玻璃体切割联合硅油注入手术对白内障合并糖尿病性视网膜病变有效晶体位置的影响

Effect of Vitrectomy Combined with Silicone Oil Tamponade on the Effective Lens Position of the Patients with Cataract and Diabetic Retinopathy

摘要: 目的：探讨玻璃体切割联合硅油注入手术对白内障合并糖尿病性视网膜病变患者有效晶体位置的影响。方法：选取白内障合并糖尿病性视网膜病变患者79例(79眼)，一期行玻璃体切割联合白内障超声乳化及硅油注入，术中均未植入人工晶状体，术后3个月行二期硅油取出及人工晶状体植入手术，分别于一期手术前及手术后1周、1月、2月和二期手术前及手术后1周、1月、3月、6月记录最佳矫正视力、眼压、中央前房深度及眼轴，统计分析结果。结果：1) 最佳矫正视力(BCVA)：一期玻璃体切割联合白内障超声乳化及硅油注入手术后1周、1月、2月均较术前提高，有统计学意义(P < 0.05)，术后1月与术后2月对比无明显差异(P > 0.05)，余各时间点有差异(P < 0.05)；二期硅油取出及人工晶状体植入手术前及手术后各时间点无明显差异(P > 0.05)。2) 眼压：一期玻璃体切割联合白内障超声乳化及硅油注入手术前及手术后各时间点无明显差异(P > 0.05)；二期硅油取出及人工晶状体植入手术前及手术后各时间点无明显差异(P > 0.05)。3) 中央前房深度(CACD)：一期玻璃体切割联合白内障超声乳化及硅油注入手术后1月、术后2月均较术后1周加深，均有统计学意义(P < 0.05)，术后1月与术后2月比较无明显差异(P > 0.05)；二期硅油取出及人工晶状体植入手术后1周、1月、3月、6月均较术前加深，有统计学意义(P < 0.05)，术后1月、3月、6月均较术后1周加深，均有统计学意义(P < 0.05)，术后1月、3月、6月各时间点无明显差异(P > 0.05)。4) 眼轴：一期玻璃体切割联合白内障超声乳化及硅油注入手术后1周、1月、2月均较术前缩短，有统计学意义(P < 0.05)，术后各时间点无明显差异(P > 0.05)；二期硅油取出及人工晶状体植入手术前及手术后各时间点无明显差异(P > 0.05)。结论：玻璃体切割联合超声乳化及硅油注入术后，前房加深，眼轴有一定缩短；玻璃体腔硅油取出联合人工晶状体植入术后，前房进一步加深，而眼轴无变化。有效晶体位置在玻璃体切割联合硅油注入手术及硅油取出手术前后发生了变化，对人工晶状体度数的选择有一定的指导意义。

Abstract: Objective: To investigate the effect of vitrectomy combined with silicone oil tamponade on the effective lens position of the patients with cataract and diabetic retinopathy. Method: Seventy-nine patients (79 eyes) with cataract and diabetic retinopathy were included. Vitrectomy combined with phacoemulsification and silicone oil tamponade was performed firstly, but the intraocular lens was not implanted in the first operation. Then, the second stage surgery was performed for the removal of the silicon oil in the eyes of the patients and intraocular lens implantation 3 months later. The best corrected visual acuity (BCVA), intraocular pressure, central anterior chamber depth, and ocular axis were examined before and 1 week, 1 month, 2 months after the first surgery and before and 1 week, 1 month, 3 months, and 6 months after the second surgery, respectively. The results were statistically analyzed. Result: 1) BCVA: At 1 week, 1 month and 2 months after the first stage surgery, BCVA of the patients was significantly improved compared with those before surgery (P < 0.05). There was no significant difference between the patients’ BCVA at 1 month and that at 2 months after the first operation (P > 0.05), but significant differences were observed in the patients’ BCVA between postoperative 1 week and all other time points after (P < 0.05). No significant difference was found in the patients’ BCVA before and after the second stage operation (P > 0.05). 2) Intraocular pressure: the intraocular pressure of the patients showed no significant difference at each time point before and after the first stage surgeries (P>0.05); the intraocular pressure of the patients showed no significant difference at each time point before and after the second stage surgeries(P>0.05). 3) Central anterior chamber depth (CACD): Compared with 1 week after the first stage surgery, CACD of the patients was much deeper at 1 month and 2 months after surgery, and a statistically significant difference was detected (P < 0.05), but there was no significant difference at 1 month and 2 months after the first stage surgery (P > 0.05). CACD of the patients was shallower at 1 week, 1 month, 3 months, 6 months after the second stage surgery compared with that before surgery (P < 0.05). However, CACD of the patients at 1 month, 3 months, and 6 months after the second stage surgery was deeper than that at 1 week (P < 0.05). No significant difference was observed in CACD at 1 month, 3months, and 6months after the second stage surgery (P > 0.05). 4) Axis length: The axis length of the patients was shorter at each time point after the first stage surgery when compared with that before surgery (P < 0.05). There was no significant difference among all the time points after the first operation (P > 0.05), and no significant difference was detected among before and all the time points after the second stage operation, too (P > 0.05). Conclusion: After vitrectomy combined with silicone oil tamponade, the anterior chamber tended to deepen, and the axis length might get shorter partly. After silicon oil removal and intraocular lens implantation, the anterior chamber would further deepen, but the axis length would not change. The effective lens position change before and after vitrectomy combined with silicone oil tamponade and removal, these results may play some roles in guiding the selection of intraocular lens power in clinical practice.