目的：分析术前黄斑区神经节细胞复合体(GCC)厚度对白内障合并青光眼术后视觉质量的影响。

方法：采用回顾性研究。收集2023年1月至2024年12月于我院接受超声乳化吸除人工晶状体植入联合房角分离手术治疗的白内障合并青光眼患者临床资料，术前评估黄斑区GCC厚度，采用三分位法按术前黄斑区GCC厚度分为低厚度组(<43.8 μm)、中厚度组(43.8-60.4 μm)、高厚度组(>60.4 μm)。术后1、3、6 mo通过视力(LogMAR值)、对比敏感度、视野情况以及主观视觉质量(QoV)评估术后视觉质量； 采用线性回归分析验证术前黄斑区GCC厚度对术后6 mo视力的影响。

结果：本研究纳入白内障合并青光眼患者115例115眼，低厚度组31例31眼，中厚度组47例47眼，高厚度组37例37眼。低厚度组年龄65.23±8.11岁，男17例，女14例。中厚度组年龄64.87±7.89岁，男20例，女27例。高厚度组年龄63.92±7.44岁，男23例，女14例。三组患者术前术后不同时间视力、对比敏感度值、视野平均偏差值、QoV评分比较有差异(均P<0.05)。术后1、3、6 mo，低厚度组视力LogMAR值、QoV评分高于中、高厚度组，且中厚度组高于高厚度组(均P<0.05)； 低厚度组低频、中频、高频对比敏感度值以及视野平均偏差值低于中、高厚度组，且中厚度组低于高厚度组(均P<0.05)。三组患者术后1、3、6 mo较术前视力、QoV评分均降低，低频、中频、高频对比敏感度值和视野平均偏差值均升高(均P<0.05)； 三组患者术后1 mo视力(LogMAR值)、QoV评分均高于术后3、6 mo，且术后3 mo高于术后6 mo(均P<0.05)； 三组患者术后1 mo低频、中频、高频对比敏感度值和视野平均偏差值均低于术后3、6 mo，且术后3 mo低于术后6 mo(均P<0.05)。经线性回归分析，模型拟合度良好(F=32.435，P<0.001)，术前黄斑区GCC厚度对术后6 mo视力(LogMAR)有负向影响(β=-0.003，P<0.001)； 回归方程为：Y=0.421-0.003×X_{术前黄斑区GCC厚度}； 模型决定系数R2=0.223，提示术前黄斑区GCC厚度可解释术后6 mo视力变异程度的22.3%； 术前黄斑区GCC厚度每减少1 μm，术后6 mo LogMAR视力值平均增加0.003。

结论：术前黄斑区GCC厚度是白内障合并青光眼术后视觉质量的保护因素，术前黄斑区GCC越厚，术后1、3、6 mo视力、对比敏感度、视野恢复越好，且术前黄斑区GCC厚度每减少1 μm，术后6 mo LogMAR视力值平均增加0.003，可作为术后视觉质量的术前预测指标之一。

METHODS:This retrospective study collected clinical data of patients with cataract and glaucoma who underwent phacoemulsification, intraocular lens implantation, and goniosynechialysis surgery in the hospital from January 2023 to December 2024. Preoperative macular GCC thickness was assessed and patients were divided into three groups according to preoperative macular GCC thickness using the tertile method: low thickness group(<43.8 μm), medium thickness group(43.8-60.4 μm), and high thickness group(>60.4 μm). Postoperative visual quality was evaluated by visual acuity(LogMAR), contrast sensitivity, visual field and subjective visual quality(QoV)at 1, 3 and 6 mo post-operation. Linear regression analysis was used to verify the effect of preoperative macular GCC thickness on visual acuity at 6 mo after surgery.

RESULTS: Totally 115 patients(115 eyes)with cataract combined with glaucoma were enrolled, including 31 patients(31 eyes)in the low thickness group(17 males, 14 females, 65.23±8.11 y), 47 patients(47 eyes)in the medium thickness group(20 males, 27 females, 64.87±7.89 y)and 37 patients(37 eyes)in the high thickness group(23 males, 14 females, 63.92±7.44 y). There were significant differences in visual acuity, contrast sensitivity, mean deviation of visual field, and QoV scores among the three groups at different time points pre- and post-operation(all P<0.05). At 1, 3 and 6 mo postoperatively, the visual acuity(LogMAR)and QoV scores in the low thickness group were higher than those in the medium thickness and high thickness groups, and the medium thickness group showed higher values than the high thickness group(all P<0.05). The low thickness group had lower low-frequency, medium-frequency and high-frequency contrast sensitivity values as well as lower mean deviation of visual field compared with the medium and high thickness groups, and the medium thickness group had lower values than the high thickness group(all P<0.05). Visual acuity and QoV scores at 1, 3 and 6 mo post-operation were significantly decreased, while low-, medium- and high-frequency contrast sensitivity values and mean deviation of visual field were significantly elevated in the three groups compared with pre-operation.(all P<0.05). In all three groups, visual acuity(LogMAR)and QoV scores were higher at 1 mo postoperatively than those at 3 and 6 mo, and the values at 3 mo were higher than those at 6 mo(all P<0.05). Low-, medium- and high-frequency contrast sensitivity and mean deviation of visual field in three groups were lower at 1 mo postoperatively than those at 3 and 6 mo, with lower values at 3 mo than at 6 mo(all P<0.05). Through linear regression analysis, the model fit was good(F=32.435, PSymbol|@@0.001), and the thickness of GCC in the macular area pre-opertation had a negative impact on visual acuity(LogMAR)at 6 mo post-operation(β=-0.003, PSymbol|@@0.001). The regression equation was: Y=0.421-0.003×X _{preoperative macular GCC thickness}. The model determination coefficient R2=0.223. It indicated that the preoperative macular GCC thickness could explain 22.3% of the variance in visual acuity at 6 mo postoperatively. For every 1 μm decrease in preoperative GCC thickness, the average visual acuity(LogMAR)increased by 0.003 at 6 mo postoperatively.

CONCLUSION: Preoperative macular GCC thickness is a protective factor for visual quality after cataract combined with glaucoma surgery. The thicker the preoperative GCC thickness, the better the visual acuity, contrast sensitivity, and visual field recovery at 1, 3, and 6 mo post-operation. Moreover, for every 1 μm decrease in preoperative GCC thickness, the average visual acuity(LogMAR)at 6 mo after surgery increases by 0.003, which can be used as one of the preoperative predictive indicators for postoperative visual quality.