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中华眼科医学杂志(电子版) ›› 2019, Vol. 09 ›› Issue (03) : 146 -152. doi: 10.3877/cma.j.issn.2095-2007.2019.03.004

论著

不同年龄患者选择白内障手术时机变化趋势的临床研究
赵黎明1, 王震宇2, 万雨2, 王银浩2, 敖明昕2, 李学民2,†()   
  1. 1. 100191　北京大学第三医院眼科；100070　北京丰台医院眼科
    2. 100191　北京大学第三医院眼科
  • 收稿日期:2019-05-04 出版日期:2019-06-28
  • 通信作者: 李学民
  • 基金资助:
    国家自然科学基金项目(81600760); 北京大学第三医院院种子基金(Y84496-01)

Clinical study on the change trend of cataract surgery timing in different age patients

Liming Zhao1, Zhenyu Wang2, Yu Wan2, Yinhao Wang2, Mingxin Ao2, Xuemin Li2,†()   

  1. 1. Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China; Department of Ophthalmology, Beijing Fengtai Hospital, Beijing 100070, China
    2. Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
  • Received:2019-05-04 Published:2019-06-28
  • Corresponding author: Xuemin Li
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引用本文：

赵黎明, 王震宇, 万雨, 王银浩, 敖明昕, 李学民. 不同年龄患者选择白内障手术时机变化趋势的临床研究[J]. 中华眼科医学杂志(电子版), 2019, 09(03): 146-152.

Liming Zhao, Zhenyu Wang, Yu Wan, Yinhao Wang, Mingxin Ao, Xuemin Li. Clinical study on the change trend of cataract surgery timing in different age patients[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2019, 09(03): 146-152.

目的

了解不同年龄患者白内障手术时机的选择及变化趋势。

方法

横断面研究。选取2019年1月至2019年4月于北京大学第三医院眼科接受白内障超声乳化联合人工晶状体植入术的患者900例(900只眼)进行研究。根据联合国世界卫生组织制订的年龄划分标准，分为45~59岁组、60~74岁组及75~89岁组三组。应用分层抽样法，在每组中各随机抽取50例(50只眼)。采用国际标准对数视力表检查术眼裸眼视力，根据晶状体混浊分类系统Ⅲ(LOCS Ⅲ)对术眼晶状体混浊程度进行分级，并采用视功能相关生命质量量表(NEI-VFQ-25)中文版评价术眼主观视功能。通过万方数据库及中国知网数据库，检索2005年以来不同年龄白内障患者选择手术时机的相关文献。采用R软件进行统计学分析，三组比较采用单因素方差分析，组间两两比较采用Tukey法。

结果

45~59岁组患者术眼最小分辨角对数(LogMAR)视力为0.6±0.3，60~74岁组患者术眼的LogMAR视力为0.8±0.3，75~89岁组患者术眼的LogMAR视力为0.8±0.4，三组比较差异有统计学意义(F＝8.373，P<0.05)；其中，45~59岁组患者术眼的LogMAR视力低于60~74岁组和75~89岁组患者(DF＝0.202，0.260；P<0.05)。根据LOCS Ⅲ，45~59岁组术眼晶状体混浊程度分级为(2.4±0.5)级，60~74岁组术眼晶状体混浊程度分级为(2.7±1.0)级，75~89岁组术眼晶状体混浊程度分级为(3.4±0.9)级。三组比较，差异有统计学意义(F＝14.870，P<0.05)；45~59岁组、60~74岁术眼组晶状体混浊程度分级低于75~89岁组患者，差异有统计学意义(DF＝0.920，0.640；P<0.05)。根据NEI-VFQ-25量表，三组患者的整体健康状况评分、近距离活动评分、远距离活动评分、精神健康评分、社会角色限制评分、依赖程度评分、驾车评分、色觉评分及周边视力评分比较，差异均有统计学意义(F＝21.580, 9.912, 5.069, 17.570, 10.440, 20.800, 3.749, 3.145, 9.292；P<0.05)。45~59岁组患者的整体健康状况评分、近距离活动评分及周边视力评分高于60~74岁组、75~89岁组患者，差异有统计学意义(DF＝-19.500，-22.000，-11.000，-14.916，-9.500，-14.500；P<0.05)。45~59岁组患者的远距离活动评分、驾车评分及色觉评分高于75~89岁组患者，差异有统计学意义(DF＝-11.750，1.320，-6.500；P<0.05)。45~59岁组和60~74岁组患者的精神健康评分、社会角色限制评分高于75~89岁组患者，差异有统计学意义(DF＝-16.750，-11.000，-19.250，-19.000；P<0.05)。三组患者依赖程度评分的两两比较，差异均有统计学意义(F＝20.800，P<0.05)，年龄越大，依赖程度越重。本研究中选择白内障手术治疗的患者平均年龄为(70.3±9.8)岁，60~69岁的患者占比为29.78%。与2005—2015年各研究数据相比，本研究中患者的平均年龄更小，60~69岁患者占比更高。

