探讨术中光学相干断层扫描(iOCT)辅助下玻璃体Berger腔切除术的临床应用效果。

纳入2020年1月至2021年4月于同济大学附属同济医院眼科完成超声乳化白内障吸除联合人工晶状体植入及玻璃体切除术的患者73例(73只眼)进行研究。其中，男性37例(37只眼)，女性36例(36只眼)。年龄59~79岁，平均(65.1±4.2)岁。根据对Berger间隙处理的不同，分为传统组和Berger切除组。所有患眼均一期同时行硅油填充。Berger切除组患者，一期术中行晶状体后囊后方居中8 mm范围内玻璃体前皮质的彻底切除，切除时交替进行负压抽吸和切割。传统组患者，行传统术式而不处理Berger间隙。记录两组患者的性别、年龄、糖化血红蛋白、空腹血糖、白内障核分级、术前玻璃体腔内注药次数、眼压、最佳矫正视力(BCVA)、眼轴长度、手术时间、硅油取出后晶状体后囊区混浊程度及其光密度值。年龄、眼轴长度、糖化血红蛋白、空腹血糖、术前玻璃体腔内注药次数、眼压、手术时间及后囊光密度值符合正态分布以±s表示，各时间点的组间比较采用两因素重复测量方差分析，组间比较采用独立样本t检验。性别、高血压比例及白内障核分级等分类以例数和百分比描述，组间比较采用卡方检验。后囊区混浊程度以四分位数和中位数表示，组间比较采用秩和检验。

Berger切除组患眼在术前、一期术后1个月、二期取油前及二期取油后3个月的最小分辨角度对数视力(logMAR)BCVA分别为(0.93±0.73)、(0.62±0.18)、(0.50±0.08)及(0.48±0.08)；传统组患眼分别为(0.90±0.10)、(0.69±0.14)、(0.56±0.12)及(0.52±0.61)。经两因素重复方差分析，两组差异具有统计学意义(F＝19.35，P<0.05)，交互作用无统计学意义(F＝0.113，P>0.05)，经组间t检验比较的差异在二期取油后3月差异有统计学意义(t＝－2.36，P<0.05)。Berger切除组iOCT光密度值为(0.60±0.03)，传统组为(0.86±0.04)，Berger切除组低于传统组其差异有统计学意义(t＝20.04，P<0.05)。Berger切除组取油后3个月的pentacam光密度值为(4.21±0.51)，传统组为(5.37±1.28)，Berger切除组低于传统组其差异有统计学意义(t＝－3.29，P<0.05)。Berger切除组一期手术时间为(60.33±10.08)min，传统组为(57.22±9.89)min，组间差异无统计学意义(t＝0.89，P>0.05)。二期取油术后3个月时，Berger切除组和传统组后囊混浊程度的四分位数(中位数)分别为1.00(1.00)和2.00(2.00)，Berger切除组轻于传统组其差异具有统计学意义(Z＝3.27，P<0.05)。

Berger腔完整切除可增加硅油取出术后后囊后视轴区的透亮度。

To discuss the clinical effect of Berger′s space vitrectomy assisted by optical coherence tomography (OCT) in posterior capsular lens.

A study was conducted on 73 patients (73 eyes) who underwent phacoemulsification cataract extraction combined with intraocular lens implantation and vitrectomy at the Ophthalmology Department of Tongji Hospital affiliated to Tongji University from January 2020 to April 2021. Among them, there were 37 males (37 eyes) and 36 females (36 eyes). The age ranges from 59 to 79 years, with an average of (65.1±4.2) years. According to the different treatment of Berger gap, they were divided into traditional group and Berger resection group. All affected eyes underwent silicone oil filling at the same time. Patients of Berger resection group underwent a thorough resection of the anterior vitreous cortex within a range of 8 mm centered behind the posterior capsule of the lens during the first stage of surgery, with alternating negative pressure suction and cutting during the resection. Patients of traditional group underwent traditional surgery without managing the Berger gap. The gender, age, glycosylated hemoglobin, fasting blood glucose, cataract nucleus grading, preoperative intravitreal injection frequency, intraocular pressure, best corrected visual acuity (BCVA), axial length, surgical time, degree of opacification in the posterior capsule area after silicone oil removal, and optical density values of the two groups of patients were recorded. Age, axial length, glycosylated hemoglobin, fasting blood glucose, preoperative intravitreal injection frequency, intraocular pressure, surgical time, and posterior capsule optical density values conforming to a normal distribution, were expressed by ±s and compared by two ways repeated measurement ANOVA for inter group at each time point, and independent sample t test between groups. Gender, proportion of hypertension, cataract nuclear grading were described in terms of number and percentage of cases, and chi square test was used for inter group comparison. The degree of posterior capsule opacification was expressed in quartiles and median, and rank sum test was used for inter group comparison.

The minimum resolution angle logarithmic visual acuity (logMAR) BCVA of the affected eyes in the Berger resection group were (0.93±0.73), (0.62±0.18), (0.50±0.08), and (0.48±0.08) before surgery, after primary surgery for 1 month, before secondary oil removal, and after secondary oil removal for 3 months, respectively. Those of the traditional group were (0.90±0.10), (0.69±0.14), (0.56±0.12), and (0.52±0.61), respectively. After two ways repeated ANOVA, the differences between the two groups were statistically significant (F=19.35, P<0.05), and the interaction was not statistically significant (F=0.113, P>0.05). The differences between the groups were statistically significant (t=-2.36, P<0.05) after the second phase of oil extraction for 3 months. The iOCT optical density value of the Berger resection group was (0.60±0.03), while that of the traditional group was (0.86±0.04). The former was lower than the latter with a statistically significant difference between groups (t=20.04, P<0.05). The pentacam optical density values of the Berger resection group and the traditional group after oil extraction for 3 months were (4.21±0.51) and (5.37±1.28), respectively. There was a statistically significant difference between groups (t=-3.29, P<0.05). The primary stage surgical time in the Berger resection group and the traditional group were (60.33±10.08) min and (57.22±9.89) min, respectively. There was no statistically significant difference between the groups (t=0.89, P>0.05). After secondary oil removal for 3 months, the quartiles (median) of posterior capsule opacity in the Berger resection group and the traditional group were 1.00 (1.00) and 2.00 (2.00), respectively. The Berger resection group was lighter than the traditional group, and the difference was statistically significant (Z=3.27, P<0.05).

Complete resection of the vitreous cortex behind the posterior capsule of the lens can brighten posterior capsular opacity in the axial region after silicone oil removal surgery.