四种人工晶状体计算公式对三联白内障玻璃体切除术后屈光状态预测准确性的临床研究

The accuracy of four artificial lens calculation formulas in predicting refractive status after vitrectomy for triple cataract patients

目的探讨BUⅡ、Kane、EVO 2.0及LSF等4种新型人工晶状体(IOL)计算公式对超声乳化白内障吸除联合后房型IOL植入、玻璃体切除及晶状体后囊膜切除三联手术后屈光状态预测的准确性。方法收集2021年9月至2022年10月期间在首都医科大学附属北京同仁眼科中心就诊的眼科患者104例(104只眼)。其中,男性26例(26只眼),女性74例(74只眼);年龄56~87岁,平均年龄(68.4±6.3)岁。根据所行手术方式不同将患者分为对照组和三联组。对照组患者行超声乳化白内障吸除联合后房型IOL植入术,三联组患者行超声乳化白内障吸除联合后房型IOL植入、玻璃体切除及晶状体后囊膜切除三联手术。使用BUⅡ公式计算两组患者IOL的屈光度,并计算Kane、EVO 2.0及LSF等3种IOL公式的预测结果。记录患者的年龄和性别,检测患者术眼手术前和术后1个月的最佳矫正视力(BCVA)、眼轴长度、角膜曲率,前房深度、晶状体厚度、水平角膜直径及植入IOL的屈光度,计算术后1个月两组患者的屈光误差(PE)、PE的标准差(SD)、平均绝对误差(MAE)及绝对误差中位数(MedAE);计算PE在±0.25 D、±0.50 D、±0.75 D及±1.00 D范围内的百分比,BUⅡ、Kane、EVO 2.0及LSF等4种公式的公式性能指数(FPI)。年龄、眼轴长度、角膜曲率,前房深度、晶状体厚度、水平角膜直径及植入IOL的屈光度等均符合正态分布,以±s表示,组间比较采用独立样本t检验,BCVA采用中位数和四分位间距描述,组间比较采用Mann-Whitney U检验。性别和眼别采用例数和百分比描述,组间比较采用卡方检验。ME值与零取值的比较采用单样本t检验。不同公式的MAE及MedAE采用Friedman test进行比较。PE在不同范围内百分比的比较采用Cochran Q检验。结果在对照组中,BUⅡ、LSF、Kane及EVO 2.0等4种公式的PE分别为(0.032±0.405)D、(0.056±0.389)D、(0.186±0.392)D及(0.197±0.395)D,在三联组分别为(-0.084±0.656)D、(-0.041±0.652)D、(0.047±0.637)D及(0.050±0.666)D。对照组中,Kane和EVO2.0公式显示出远视系统误差,差异具有统计学意义(t=3.414,3.599;P<0.05);BUⅡ和LSF公式在对照组中的系统误差无统计学意义(t=0.570,1.029;P>0.05)。在三联组中,BUⅡ、Kane、EVO 2.0及LSF等4种公式的系统误差均无统计学意义(t=-0.920,0.530,0.545,-0.450;P>0.05)。BUⅡ、LSF、Kane及EVO 2.0等4种公式的PE,三联组与对照组比较均偏向近视,但并无统计学意义(t=1.641,1.526,2.315,1.624;P>0.05)。BUⅡ、Kane、EVO 2.0及LSF等4种公式的FPI,在对照组中的表现均高于三联组。对照组和三联组BUⅡ公式的FPI分别为0.648和0.393,均位列第一;LSF公式的FPI分别为0.526和0.381,位列第二;Kane公式的FPI分别为0.479和0.351,位列第三;EVO 2.0公式的FPI分别为0.463和0.346,位列第四。结论术后1个月时,在三联组中应用BUⅡ、LSF、Kane及EVO 2.0公式均未显示出远视或近视漂移。其中,预测准确性表现最优的是BUⅡ公式。

Objective To explore the accuracy of four new intraocular lens(IOL)calculation formulas,including BUⅡ,Kane,EVO 2.0,and LSF,in predicting refractive status after phacoemulsification cataract extraction combined with posterior chamber IOL implantation,vitrectomy,and posterior capsule resection triple surgery.Methods A total of 104 ophthalmic patients(104 eyes)who visited the Beijing Tongren Eye Center affiliated with Capital Medical University from September 2021 to October 2022 were collected.Among them,there were 26 males(26 eyes)and 74 females(74 eyes)with an average age of(68.4±6.3)years(ranging from 56 to 87 years old).According to the surgical methods,they were divided into a control group and a triple group.The patients of control group underwent phacoemulsification cataract extraction combined with posterior chamber IOL implantation,while those of the triple group underwent phacoemulsification cataract extraction combined with posterior chamber IOL implantation,vitrectomy,and posterior capsule resection triple surgery.The diopter of IOL for all patients using the BUⅡformula and prediction results of Kane,EVO 2.0 and LSF were calculated,respectively.The patient′s age and gender was recorded,and the best corrected visual acuity(BCVA),axial length,corneal curvature,anterior chamber depth,lens thickness,horizontal corneal diameter,and refractive error of implanted IOL before an dafter surgery for 1 month were measured,and the refractive error(PE)of the two groups of patients at 1 month after surgery and the standard deviation(SD),mean absolute error(MAE),and median absolute error(MedAE)of PE and the percentage of PE within the range of±0.25 D,±0.50 D,±0.75 D,and±1.00 D,formula performance index(FPI)for BUⅡ,Kane,EVO 2.0,and LSF formulas were calculated.Age,axial length,corneal curvature,anterior chamber depth,lens thickness,horizontal corneal diameter,and refractive index of implanted IOL all followed a normal distribution,were expressed as±s and compared by independent sample t-test for inter group.BCVA was described using median and interquartile spacing,and compared by Mann′s-Whitney U test.Gender and eye type were described using percentages,and compared by chi square tests.ME values and zero values were compared by a single sample t test.The MAE and MedAE of different formulas were compared by Friedman test.The percentages of PE within different ranges was compared by Cochran Q test.Results The PE values for four formulas,BUⅡ,LSF,Kane,and EVO 2.0 in the control group,were(0.032±0.405)D,(0.056±0.389)D,(0.186±0.392)D,and(0.197±0.395)D,respectively.In the triple group,those were(-0.084±0.656)D,(-0.041±0.652)D,(0.047±0.637)D,and(0.050±0.666)D,respectively.In the control group,there was a statistically significant difference in farsightedness system error between Kane and EVO2.0 formulas(t=3.414,3.599;P<0.05).The systematic error of BUⅡand LSF formulas in the control group was not statistically significant(t=0.570,1.029;P>0.05).In the triple group,the systematic errors of four formulas were not statistically significant(t=-0.920,0.530,0.545,-0.450;P>0.05).The PE of four formulas showed a tendency towards myopia in the triple group compared to the control group,but there was no statistically significant difference(t=1.641,1.526,2.315,1.624;P>0.05).The FPI performance of four formulas was higher in the control group than that of the triple group.The FPI of the BUⅡformula for the control group and triple group were 0.648 and 0.393,respectively,ranking first.The FPI of the LSF formula were 0.526 and 0.381,respectively,ranking second.The FPI of Kane′s formula were 0.479 and 0.351,respectively,ranking third.The FPI of EVO 2.0 formula were 0.463 and 0.346,respectively,ranking fourth.Conclusions After surgeryt for one month,BUⅡ,LSF,Kane,and EVO 2.0 formulas applied in the triple group do not show hyperopia or myopia drift.Among them,the BUⅡformula has the best performance in predicting accuracy.