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中华眼科医学杂志(电子版) ›› 2024, Vol. 14 ›› Issue (02) : 71 -76. doi: 10.3877/cma.j.issn.2095-2007.2024.02.002

论著

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
何渊1, 万修华1, 朱静芬2, 赵世强1, 綦碧莹1, 杨文利1, 刘武1,†()   
  1. 1. 100730　首都医科大学附属北京同仁医院　北京同仁眼科中心　北京市眼科研究所　眼科学与视觉科学北京市重点实验室
    2. 200025　上海交通大学医学院　公共卫生学院
  • 收稿日期:2024-02-01 出版日期:2024-04-28
  • 通信作者: 刘武
  • 基金资助:
    北京市医院管理中心临床医学发展专项经费项目(XMLX202133)

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

Yuan He1, Xiuhua Wan1, Jingfen Zhu2, Shiqiang Zhao1, Biying Qi1, Wenli Yang1, Wu Liu1,†()   

  1. 1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
    2. School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2024-02-01 Published:2024-04-28
  • Corresponding author: Wu Liu
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何渊, 万修华, 朱静芬, 赵世强, 綦碧莹, 杨文利, 刘武. 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[J]. 中华眼科医学杂志(电子版), 2024, 14(02): 71-76.

Yuan He, Xiuhua Wan, Jingfen Zhu, Shiqiang Zhao, Biying Qi, Wenli Yang, Wu Liu. 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[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2024, 14(02): 71-76.

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(χ2＝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。

关键词: 白内障, 玻璃体切除术, 有效人工晶状体位置, 屈光误差
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 (χ2=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.

Key words: Cataract, Vitrectomy, Effective position of artificial intraocular lens, Refractive error
表1 两组患者术前的基本情况(±s)
组别 眼数 AL(mm) 角膜曲率(D) 中央角膜厚度(μm) ACD (mm) 晶状体厚度(mm) 水平角膜直径(mm) IOL屈光度(D)
白内障组 50 23.333±0.790 44.241±1.508 548.160±30.677 2.944±0.387 4.608±0.401 11.602±0.473 20.980±1.890
联合组 50 23.449±0.903 44.199±1.375 549.760±36.369 2.874±0.358 4.663±0.336 11.629±0.514 20.930±2.284
t值   －0.686 0.146 －0.238 0.936 －0.744 －0.278 0.119
P值   >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
图1 白内障组和联合组患者术后屈光误差、前房深度及预测误差的比较　图A示白内障组和联合组患者术后屈光误差的比较；图B示白内障组和联合组患者术后前房深度的比较；图C示白内障组和联合组患者术后预测误差分别在±0.25D、±0.5 D、±0.75 D及±1.00 D范围内百分比的比较
表2 两组患者术后屈光误差、前房深度及最佳矫正视力的比较
分组 眼数 PE (±s，D) ACD (±s，mm) BCVA(logMAR)
白内障组 50 0.155±0.345 4.377±0.336 0.000(0.097)
联合组 50 －0.007±0.600 4.213±0.357 0.398(0.222)
t/Z值   1.653* 2.364* 70.049#
P值   >0.05 <0.05 <0.05
表3 两组患者术眼屈光标准差、平均绝对误差、绝对误差中位数及不同屈光范围屈光误差的比较
组别 眼数 Mean SD MAE MedAE 指定屈光误差范围内术眼的百分比
±0.25 D(%) ±0.50 D(%) ±0.75 D(%) ±1.00 D(%)
白内障组 50 0 0.344 0.287 0.210 56% 82% 98% 100%
联合组 50 0 0.600 0.459 0.353 36% 60% 76% 88%
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