(均P>0.05);而在角膜瘢痕、散光、后囊浑浊、人工晶状体前膜形成、角膜水肿、虹膜睫状体炎等资料比较中, 差异均具有统计学意义(均P<0.05)。二元logistic回归分析显示, 角膜瘢痕位于瞳孔区和伴有散光、后囊浑浊、人工晶状体前膜形成、角膜水肿、虹膜睫状体炎是影响外伤性白内障患者术后视力恢复的独立危险因素(P<0.05)。结论 IOL Ⅰ期与Ⅱ期植入术治疗外伤性白内障在视力改善方面疗效相当, 但Ⅱ期植入术后并发症更低;且角膜瘢痕位置、伴有散光、后囊浑浊、人工晶状体前膜形成、角膜水肿、虹膜睫状体炎是外伤性白内障患者术后视力恢复的影响因素。

bjectiveTo investigate the efficacy of intraocular lens(IOL)implantation at different times in the treatment of traumatic cataract and the correlation analysis of postoperative visual acuity.MethodsThis was a retrospective case-control study.A total of 104 eyes of 104 patients with traumatic cataract diagnosed treated from Aug.2019 to Jun.2021 in the Fifth Clinical Medical College of Henan University of Traditional Chinese Medicine were selected as the research objects.The patients were divided into stage I group(treated with IOL implantation at stage I)and stage II group(treated with IOL implantation at stage II)by 1:1 matching method on the basis of the surgical indications,with 52 eyes of 52 cases in each group.The operation time,intraoperative blood loss,hospitalization time,excellent and good rate of visual acuity were compared.The patients were divided into good visual acuity group(n=81)and poor visual acuity group(n=23)based on visual acuity recovery at 6 months after operation.Binary logistic regression was used to analyze the risk factors affecting visual acuity recovery.Results Therewereno significant dfferences in operation time,intraoperative blood loss and hospital stay between stage I group and stage II group(all P>0.05).After operation,there was no significant difference in the excellent and good rate of visual acuity between the two groups(P>0.05).There was no significant dfference between the poor visual acuity group and the good group in gender,age,preoperative visual acuity,visiting time,injury cause and other baseline data(all P>0.05).There were significant diferences in corneal scarring,astigmatism,posterior capsule opacification,intraocular lens anterior membrane formation,corneal edema and iridocyclitis between poor and good visual acuity recovery groups(all P<0.05).There were statistically significant differences in the data of the formation of intraocular lens anterior membrane formation,corneal edema,and iridocyclitis(all P<0.05).Binary logistic regression analysis showed that corneal scars located in the pupil area and associated with astigmatism,posterior capsular opacity,intraocular lens anterior membrane formation,corneal edema,and iridocyclitis were independent risk factors for postoperative visual acuity in patients with traumatic cataract(P<0.05).Conclusion IOL implantation at stage I and stage II for traumatic cataract have similar efficacy in visual improvement,but the complications after stage Il implantation are lower.Corneal scar location,astigmatism,posterior capsule opacity,intraocular lens anterior membrane formation,corneal edema,iridocyclitis are the influencing factors of visual recovery in patients with traumatic cataract.