背景 小切口超声乳化白内障摘出联合人工晶状体(IOL)植入术是目前白内障治疗的主流术式,其术后视力的恢复受术中、术后并发症以及术后角膜屈光和中央角膜厚度(CCT)改变的影响,其中角膜屈光改变和CCT对视力波动的影响研究较少. 目的 分析小切口超声乳化白内障摘出术后早期患者的视力波动情况及其影响因素.方法 采用系列病例观察研究设计,选取2011年11月至2012年4月于复旦大学附属眼耳鼻喉科医院行2.6mm颞侧透明角膜切口超声乳化白内障摘出联合折叠型IOL植入术的年龄相关性白内障患者25例29眼,白内障手术均由同一医师完成.分别于术前1d,术后1、3、14d及术后1个月、2个月进行电脑验光和主觉验光,检查术眼裸眼视力(UCVA)和最佳矫正视力(BCVA),用Pentacam眼前节分析系统测量CCT及角膜散光值,结果均采用矢量分析法.对术眼手术前后UCVA、BCVA、等效球镜度(SE)、角膜散光值和CCT进行比较,并分析UCVA和BCVA的影响因素. 结果 术眼术后1d平均UCVA(LogMAR)为0.52±0.06,2个月为0.64±0.07,差异有统计学意义(t=-3.051,P＜0.05);术眼术后1d平均BCVA(LogMAR)为0.24±0.04,术后2个月为0.13±0.04,差异有统计学意义(t=-3.031,P＜0.05).术眼术后1、14、60 d的SE差异有统计学意义(F=3.562,P=0.039),术后1d的SE为(-1.74±0.28)D,术后14 d为(-1.99±0.27)D,差异有统计学意义(t=2.515,P＜0.05);术眼术后2个月SE为(-1.69±0.24)D,明显低于术后14d的SE值,差异有统计学意义(=-2.987,P＜0.05).术眼术前J0成分为(0.06±0.06)D,术后1d增加到(0.29±0.08)D,差异有统计学意义(t=-4.625,P＜0.01);术后14 d J0成分为(0.38±0.07)D,明显高于术后1d值,差异亦有统计学意义(t=-7.858,P＜0.01);术后2个月J0成分为(0.27±0.07)D,与术后14d比较差异有统计意义(t=-5.649,P＜0.01).术眼手术前后CCT的差异有统计学意义(F=9.792,P＜0.001).术眼术前平均CCT为(547.1±25.3) μm,术后ld为(599.4±56.9) μm,差异有统计学意义(t=-5.116,P＜0.01),至术后14 d为(557.0±27.1)μm,明显低于术后ld值,差异有统计学意义(t=4.135,P＜0.01),术后2个月时CCT为(551.0±25.9) μm,与术后14d时比较差异有统计学意义(t=2.082,P＜0.05).术后UCVA仅与角膜J45相关,UCVA=0.513-1.183×C J45(F=16.724;t=-4.089,P=0.026);BCVA仅与CCT相关,BCVA=-1.314+0.003×CCT(F=22.322;t =4.725,P=0.018). 结论 在无明显术中术后并发症的情况下,2.6mm颞侧透明角膜切口超声乳化白内障摘出联合IOL植入术术后早期术眼UCVA呈下降趋势,其波动主要受角膜散光改变的影响;而BCVA呈上升趋势,主要受CCT改变的影响.
