超声乳化白内障吸除术后眼压变化及其影响因素分析

Analysis on the changes of intraocular pressure and relevant factors after phacoemulsification

目的分析超声乳化白内障吸除术后眼压变化及其影响因素。方法前瞻性病例系列研究。连续纳入2022年1至3月北京大学第三医院行超声乳化白内障吸除手术的患者73例(127只眼)。记录白内障术前、术后1 d、1周及6周的眼压、最佳矫正视力(BCVA,logMAR)及等效球镜度(SE)。应用IOL Master、Pentacam测量眼轴长度(AL)、前房深度(ACD)、前房角度数(ACA)、前房容积(ACV)、角膜缘白到白(WTW)距离以及晶状体厚度(LT)。手术前后多个时间点眼压比较采用重复测量方差分析;术前与术后6周BCVA、SE及ACD等比较采用配对t检验;应用单因素及多因素线性回归分析术后眼压变化的相关因素。结果患者术前、术后1 d、1周及6周眼压分别为(15.00±2.76)、(17.63±6.38)、(15.25±3.90)及(13.14±2.99)mmHg(1 mmHg=0.133 kPa),总体比较差异有统计学意义(F=23.09,P<0.001),术后6周眼压下降幅度(1.70±2.45)mmHg。术后6周BCVA、ACD、ACA、ACV分别为0.10±0.25、(4.66±0.45)mm、(44.10±5.91)°及(153.87±27.04)mm 3,均较术前[0.37±0.46、(2.66±0.61)mm、(30.43±7.51)°、(102.57±29.22)mm 3]提高(t=-7.33、22.22、17.49、17.94,均P<0.001)。单因素线性回归分析显示,术前眼压(B=-0.31,95%CI:-0.460~-0.153,P<0.001)、SE(B=-0.43,95%CI:-0.579~-0.285,P<0.001)、ACD(B=1.08,95%CI:0.237~1.927,P=0.013)、ACA(B=0.13,95%CI:0.074~0.192,P<0.001)、ACV(B=0.02,95%CI=0.004~0.035,P=0.016)、LT(B=-2.19,95%CI=-3.023~-1.354,P<0.001)、ACD变化量(B=-1.68,95%CI:-2.492~-0.874,P<0.001)、ACA变化量(B=-0.13,95%CI:-0.185~0.071,P<0.001)以及ACV变化量(B=-0.04,95%CI:-0.054~0.025,P<0.001)均与眼压变化显著相关。多因素线性回归分析显示,术前眼压(B=-0.23,95%CI=-0.416~-0.039,P=0.019)、SE(B=-0.40,95%CI=-0.675~-0.132,P=0.004)及ACD(B=1.81,95%CI=1.034~2.581,P<0.001)与术后眼压下降显著相关。结论超声乳化白内障吸除术后眼压较术前降低,术后眼压变化与术前眼压ACD及SE密切相关。

ObjectiveTo analyzed the intraocular pressure(IOP)changes and influencing factors after phacoemulsification.MethodsThis was a prospective case series study.A total of 127 eyes of 73 patients who underwent phacoemulsification in Peking University Third Hospital from Jan.to Mar.2022 were consecutively collected.IOP,best corrected visual acuity(BCVA,logMAR)and spherical equivalent(SE)were checked preoperatively and at 1 day,1 and 6 weeks postoperatively.The axial length(AL),anterior chamber depth(ACD),anterior chamber angle(ACA),anterior chamber volume(ACV),corneal white to white(WTW)distance and lens thickness(LT)were measured with IOL Master and Pentacam.Repeated analysis of measurement variance analysis of variance was used to compare the IOP at multiple time points,and paired t test was used to compare BCVA,SE and ACD before and at 6 weeks after surgery.Univariate and multivariate linear regression were performed to explore the relationship between IOP changes and the parameters.ResultsPreoperatively and at 1 day,1 week and 6 weeks postoperatively,IOP was(15.00±2.76),(17.63±6.38),(15.25±3.90)and(13.14±2.99)mmHg(1 mmHg=0.133 kPa),respectively.There was statistically significant difference in the overall comparison(F=23.09,P<0.001).IOP decreased by(1.70±2.45)mmHg at 6 weeks after surgery.BCVA,ACD,ACA,and ACV at 6 weeks postoperatively were 0.10±0.25,(4.66±0.45)mm,(44.10±5.91)°,and(153.87±27.04)mm 3,respectively,which were higher than those before surgery[0.37±0.46,(2.66±0.61)mm,(30.43±7.51)°,(102.57±29.22)mm 3](t=-7.33,22.22,17.49,17.94;all P<0.001).Univariate linear regression analysis showed that preoperative IOP(B=-0.31,95%CI=-0.460--0.153,P<0.001),SE(B=-0.43,95%CI=-0.579--0.285,P<0.001),ACD(B=1.08,95%CI=0.237-1.927,P=0.013),ACA(B=0.13,95%CI=0.074-0.192,P<0.001),ACV(B=0.02,95%CI=0.004-0.035,P=0.016),LT(B=-2.19,95%CI=-3.023--1.354,P<0.001),ACD change(B=-1.68,95%CI=-2.492--0.874,P<0.001),ACA change(B=-0.13,95%CI=-0.185-0.071,P<0.001),and ACV change(B=-0.04,95%CI=-0.054-0.025,P<0.001)were significantly associated with IOP changes.In multivariate linear regression analysis,preoperative IOP(B=-0.23,95%CI=-0.416--0.039,P=0.019),SE(B=-0.40,95%CI=-0.675--0.132,P=0.004)and ACD(B=1.81,95%CI=1.034-2.581,P<0.001)were significantly associated with IOP reduction.ConclusionIOP after phacoemulsification is lower than that before operation.Preoperative IOP and ACD,SE,are significantly associated positively with reduced IOP.