白内障术后黄斑区光学相干断层扫描动态观察

Dynamic observation of macular thickness after cataract operation by optical coherence tomography

摘要:

目的：观察白内障术后黄斑厚度的改变。

方法：将126例白内障患者分为两组，分别行常规白内障超声乳化联合人工晶状体植入术64例和小切口非超声乳化联合人工晶状体植入术62例。两组术前、术中无并发症，术前及术后1，3mo黄斑区行OCT检查，观察两组术后黄斑厚度及视力变化。本研究采用SPSS 17.0统计学软件处理，每组术前、后采用配对t检验对数据进行统计学处理； 两组间术前、后分别采用独立样本t检验对数据进行统计学处理，取α=0.05检验水准。

结果：两组术后黄斑厚度变化：超声乳化组：术前、术后1，3mo黄斑厚度分别为241.3±10.9， 279.7±16.5，245.6± 12.6μm。术后1mo与术前比较差异有显著差异(P<0.01)； 术后3mo与术前比较，差异无统计学差异(P>0.05)； 术后1mo与3mo比较有统计学差异(P<0.05)。有3例术后1mo出现黄斑囊样水肿，2例术后3mo完全消退。小切口非超声乳化组：术前、术后1，3mo黄斑厚度分别为240.5±11.9，280.9±16.8，246.6±13.2μm。黄斑厚度术后1mo与术前比较有显著统计学差异(P<0.01)； 术后3mo与术前比较，无统计学差异(P>0.05)； 术后1mo与3mo比较有统计学差异(P<0.05)。有2例术后1mo出现黄斑囊样水肿，2例术后3mo完全消退。超声乳化组与小切口非超声乳化组，两组间术前、术后1，3mo分别比较均无统计学差异(P均>0.05)。

结论：无论选择白内障超声乳化还是小切口非超声乳化白内障联合人工晶状体植入，术后1mo黄斑厚度明显增加，证明术后造成黄斑水肿； 术后3mo厚度基本恢复术前。黄斑增厚与术式选择无明显关系。

Abstract:

AIM:To observe the changes of macular thickness in patients after cataract operation.

METHODS: A total of 126 patients(133 eyes)were divided into two groups that were included in this study. The group(68 eyes of 64 case)with phacoemulsification combined intraocular lens implantation and(65 eyes of 62 cases)with manual small incision cataract surgery(MSICS). There was no complication before and during the surgery. Optical coherence tomography(OCT)was examined 1, 3mo before and after surgery. The visual acuity and macular thickness were compared after surgery. The SPSS 17.0 software was used for statistical analysis. The paired t-test was used before and after surgery. Independent-samples t test was used in two groups before and after surgery, α=0.05.

RESULTS: The cataract phacoemulsification group: preoperative and 1mo after surgery, the mean macular thickness was 241.3±10.9μm and 279.7±16.5μm,with significant difference(P<0.01). The mean macular thickness was 245.6±12.6μm 3mo after surgery without statistical difference compared with preoperative(P>0.05). The mean macular thickness was 279.7±16.5μm 1mo after surgery and 245.6±12.6μm 3mo after surgery with statistical difference(P<0.05). Three eyes displayed cystoid macular edema at 1mo after surgery and 2 eyes of them was resolved 3mo after surgery. The group of MSICS: preoperative and 1mo after surgery, the mean macular thickness was 240.5±11.9μm and 280.7±16.8μm,with significant difference(P<0.01).The mean macular thickness was 246.6±13.2μm 3mo after surgery without statistical difference compared with preoperative(P>0.05). One month after surgery and 3mo after surgery, the mean macular thickness were 280.7±16.8μm and 246.6±13.2μm, with statistical difference(P<0.05). Two eyes displayed cystoid macular edema at 1mo after surgery and 2 eyes were resolved 3mo after surgery. Between the two groups pre-operation or after operation for 1, 3mo respectively P values were without statistical difference(P>0.05).

CONCLUSION: The macular thickness and macular edema can be found 1mo after cataract phacoemulsification and MSICS. Three months post-operatively, macular edema disappears and does not show statistical difference compared with preoperative. The increase of macular thickness has no obvious relationship with the choice of surgery.