玻璃体切除联合一期晶状体后囊膜切除对白内障手术后屈光结果及前房深度的影响

The impact of primary posterior capsulotomy on the refractive outcomes and anterior chamber depth after phaco-vitrectomy

目的分析玻璃体切除(pars plana vitrectomy,PPV)联合白内障手术中一期进行晶状体后囊膜切除(posterior capsulotomy,PC)对术后屈光结果及前房深度的影响。设计前瞻性非随机对照研究。研究对象2021年9月至2022年9月因全层黄斑裂孔、黄斑前膜或玻璃体黄斑牵拉综合征行白内障摘除、IOL植入、PPV联合PC术患者50例(50眼)(PhacoPPVc组),或由于单纯白内障需接受白内障摘除联合IOL植入的患者50例(50眼)(Phaco组)。方法使用Barrett UII公式进行两组患者IOL屈光度计算。记录患者术前和术后1个月最佳矫正视力、屈光误差(predictive error,PE)、前房深度(anterior chamber depth,ACD)、PE的标准差、平均绝对误差、绝对误差中位数和PE在±0.25 D、±0.50 D、±0.75 D和±1.00 D范围内的比例。主要指标术后PE及ACD。结果Phaco组术后PE为(0.054±0.397)D,而PhacoPPVc组为(-0.091±0.668)D,两组与0比较均无统计学差异(t=0.962,P=0.341;t=-0.963,P=0.340)。术后1个月两组ACD均较术前加深,Phaco组为(4.407±0.324)mm,PhacoPPVc组为(4.259±0.254)mm,但PhacoPPVc组的ACD较Phaco组明显变浅,差异具有显著性(t=2.537,P=0.013)。PhacoPPVc组患者的屈光预测准确性较差,标准差、平均绝对误差、绝对误差中位数均高于Phaco组,而在所有给定范围内的比例均低于Phaco组。结论与单纯白内障组比,PPV联合白内障手术中同时进行PC术后1个月时ACD显著变浅,尽管PhacoPPVc组未出现明显的近视或远视误差,但其屈光预测准确性低于单纯白内障组。

Objective To analyze the impact of primary posterior capsulotomy(PC)in phaco-vitrectomy on postoperative refractive outcomes and anterior chamber depth(ACD).Design Prospective non-randomized controlled study.Parcitipants Between September 1,2021 and September 30,2022,50 patients(50 eyes)in the triple group who underwent Phaco-vitrectomy combined with PC surgery due to full-thickness macular hole,epiretinal membrane,or vitreoretinal traction syndrome,and 50 patients(50 eyes)in the control group who needed cataract extraction combined with IOL implantation due to cataracts were prospectively recruited.Methods The Barrett UII formula was used to calculate the IOL power for all the patients.The best corrected visual acuity,refractive error(PE),anterior chamber depth(ACD),standard deviation,mean absolute error,median absolute error,and percentage of eyes with PE within±0.25 D,±0.50 D,±0.75 D,and±1.00 D for all patients before and 1 month after surgery were checked and recorded.Main Outcome Measures Postoperative PE and ACD.Results The postoperative PE of the control group was 0.054±0.397 D,and that of the triple group was-0.091±0.668 D.Both groups showed no systematic error compared to 0(t=0.962,P=0.341,and t=-0.963,P=0.340,respectively).The postoperative ACD in both groups deepened compared to preoperative levels,with a control group of 4.407±0.324 mm and a triple group of 4.259±0.254 mm.However,the ACD in the triple group was shallower than that in the control group,with a significant difference(t=2.537,P=0.013).The accuracy of refractive prediction in the triple group patients was poor,manifested as higher standard deviation,mean absolute error,and median absolute error compared to the control group,while the percentage of eyes in all given PE ranges was lower than that in the cataract group.Conclusions Compared with the cataract group,simultaneous use of PC during phaco-vitrectomy resulted in a significant shallowness in ACD at 1 month post-surgery.Although the triple group did not show significant myopic or hyperopic errors,its accuracy in predicting refractive error was significantly lower than that of the cataract group.