结论

不同年龄患者选择白内障手术时机不同，相比高年龄患者，低年龄患者白内障严重程度更轻，但手术时机较早，与既往调查相比手术年龄有前移的趋势。这可能与低年龄患者对视力要求高、高年龄患者受限于身体条件有关。

关键词: 白内障手术时机, 晶状体混浊分类系统Ⅲ, 视功能相关生命质量量表
Objective

The aim of this study was to investigate cataract surgery timing and change trend in patients of different ages.

Methods

This study was cross-sectional . 900 patients (900 eyes) who underwent phacoemulsification and intraocular lens implantation in the Department of Ophthalmology, the Third Hospital of Peking University from January 2019 to April 2019 were collected. According to the age division of the World Health Organization, the patients were divided into three groups: 45 to 59 age group, 60 to 74 age group and 75 to 89 age group. 50 cases (50 eyes) were selected from each group by stratified sampling. Operating eyes were examined by international standard logarithmic visual acuity chart; lens opacity was graded according to Lens Opacities Classification System Ⅲ (LOCS Ⅲ); the subjective visual function was assessed by National Eye Institute 25-Item Visual Function Questionnaire(Chinese verson, NEI-VFQ-25). In Wanfang and CNKI database, literatures on the cataract surgery timing in patients of different ages since 2005 were retrieved. All the data were analyzed by R statistical software. One-way ANOVA was used to comparise differents among three groups and Tukey method was used to comparise differents between two groups.

Results

The logarithm of minimal angle of resolution (logMAR) visual acuity of 45 to 59 age group was 0.6±0.3, 60 to 74 age group was 0.8±0.3, 75 to 89 age group was 0.8±0.4, the difference was statistically significant (F=8.373; P<0.05); the logMAR visual acuity of 45 to 59 age group was lower than that of 60 to 74 age group and 75 to 89 age group, the difference was statistically significant (DF=0.202, 0.260; P<0.05). The LOCS Ⅲ of nuclear turbidity in 45 to 59 age group was 2.4±0.5. In 60 to 74 age group, that was 2.7±1.0. In 75 to 89 age group, that was 3.4±0.9. The difference was statistically significant (F=14.870; P<0.05); the LOCS Ⅲ of nuclear turbidity in 45 to 59 age group and 60 to 74 age group was less than that of 75 to 89 age group, the difference was statistically significant (DF=0.920, 0.640; P<0.05). There were statistically significant differences in overall health status score, short-range activity score, long-distance activity score, mental health score, social role limitation score, dependence score, driving score, color vision score and peripheral visual acuity score among three groups (F=21.580, 9.912, 5.069, 17.570, 10.440, 20.800, 3.749, 3.145, 9.292; P<0.05). The overall health status score, short-range activity score and peripheral visual acuity score of 45 to 59 age group were higher than those of 60 to 74 age group and 75 to 89 age group, with statistical significance (DF=-19.500, -22.000, -11.000, -14.916, -9.500, -14.500; P<0.05). The scores of long-distance activity, driving and color vision in 45 to 59 age group were higher than those in 75 to 89 age group, with statistical significance (DF=-11.750, 1.320, -6.500; P<0.05). The mental health score and social role limitation score of 45 to 59 age group and 60 to 74 age group were higher than those of 75 to 89 age group, with statistical significance (DF=-16.750, -11.000, -19.250, -19.000; P<0.05). There was significant difference between two groups in the dependence degree score (F=20.800, P<0.05), the older the age, the heavier the dependence degree. Compared with the studies from 2005 to 2015, the mean age of the patients in our study was younger, and the proportion of the patients aged 60 to 69 increased.

