玻璃体切除联合超声乳化白内障吸除及后房型人工晶状体植入术对术后眼屈光状态及人工晶状体有效位置影响的临床研究

The effects of vitrectomy combined with phacoemulsification cataract extraction and posterior chamber intraocular lens implantation on postoperative refractive status and effective position of the intraocular lens

目的探讨玻璃体切除(PPV)联合超声乳化白内障吸除及后房型人工晶状体(IOL)植入术对术后眼屈光状态及人工晶状体有效位置的影响。方法前瞻性研究。连续招募2021年9月至2022年10月期间在北京同仁眼科中心就诊的患者100例(100只眼)。其中,男性38例(38只眼),女性62例(62只眼);年龄56~87岁,平均年龄(67.7±6.2)岁。根据所行手术方式不同将患者分为白内障组和联合组。白内障组患者行超声乳化白内障吸除及后房型IOL植入术,联合组患者行PPV联合超声乳化白内障吸除及后房型IOL植入术。使用Kane公式进行两组患者IOL屈光度计算。记录患者的年龄和性别,检测患者术眼术后1个月的最佳矫正视力(BCVA)、眼轴长度(AL)、角膜曲率,前房深度(ACD)、晶状体厚度、水平角膜直径及植入IOL的屈光度,计算术后1个月时两组患者术眼的屈光误差(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和±1.00 D范围内的百分比。经检验,年龄、AL、角膜曲率,ACD、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不符合正态分布,采用中位数和四分位间距描述,组间比较采用Mann-AWhitney 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。结果白内障组和联合组患者术后的PE分别为(0.155±0.345)D和(-0.007±0.600)D。与零取值比较,白内障组显示出远视系统误差,其差异具有统计学意义(t=3.176,P<0.05)。而联合组的系统误差并无统计学意义(t=-0.083,P>0.05)。白内障组和联合组患者术后的ACD均较术前加深,分别为(4.377±0.336)mm和(4.213±0.357)mm,但联合组与白内障组比较ACD偏浅,两组比较差异具有统计学意义(t=2.364,P<0.05)。联合组患者的屈光预测准确性较差,表现为SD、MAE及MedAE均高于于白内障组,而在±0.25 D、±0.50 D、±0.75 D和±1.00 D范围内PE的百分比均低于白内障组,其差异具有统计学意义(χ^(2)=4.026,5.877,10.698,6.383;P<0.05)。结论术后1月时,与白内障组相比联合组患者术后IOL的有效位置前移。PPV术及玻璃体腔填充空气或全氟丙烷并未产生远视或近视误差,但与白内障组相比联合组患者屈光预测的准确性较差。

Objective To explore the effects of vitrectomy(PPV)combined with phacoemulsification cataract extraction and posterior chamber intraocular lens(IOL)implantation on postoperative refractive status and effective position of the intraocular lens.Methods Prospective continuous recruitment of 100 patients(100 eyes)who visited Beijing Tongren Eye Center between September 2021 and October 2022.Among them,there were 38 males(38 eyes)and 62 females(62 eyes)with an average age of(67.7±6.2)years(ranging from 56 to 87 years old).According to the different surgical methods performed,patients were divided into cataract group and combination group.The cataract group patients underwent phacoemulsification cataract extraction and posterior chamber IOL implantation,while the combined group patients underwent PPV combined phacoemulsification cataract extraction and posterior chamber IOL implantation.The IOL diopter for two groups of patients were calculated using the Kane formula.The age and gender of the patient were recorded,the best corrected visual acuity(BCVA),axial length(AL),corneal curvature,anterior chamber depth(ACD),lens thickness,horizontal corneal diameter,and refractive error of the implanted IOL one month after surgery were measured,and the refractive error(PE),standard deviation(SD),mean absolute error(MAE),and median absolute error(MedAE)of the two groups of patients at one month after surgery were calculated.The percentage of PE within the range of±0.25 D,±0.50 D,±0.75 D,and±1.00 D were calculated.After testing,age,axial length,corneal curvature,anterior chamber depth,lens thickness,horizontal corneal diameter,and refractive index of implanted IOL all conform to normal distribution,expressed as±s,and compared by independent sample t-test for inter group.BCVA did not follow a normal distribution and was described using median and interquartile intervals,and compared by Mann Whitney's U test for inter group.Gender and eye type were described using examples and percentages,and compared bychi square tests test for inter group.The comparison between ME values and zero values was performed by a single sample t test.Results The postoperative PE of patients in the cataract group and the combination group were(0.155±0.345)D and(-0.007±0.600)D,respectively.Compared with zero values,the cataract group showed hyperopia system error,with a statistically significant difference(t=3.176,P<0.05).However,the combined group had no statistically significant system error(t=-0.083,P>0.05).The postoperative ACD of patients in the cataract group and the combined group was deeper than before surgery,with values of(4.377±0.336)mm and(4.213±0.357)mm,respectively.However,the ACD of patients in the combined group was shallower than that of the cataract group,and the difference between the two groups was statistically significant(t=2.364,P<0.05).The accuracy of refractive prediction in the combined group was poor,with SD,MAE,and MedAE being higher than those in the white cataract group.The percentage of PE within the range of±0.25 D,±0.50 D,±0.75 D,and±1.00 D was lower than that of the cataract group,and the differences were statistically significant(χ^(2)=4.026,5.877,10.698,6.383;P<0.05).Conclusions After surgery for one month,the effective position of IOL in the combined group was moved forward compared to the cataract group.PPV surgery and filling the vitreous cavity with air or perfluoropropane did not produce errors in hyperopia or myopia,but the accuracy of refractive prediction in the combined group was poorer compared to the cataract group.