超声乳化术对年龄相关性白内障黄斑部超微结构的影响

Effect of Phacoemulsification on Macular Area Ultrastructure of Age-Related Cataract Patients

摘要: 目的：本研究通过对年龄相关性白内障患者术前及术后不同时间点的黄斑部OCT检查，来观察黄斑部不同部位视网膜厚度及黄斑容积等超微结构的变化，为白内障术前风险评估与术后临床治疗提供一定的参考。方法：选取在我院进行白内障手术的患者34例(68眼)，分别检查患者术前、术后1 d、1 w、1 m、3 m的黄斑中心区直径1 mm范围的厚度、黄斑中心区直径1 mm范围的容积、黄斑中心区直径3 mm的平均厚度、黄斑中心区直径3 mm的容积、黄斑中心区直径6 mm的平均厚度、黄斑中心区直径6 mm的容积及黄斑中心区直径的总体积，对上述不同时间点黄斑部超微结构的变化进行评估。结果：和术前比较，术后1 d的黄斑中心区直径1 mm范围的厚度、黄斑中心区直径1 mm范围的容积、黄斑中心区直径3 mm的平均厚度、黄斑中心区直径3 mm的容积、黄斑中心区直径6 mm的平均厚度、黄斑中心区直径6 mm的容积及黄斑中心区直径的总体积均增加p < 0.05；和术后1d比较，术后1 w的上述指标均增加p < 0.05；和术后1 w比较，术后1 m的上述指标均显著增加达到峰值p < 0.0001；和术后1 m比较，术后3 m的上述指标均显著降低p < 0.05。和术前比较，术后3 m的上述指标均无显著变化p > 0.05。结论：本研究通过对白内障手术患者术前及术后不同时间点黄斑部超微结构的分析，发现术后1 d、1 w、1 m时的黄斑中心区直径1 mm范围的厚度、黄斑中心区直径1 mm范围的容积、黄斑中心区直径3 mm的平均厚度、黄斑中心区直径3 mm的容积、黄斑中心区直径6 mm的平均厚度、黄斑中心区直径6 mm的容积及黄斑中心区直径的总体积均显著增加，在术后1 m的上述指标增加均达到峰值，而后逐渐下降在术后3 m时基本恢复到术前水平，故进行白内障超声乳化术时应及时观察术前术后患者的眼底变化，将超声乳化术对患者的副损伤降到最低程度。

Abstract: Objective: In this study, the changes of retinal thickness and macular volume in different parts of macular area were observed through OCT examination of macular area of age-related cataract patients at different time points before and after surgery, providing certain reference for preoperative risk assessment and postoperative clinical treatment of cataract. Methods: Thirty-four patients (68 eyes) who underwent cataract surgery in our hospital were selected to check 1 mm thickness central subfield (1 mm TCS), 1 mm volume central subfield (1 mm VCS), 3 mm thickness avg cube (3 mm TAC), 3mm volume Cube (3 mm VC), 6mm thickness avg (6 mm TAC), 6 mm volume Cube (6 mm VC) and Overall volume Cube (OVC) of the diameter of the macula central area before operation and 1 d, 1 w, 1 m, 3 m after operation. The ultrastructural changes of macular areas at different time points were evaluated. Result: Compared with preoperative, postoperative 1 d of 1 mm TCS, 1 mm VCS, 3 mm TAC, 3 mm VC, 6 mm TAC, 6 mm VC, OVC all increased by p < 0.05; Compared with postoperative 1 d, the above indicators at postoperative 1 w all increased p < 0.05; compared with postoperative 1 w, the above indicators at postoperative 1 m increased significantly to the peak p < 0.0001; compared with postoperative 1 m, the above indicators at postoperative 3 m all significantly decreased p < 0.05. Compared with preoperative, there was no significant change in the above indexes at postoperative 3 m p > 0.05. Conclusions: This research analyzed the cataract surgery in patients with preoperative and postoperative macular ultrastructure at different time points analysis, found that after 1 d, 1 w, 1 m of 1 mm TCS, 1 mm VCS, 3 mm TAC, 3 mm VC, 6 mm TAC, 6 mm VC, OVC were significantly increased. The increase of the above indicators reached a peak at postoperative 1 m, then gradually decreased, and basically returned to the preoperative level at postoperative 3 m. So the cataract phaco should timely observe postoperative and preoperative patients with fundus changes, minimize the side effects of phacoemulsification on patients.