Conclusions

Cataract surgery timing was different from age to age. The cataract severity in the younger age group was lighter than that in the older age group, but the cataract surgery timing was relatively early, which has shown a forward trend compared with previous investigations. This was related to the high requirement for vision in the younger age group and the limitation of physical conditions in the older age group.

Key words: Cataract surgery timing, Lens opacities classification system Ⅲ, National Eye Institute 25-Item Visual Function Questionnaire
表1 三组白内障患者术眼的晶状体混浊分类系统Ⅲ分级的比较(级，±s )
组别 例数 晶状体核混浊 晶状体皮质混浊 晶状体后囊膜下混浊
45~59岁组 50 2.4±0.5* 1.9±0.8 1.7±1.3
60~74岁组 50 2.7±1.0* 1.9±1.1 2.2±1.6
75~89岁组 50 3.4±0.9 2.2±0.9 1.8±1.1
F值   14.870 1.768 1.850
P值   <0.05 <0.05 <0.05
表2 三组白内障患者视功能相关生命质量量表各维度评分的比较(分，±s)
组别 例数 整体健康 总体视力 眼痛 近距离活动 远距离活动 社会功能
45~59岁组 50 55.0±19.3 45.2±15.3 94.8±10.6 85.5±17.7 88.0±19.3 97.0±10.1
60~74岁组 50 35.5±18.1* 43.6±7.7 94.0±11.0 74.5±15.9* 80.3±17.4 92.2±14.8
75~89岁组 50 33.0±16.9* 42.4±9.5 89.8±16.5 76.2±18.9* 76.2±18.9* 91.2±14.0
F值   21.580 0.751 2.111 9.912 5.069 2.684
P值   <0.05 >0.05 >0.05 <0.05 <0.05 >0.05
组别 例数 精神健康 角色限制 依赖程度 驾车 色觉 周边视力
45~59岁组 50 87.2± 8.8# 88.2±21.1# 96.0± 9.6 88.5±22.7 98.5±5.9 92.5±14.3
60~74岁组 50 81.5±12.7# 88.0±22.4# 86.8±16.3*# 78.7±29.0 93.5±17.9 83.0±17.6*
75~89岁组 50 70.5±19.2 69.0±27.8 73.7±23.1* 61.7±35.0* 92.0±13.6* 78.0±18.5*
F值   17.570 10.440 20.800 3.749 3.145 9.292
P值   <0.05 <0.05 <0.05 <0.05 <0.05 <0.05
表3 不同年份文献中手术时机的对比
作者 患者纳入年份 地区 例数 年龄范围(岁) 平均年龄(岁) 年龄分布情况(%)
60~69岁 70~79岁 80岁以上
肖通龙等[5] 2007—2008 井冈山 528 5~ 93 73 22.16 48.49 20.79
周媛等[6] 2008—2010 上海奉贤东部 994 55~ 99 74.75±7.92 19.82 51.81 25.45
李香亭[7] 2010—2013 上海市某区 27 584 2~101* - 25.59 32.17 24.33
蒋燕等[8] 2013—2015 泸州 813 45~ 95 70.89±8.91 - - -
本研究 2019 北京 900 45~ 89 70.3 ±9.8 29.78 40.22 17.11
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