揹景 小切口超聲乳化白內障摘齣聯閤人工晶狀體(IOL)植入術是目前白內障治療的主流術式,其術後視力的恢複受術中、術後併髮癥以及術後角膜屈光和中央角膜厚度(CCT)改變的影響,其中角膜屈光改變和CCT對視力波動的影響研究較少. 目的 分析小切口超聲乳化白內障摘齣術後早期患者的視力波動情況及其影響因素.方法 採用繫列病例觀察研究設計,選取2011年11月至2012年4月于複旦大學附屬眼耳鼻喉科醫院行2.6mm顳側透明角膜切口超聲乳化白內障摘齣聯閤摺疊型IOL植入術的年齡相關性白內障患者25例29眼,白內障手術均由同一醫師完成.分彆于術前1d,術後1、3、14d及術後1箇月、2箇月進行電腦驗光和主覺驗光,檢查術眼裸眼視力(UCVA)和最佳矯正視力(BCVA),用Pentacam眼前節分析繫統測量CCT及角膜散光值,結果均採用矢量分析法.對術眼手術前後UCVA、BCVA、等效毬鏡度(SE)、角膜散光值和CCT進行比較,併分析UCVA和BCVA的影響因素. 結果 術眼術後1d平均UCVA(LogMAR)為0.52±0.06,2箇月為0.64±0.07,差異有統計學意義(t=-3.051,P＜0.05);術眼術後1d平均BCVA(LogMAR)為0.24±0.04,術後2箇月為0.13±0.04,差異有統計學意義(t=-3.031,P＜0.05).術眼術後1、14、60 d的SE差異有統計學意義(F=3.562,P=0.039),術後1d的SE為(-1.74±0.28)D,術後14 d為(-1.99±0.27)D,差異有統計學意義(t=2.515,P＜0.05);術眼術後2箇月SE為(-1.69±0.24)D,明顯低于術後14d的SE值,差異有統計學意義(=-2.987,P＜0.05).術眼術前J0成分為(0.06±0.06)D,術後1d增加到(0.29±0.08)D,差異有統計學意義(t=-4.625,P＜0.01);術後14 d J0成分為(0.38±0.07)D,明顯高于術後1d值,差異亦有統計學意義(t=-7.858,P＜0.01);術後2箇月J0成分為(0.27±0.07)D,與術後14d比較差異有統計意義(t=-5.649,P＜0.01).術眼手術前後CCT的差異有統計學意義(F=9.792,P＜0.001).術眼術前平均CCT為(547.1±25.3) μm,術後ld為(599.4±56.9) μm,差異有統計學意義(t=-5.116,P＜0.01),至術後14 d為(557.0±27.1)μm,明顯低于術後ld值,差異有統計學意義(t=4.135,P＜0.01),術後2箇月時CCT為(551.0±25.9) μm,與術後14d時比較差異有統計學意義(t=2.082,P＜0.05).術後UCVA僅與角膜J45相關,UCVA=0.513-1.183×C J45(F=16.724;t=-4.089,P=0.026);BCVA僅與CCT相關,BCVA=-1.314+0.003×CCT(F=22.322;t =4.725,P=0.018). 結論 在無明顯術中術後併髮癥的情況下,2.6mm顳側透明角膜切口超聲乳化白內障摘齣聯閤IOL植入術術後早期術眼UCVA呈下降趨勢,其波動主要受角膜散光改變的影響;而BCVA呈上升趨勢,主要受CCT改變的影響.
배경 소절구초성유화백내장적출연합인공정상체(IOL)식입술시목전백내장치료적주류술식,기술후시력적회복수술중、술후병발증이급술후각막굴광화중앙각막후도(CCT)개변적영향,기중각막굴광개변화CCT대시력파동적영향연구교소. 목적 분석소절구초성유화백내장적출술후조기환자적시력파동정황급기영향인소.방법 채용계렬병례관찰연구설계,선취2011년11월지2012년4월우복단대학부속안이비후과의원행2.6mm섭측투명각막절구초성유화백내장적출연합절첩형IOL식입술적년령상관성백내장환자25례29안,백내장수술균유동일의사완성.분별우술전1d,술후1、3、14d급술후1개월、2개월진행전뇌험광화주각험광,검사술안라안시력(UCVA)화최가교정시력(BCVA),용Pentacam안전절분석계통측량CCT급각막산광치,결과균채용시량분석법.대술안수술전후UCVA、BCVA、등효구경도(SE)、각막산광치화CCT진행비교,병분석UCVA화BCVA적영향인소. 결과 술안술후1d평균UCVA(LogMAR)위0.52±0.06,2개월위0.64±0.07,차이유통계학의의(t=-3.051,P＜0.05);술안술후1d평균BCVA(LogMAR)위0.24±0.04,술후2개월위0.13±0.04,차이유통계학의의(t=-3.031,P＜0.05).술안술후1、14、60 d적SE차이유통계학의의(F=3.562,P=0.039),술후1d적SE위(-1.74±0.28)D,술후14 d위(-1.99±0.27)D,차이유통계학의의(t=2.515,P＜0.05);술안술후2개월SE위(-1.69±0.24)D,명현저우술후14d적SE치,차이유통계학의의(=-2.987,P＜0.05).술안술전J0성분위(0.06±0.06)D,술후1d증가도(0.29±0.08)D,차이유통계학의의(t=-4.625,P＜0.01);술후14 d J0성분위(0.38±0.07)D,명현고우술후1d치,차이역유통계학의의(t=-7.858,P＜0.01);술후2개월J0성분위(0.27±0.07)D,여술후14d비교차이유통계의의(t=-5.649,P＜0.01).술안수술전후CCT적차이유통계학의의(F=9.792,P＜0.001).술안술전평균CCT위(547.1±25.3) μm,술후ld위(599.4±56.9) μm,차이유통계학의의(t=-5.116,P＜0.01),지술후14 d위(557.0±27.1)μm,명현저우술후ld치,차이유통계학의의(t=4.135,P＜0.01),술후2개월시CCT위(551.0±25.9) μm,여술후14d시비교차이유통계학의의(t=2.082,P＜0.05).술후UCVA부여각막J45상관,UCVA=0.513-1.183×C J45(F=16.724;t=-4.089,P=0.026);BCVA부여CCT상관,BCVA=-1.314+0.003×CCT(F=22.322;t =4.725,P=0.018). 결론 재무명현술중술후병발증적정황하,2.6mm섭측투명각막절구초성유화백내장적출연합IOL식입술술후조기술안UCVA정하강추세,기파동주요수각막산광개변적영향;이BCVA정상승추세,주요수CCT개변적영향.
