前后段联合手术治疗玻璃体视网膜疾病合并白内障的临床疗效

Clinical effect of combined anterior and posterior segment surgery for vitreoretinal diseases with cataract

摘要:

目的：观察前后段联合手术治疗玻璃体视网膜疾病合并白内障的临床疗效及对患者术后视力恢复和并发症的影响。

方法：回顾性分析2016-01/2017-12我院收治的玻璃体视网膜疾病合并白内障患者94例94眼的临床资料，其中A组50例50眼行同期玻璃体切除联合白内障超声乳化吸出术，B组44例44眼先行Ⅰ期玻璃体切除术，再行Ⅱ期白内障超声乳化吸出术。比较两组患者术后视力改善情况和最佳矫正视力(BCVA)、眼压及术后并发症发生情况。

结果：末次随访时，两组患者视力提高率差异无统计学意义(P>0.05)，B组患者BCVA为0.59±0.17，明显优于A组(0.78±0.28)，差异有统计学意义(P<0.05)； 两组患者手术前后眼压比较，差异均无统计学意义(P>0.05)。随访期间，A组患者前房炎性反应发生率为52%，明显高于B组的20%，差异有统计学意义(P<0.05)，而两组患者一过性高眼压、虹膜红变等其它并发症发生率比较，差异均无统计学意义(P>0.05)。

结论：同期前后段联合手术与分期联合手术治疗玻璃体视网膜疾病合并白内障均安全、有效，前者手术视野更为清晰，操作更为简便，后者则能够减轻前房炎性反应，对术后视力改善具有一定优势，临床应根据病情选择恰当的手术方式。

Abstract:

AIM: To observe the clinical effect of combined anterior and posterior segment surgery in the treatment of vitreoretinal diseases with cataract and the influence on visual acuity recovery and complications after surgery.

METHODS: The clinical data of 94 patients(94 eyes)with vitreoretinal diseases complicated with cataract treated in the hospital during the period from January 2016 to December 2017 were collected retrospectively. Fifty of them treated by vitrectomy combined with phacoemulsification were included in Group A, and the other 44 cases treated by one-stage vitrectomy and two-stage phacoemulsification were included in Group B. The improvement rate of visual acuity, best corrected visual acuity(BCVA), changes of intraocular pressure(IOP)and incidence of complications after surgery were compared between the two groups.

RESULTS: There was no significant difference in the improvement rate of visual acuity between Group A and Group B(P>0.05). The logMAR BCVA of Group B at the last follow-up was significantly better than that of Group A(0.59±0.17 vs 0.78±0.28, P<0.05), but there was no significant difference in IOP between the two groups before and after surgery(P>0.05). The incidence of anterior chamber inflammatory response in Group A was significantly higher than that in Group B(52% vs 20%, P<0.05), but there was no significant difference between the two groups in other complications, such as transient high IOP or rubeosis iridis(P>0.05).

CONCLUSION: Both concurrent anterior and posterior segment surgery and stage surgery are safe and effective in the treatment of vitreoretinal diseases with cataract. The surgical field of the former is clearer and it is easier to operate while the latter can alleviate the anterior chamber inflammatory response, with certain advantages in improvement of postoperative visual acuity. The appropriate surgical method should be chosen according to the patient's condition.