白內障術后對黃斑的影響機制研究

林婉明

【摘要】 目的：研究白內障術后對黃斑的影響機制。方法：將2018年4月-2019年4月在本院就診的90例（135只眼）白內障行手術治療的患者納為研究象，單眼手術45例，雙眼手術45例。根據手術方式將入選者分為兩組：A組75只眼（超聲乳化），B組60只眼（青白聯合）;根據有無合并癥分為兩組：Ⅰ組85只眼（無合并癥），Ⅱ組50只眼（合并糖尿病）。所有患者術后采用OCT檢查，比較各組術后視力及黃斑變化的結果。結果：單眼與雙眼術后視力提高行數比較，差異無統計學意義（P>0.05）;A、B組手術前后FRT對比，差異均無統計學意義（P>0.05）;Ⅰ、Ⅱ組術前FRT比較，差異無統計學意義（P>0.05），Ⅱ組術后FRT相比Ⅰ組增厚（P<0.05）;A組術后CME發生率為13.33%，較B組的33.33%低（P<0.05），Ⅱ組術后CME發生率為40.00%，比Ⅰ組的23.53%高（P<0.05）。結論：白內障患者的性別、年齡、術后檢查方式對術后黃斑水腫結果均無影響，手術方式與有無合并癥是影響黃斑變化的因素，降低黃斑囊性水腫的發生率，減少視網膜中心凹厚度增加的概率。

【關鍵詞】 白內障 白內障切除術 術后 黃斑

[Abstract] Objective： To study the effect mechanism of macula lutea after cataract surgery. Method： A total of 90 patients （135 eyes） underwent cataract surgery treated in our hospital from April 2018 to April 2019 were selected. The monocular surgery was performed in 45 patients and binoculus surgery performed in 45 patients. According to operation modes， patients were assigned to group A （75 eyes， ultrasonic emulsification） and group B （60 eyes， glaucoma and cataract surgery）. According to the occurrences of complications， patients were assigned to group Ⅰ （85 eyes， no complications） and group Ⅱ （50 eyes， complicated with diabetes mellitus）. Optical coherence tomography （OCT） was performed in all patients， the visual acuity and macular changes in each group were observed. Result： After surgery， the improvement degree of visual acuity of monocular and binoculus compared， there was no significant difference （P>0.05）. Before and after surgery， the foveal retinal thickness （FRT） between group A and group B was not significant difference （P>0.05）. Before surgery， FRT between group Ⅰ and group Ⅱ was not significantly different （P>0.05）; after surgery， FRT in group Ⅱ was greater than that in group Ⅰ （P<0.05）. The incidence rate of cystoid macular edema （CME） in group A was 13.33%， which was lower than 33.33% in group B （P<0.05）. The incidence rate of CME in group Ⅱ was 40.00%， which was higher than 23.53% in group Ⅰ （P<0.05）. Conclusion： Patients gender， age and examination modes produce no effects on the occurrence of macular edema; however， the operation modes and complications will affect the macular changes， it is of great importance to reduce the incidence rate of CME and foveal retinal thickness.?[Key words] Cataract Cataract extraction Postoperative Macula luteaFirst-authors address： Jiangmen Peoples Hospital， Jiangmen 529000， China

白內障是指晶狀體發生混濁的進行性眼科疾病，可由多種原因引起，會引起眼部并發癥。白內障根本原因是晶狀體代謝功能紊亂致晶狀體蛋白質變性，主要表現為視物模糊或顏色變暗等，最初可表現為有時眼前出現固定性的黑點，后發展為視力減退、怕光等，甚至失明，對患者日常生活帶來重大影響[1-2]。目前針對白內障的治療方法主要是手術切除，稱白內障超聲乳化術。隨著醫療技術的發展，術后并發癥相對于傳統手術有所提高，但還存在一定的術后并發癥，如黃斑囊樣水腫（CME），發生率大幅度下降。有研究證明，單純白內障患者白內障超聲乳化術后CME的發生率由以前的半數以上降至1%～2%，合并并發癥的患者的下降幅度較小，因此合并癥可能是影響術后CME的發生因素[3]。本文就白內障術后對黃斑的影響機制展開討論，現報道如下。