Background Small incision cataract surgery combined with intraocular lens (IOL) implantation remains a popular way for cataract.However,some factors affect the postsurgical visual outcomes and lower the patients' satisfaction,including intraoperative and postoperative complications as well as corneal refractive and thickness changes.Objective This study was to evaluate the influence of corneal refractive and thickness changes on visual fluctuation after 2.6 mm temporal incision surgery for cataract.Methods A series cases-observational study was designed.Twenty-nine eyes of 25 age-related cataract patients received 2.6 mm temporal transparent incision phacoemulsification and IOL implantation from November,2011 through April,2012 in Eye & ENT Hospital of Fudan University under the informed consent.The uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),automatic and subjective refraction were examined,and the central corneal thickness (CCT) and corneal vector astigmatism were measured using Pentacam analysis system before and after operation.The examination outcomes were compared among different time points,and the influencing factors of UCVA or BCVA were analyzed.Results The mean UCVA (LogMAR) was 0.52±0.06 in 1 day and 0.64±0.07 in 2 months after surgery,with a significant difference between them (t=-3.051,P＜0.05).The mean BCVA (LogMAR) was 0.24±0.04 and 0.13± 0.04 in postoperative 1 day and 2 months,showing a significant difference between them (t =-3.031,P＜0.05).Spherical equivalents (SE) were (-1.74±0.28) D,(-1.99±0.27) D and (-1.69±0.24) D in postoperative 1 day,14 days and 60 days,respectively,with a significant difference among the 3 time points (F =3.562,P =0.039),and significant difference also was found between postoperative 1 day and 14 days (t =2.515,P＜0.05) or between postoperative 14 days and 60 days (t =-2.987,P ＜ 0.05).The preoperative J0 value was (0.06 ± 0.06) D,and postoperative J0 value was (0.29±0.08) D on the first day,which was significant higher than that in preoperation (t =-4.625,P＜0.01).In addition,J0 value showed a significant difference between postoperative 1 day and 14 days (t=-7.858,P＜0.01) as well as between postoperative 14 days and 2 months ([0.38±0.07] D versus [0.27±0.07] D,t=-5.649,P＜0.01).The mean CCT was (547.1±25.3) μm,(599.4±56.9) μm,(557.0±27.1) μm and (551.0 ± 25.9) μm before and 1 day,14 and 60 days after operation,with significant differences among the various time points (F =9.792,P ＜ 0.001),and significant differences also were seen in the CCT between preoperation and postoperative 1 day (t =-5.116,P＜0.01),between postoperative 1 day and 14 days (t =4.135,P＜ 0.01),between postoperative 14 days and 60 days (t=2.082,P＜0.05).UCVA=0.513-1.183×C J45(F=16.724;t=-4.089,P=0.026) and BCVA=-1.314+0.003×CCT (F=22.322;t=4.725,P=0.018).Conclusions The UCVA remains a downward trend,and BCVA sustains upward trend after 2.6 mm temporal transparent incision phacoemulsification combined with IOL implantation surgery.Postoperative UCVA is affected by corneal astigmatism change,while BCVA is influenced by CCT change.
