观察超声乳化白内障吸除联合后房型人工晶状体植入及微创玻璃体切除术治疗老年性白内障合并玻璃体后脱离(PVD)的临床效果。

选取2016年6月至2017年6月期间于中国中医科学院眼科医院内障眼病二科诊断为老年性白内障合并PVD的住院患者30例(30只眼)的临床资料。其中，男性12例(12只眼)，女性18例(18只眼)。年龄50～66岁，平均年龄(56.0±5.1)岁。依据是否行玻璃体切除术，分为暴露组和非暴露组。其中，暴露组10例(10只眼)，行超声乳化白内障吸除联合后房型人工晶状体植入及微创玻璃体切除术治疗；非暴露组20例(20只眼)，行单纯白内障手术治疗，分别观察手术时间、术后视力、术后不良视觉症状、手术并发症及患者满意度。本研究中的全部数据资料均经过K－S检验，呈正态分布，用均数±标准差(±s)描述，组内比较采用独立样本t检验。采用两因素重复测量方差分析比较术前与术后1 d、1周和3个月两组患者的最佳矫正视力。

全部病例随访至术后3个月。暴露组平均手术时间为(22.4±4.5)min，非暴露组平均手术时间为(10.5±2.8)min，差异具有统计学意义(t＝－8.99，P<0.05)。暴露组患者术前与术后1 d、1周及3个月的平均视力分别为4.39±0.18、4.73±0.14、4.91±0.07及4.95±0.08；非暴露组患者术前与术后1 d、1周及3个月的平均视力分别为4.44±0.20、4.83±0.13、4.94±0.06及4.95±0.06，两组术后1 d的比较差异有统计学意义(t＝2.11，P<0.05)，其余各时间点比较差异无统计学意义(t＝0.60，1.46，－0.10；P>0.05)。组内比较结果显示，术后各时间点，暴露组患者视力较术前提高，差异具有统计学意义(暴露组(t＝－4.71，－8.51，－9.56；P<0.05)；非暴露组患者视力较术前也有提高，差异具有统计学意义(t＝－7.13，－10.71，－11.99；P<0.05)。术后1周和3个月与术后1 d比较，暴露组患者视力较术前提高，差异具有统计学意义(t＝－3.63，－4.31；P<0.05)；非暴露组患者视力也较术前提高，差异具有统计学意义(t＝－3.43，－3.75；P<0.05)。术后3个月眼部B型超声检查结果显示暴露组患者术后PVD缓解率为100%，玻璃体混浊缓解率为80%。暴露组9例(9只眼)患者眼部不良视觉症状全部消失，仅1例(1只眼)患者仍偶感眼前黑点飘动，基本不影响正常生活；非暴露组患者仅2例(2只眼)患者无显著不良视觉症状，18例(18只眼)患者均存在较明显的黑影飘动或飞蚊现象等不良视觉症状。其中，15例(15只眼)患者均主诉影响正常生活，4例(4只眼)患者主诉症状较术前加重。暴露组患者满意度为100%(10/10)，非暴露组为75%(15/20)。

超声乳化白内障吸除联合后房型人工晶状体植入及微创玻璃体切除术可以改善老年性白内障合并PVD患者的不良视觉症状，值得借鉴。

To observe the clinical effect of phacoemulsification combined with posterior chamber intraocular lens implantation and minimally invasive vitrectomy in the treatment of senile cataract with posterior vitreous detachment (PVD).

From June 2016 to June 2017, the clinical data of 30 hospitalized patients (30 eyes) with senile cataract combined with PVD were diagnosed in two families of cataract in the ophthalmology hospital of Chinese Academy of traditional Chinese medicine (Chinese Academy of Chinese Medicine). Among them, there were 12 males (12 eyes) and 18 females (18 eyes). The age were 50~66 years old with an average age of (56±5.1)years. According to the vitrectomy, it was divided into the exposure group [10 cases(10 eyes), the vitrectomy combined with cataract surgery)] and the non exposure group [(20 cases(20 eyes) with cataract surgery]. The operation time, postoperative visual acuity, postoperative bad visual symptoms, operation and disease and patient satisfaction were observed respectively. All the data in this study were tested by K-S and showed normal distribution. Mean square deviation(±s)was used to describe them. Independent samples t-test was used in comparison. The best corrected visual acuity of two groups was compared before and after 1 day, 1 week and 3 months by two factor repeated analysis of variance.

All cases were followed up to 3 months after the operation. The average operation time of the exposed group was (22.4±4.5)min, the average operation time of the non exposed group was (10.5±2.8)min, and the difference was statistically significant (t=-8.99, P<0.05). The average visual acuity of the patients in the exposure group were 4.39±0.18, 4.73±0.14, 4.91±0.07 and 4.95±0.08, respectively before operation and 1 day, 1week and 3 months, respectively. The average visual acuity of the patients in the non exposure group before and after the operation and 1 day, 1week and 3 months were respectively. The average visual acuity of the patients in non exposure group were 4.44±0.20, 4.83±0.13, 4.94±0.06 and 4.95±0.06, 1 day, 1week, and 3 months were statistically significant(t=2.11, P<0.05). There was no significant difference in other time points (t=0.60, 1.46, -0.10; P>0.05). The results of intra group comparison showed that the visual acuity of the exposed group was higher than that before the operation, and the difference was statistically significant (the exposure group (t= 4.71, -8.51, -9.56; P<0.05); the visual acuity of the non exposed group was also higher than that before the operation. The difference was statistically significant (t=7.13, -10.71, -11.99; P<0.05). After 1 and 3 months after operation, compared with 1 day after operation, the visual acuity of the exposed group was higher than that before the operation (t=3.63, 4.31, P<0.05), and the visual acuity of the non exposed group was also higher than that before the operation. The difference was statistically significant (t=3.43, -3.75, P<0.05). 3 months after operation, the B-mode ultrasound showed that the PVD remission rate was 100%(10/10) and the vitreous turbidity remission rate was 80%(8/10) in the exposed group. The visual symptoms of 9 cases(9 eyes) in the exposure group disappeared, only 1 case(1 eye) still felt the "black spot floating" in front of the eyes, which basically did not affect the normal life. Only 2 cases(2 eyes) in the non exposed group had no significant adverse visual symptoms, and 18 cases(18 eyes) had obvious bad visual symptoms such as "black shadow fluttering" and "flying mosquito" , of which 15 cases(15 eyes) all complained of normal life. The symptoms of 4 cases(4 eyes) were more severe than those before the operation. The satisfaction rate of the exposed group was 100%(10/10), while that of the non exposed group was 75%(15/20).

Phacoemulsification combined with posterior chamber intraocular lens implantation and minimally invasive vitrectomy can improve the adverse visual symptoms of senile cataract with PVD, and should be used for reference.