折叠式人工晶状体睫状体平坦部缝线固定术后患者屈光状态的研究

Study on the refractive state of patients after pars plana suture fixation of foldable intraocular lens

目的研究折叠式人工晶状体睫状体平坦部缝线固定术后患者的屈光状态。方法回顾性病例对照研究。纳入2019年1月至2022年3月于山西省眼科医院行折叠式人工晶状体经巩膜缝线固定术的患者75例(75只眼)。根据手术固定部位将其分为两组:A组30例(30只眼)行折叠式人工晶状体睫状沟缝线固定术;B组45例(45只眼)行折叠式人工晶状体睫状体平坦部缝线固定术。术后随访3~12个月, 观察患者裸眼视力(UCVA, logMAR)、眼压、散光度、前房深度(ACD)、术后并发症及IOL位置。分析术眼实际屈光度数与预留屈光度数间的差异(即屈光误差)。结果所有患者折叠式人工晶状体巩膜缝线固定术后出现近视漂移, A组术后屈光误差-0.64(-0.93, -0.24)D, B组术后屈光误差-0.30(-0.49, 0.29)D, 差异有统计学意义(Z=-2.17, P=0.009);A组术后实际屈光度数[-1.30(-1.55, -0.87)D]与术前预留屈光度数[-0.63(-0.68, -0.61)D]比较, 差异有统计学意义(Z=-4.31, P<0.001);B组术后实际屈光度数[-0.95(-1.30, -0.40)D]与术前预留屈光度数[-0.68(-0.78, -0.58)D]比较, 差异无统计学意义(Z=-1.90, P=0.057);A、B两组术后UCVA分别为0.25(0.19, 0.26)、0.20(0.05, 0.30), 均较术前[1.57(1.11, 1.99)、1.51(1.33, 1.71)]有明显提高(均P<0.05);A、B两组眼压对比, 差异无统计学意义(P>0.05);A、B两组角膜散光比较, 差异无统计学意义(P>0.05);A、B两组屈光误差与前房深度均呈正相关(r=0.51, P=0.004;r=0.60, P<0.001);A组瞳孔夹持、色素播散综合征、反向瞳孔阻滞发生率均高于B组, 差异具有统计学意义(均P<0.05)。结论经睫状体平坦部缝线固定人工晶状体术可显著提高患者视力, 术后出现近视漂移, 但屈光误差较小, IOL术前预留度数无需调整。

Objective To study the refractive status of patients after suture fixation of pars plana of foldable intraocular lens(IOL).Methods A retrospective case-control study was conducted.A total of 75 patients(75 eyes)who underwent transscleral suture fixation of foldable IOL in Shanxi Provincial Ophthalmology Hospital from Jan.2019 to Mar.2022 were enrolled.The patients were divided into two groups based on the fixed position of the intraocular lens:in group A,30 cases(30 eyes)underwent intraocular lens ciliary sulcus suture fixation;in group B,45 cases(45 eyes)underwent pars plana intraocular lens suture fixation.After surgery,patients were followed up for 3 to 12 months,the uncorrected visual acuity(UCVA,logMAR),intraocular pressure(IOP),astigmatism,anterior chamber depth(ACD),postoperative complications and IOL position were observed.The refractive error which was determined as the difference between the actual postoperative refraction and the predicted refraction.Results Myopic shift in refraction occurred in all patients after transscleral suture fixation of foldable IOL after operation.The postoperative refractive error was-0.64(-0.93,-0.24)D in group A and-0.30(-0.49,0.29)D in group B,with statistically significant differences between the two groups(Z=-2.17,P=0.009).There was a statistically significant difference between the actual refractive power in group A[-1.30(-1.55,-0.87)D]and the preoperative refractive power[-0.63(-0.68,-0.61)D]reserved before surgery(Z=-4.31,P<0.001),while there was no statistically significant difference in group B between the actual refractive power[-0.95(-1.30,-0.40)D]and the preoperative refractive power[-0.68(-0.78,-0.58)D]reserved before surgery(Z=-1.90,P=0.057).UCVA(logMAR)was 0.25(0.19,0.26)in group A and 0.20(0.05,0.30)in group B,both of which significantly improved compared to the preoperative state[1.57(1.11,1.99),1.51(1.33,1.71)](all P<0.05).There was no statistically significant difference in IOP between the two groups(P>0.05).There was no statistically significant difference in corneal astigmatism between the two groups(P>0.05).The refractive error was positively correlated with ACD in both groups(r=0.51,P=0.004;r=0.60,P<0.001).The incidence of pupil clamping,pigment dispersion syndrome,and reverse pupillary blockage were higher in group A than those in group B,with statistically significant differences(all P<0.05).Conclusion Suture fixation of foldable IOL at the pars plana area of the ciliary body can significantly improve visual acuity,with refractive error after surgery and no need to adjust the preoperative IOL refraction power.