山东大学耳鼻喉眼学报 ›› 2022, Vol. 36 ›› Issue (4): 97-102.doi: 10.6040/j.issn.1673-3770.0.2022.020

• • 上一篇    

超声乳化术对老年性白内障黄斑区视网膜结构影响的临床研究

杨茹1,张玉光2,徐湘辉3,吴雪莲3,陶远3,谭越3   

  1. 1.潍坊医学院 临床医学院, 山东 潍坊 261042;
    2.潍坊医学院 临床医学院 眼科学教研室, 山东 潍坊 261042;
    3.济南市第二人民医院 眼科, 山东 济南 250000
  • 发布日期:2022-07-11
  • 通讯作者: 张玉光. E-mail:jnzyg1962@163.com;徐湘辉. E-mail:13969176565@163.com

A clinical study on the effect of phacoemulsification on the retinal structure in the macular region of senile cataract

YANG Ru1, ZHANG Yuguang2, XU Xianghui3, WU Xuelian3, TAO Yuan3, TAN Yue3   

  1. 1. The School of Clinical Medical, Weifang Medical University, Weifang 261042, Shandong, China;
    2. Department of Ophthalmology, School of Clinical Medicine, Weifang Medical University, Weifang 261042, Shandong, China;
    3.Department of Ophthalmology, The Jinan Second People's Hospital, Jinan 250000, Shandong, China
  • Published:2022-07-11

摘要: 目的 应用光学相干断层扫描血管成像(OCTA)观察老年性白内障患者超声乳化术后黄斑区血流密度、视网膜厚度和中心凹无血管区(FAZ)面积的变化。探究术中参数对黄斑区结构变化的影响以及探索影响术后视力的因素。 方法 这是一项前瞻性观察研究。老年性白内障患者超声乳化术前及术后1 d、1周、1个月、3个月应用OCTA进行黄斑区3 mm×3 mm自动化扫描,以获得黄斑区血流密度、视网膜厚度及FAZ面积。记录术中累计释放能量(CDE)和有效超声乳化时间(EPT),分析其与黄斑区视网膜结构变化的相关性。应用二分类Logistic回归分析探究影响术后视力的因素。 结果 41例(41眼)纳入最终分析。与术前相比,术后1 d、1周、1个月、3个月黄斑区血管线性密度、灌注密度均增加(P<0.05),FAZ面积均降低(P<0.001);术后1个月、3个月黄斑区视网膜厚度均较术前增加(P<0.05)。术中CDE、EPT与黄斑区视网膜结构变化无相关性(P>0.05),术后最佳矫正视力(BCVA)与黄斑区血流密度、视网膜厚度、FAZ面积、CDE和EPT均无相关性(P>0.05)。 结论 老年性白内障患者超声乳化术后黄斑区血流密度、视网膜厚度增加,FAZ面积降低,手术参数不是引起术后视网膜结构变化的主要因素,手术参数和视网膜结构的变化对术后视力无影响,应当进一步探究术后黄斑区视网膜结构变化的原因以及影响术后视力恢复的因素。

关键词: 光学相干断层扫描血管成像, 超声乳化术, 老年性白内障, 血流密度, 视网膜厚度, 中心凹无血管区

Abstract: Objective Optical coherence tomography angiography(OCTA)is used to observe the changes of blood flow density, retinal thickness, and foveal avascular zone(FAZ)in the macular region after phacoemulsification in patients with senile cataract. The objective of this study is to explore the influence of intraoperative parameters on the structural changes of the macular area and to explore the factors affecting postoperative visual acuity. Methods This is a prospective observational study. Patients with senile cataract who underwent phacoemulsification before operation, and 1 day, 1 week, 1 month, and 3 months after operation, underwent imaging of the macular area using the 3×3 mm OCTA scan to obtain the macular blood flow density, thickness of the retina, and the area of FAZ. Cumulative release energy(CDE)and effective phacoemulsification time(EPT)were recorded, and their correlation with the changes of macular retinal structure was analyzed. Using binary logistic regression analysis to explore the factors affecting postoperative visual acuity. Results Forty-one cases(41 eyes)were included in the final analysis. Compared with those before operation, the linear density and perfusion density of the macular area increased at 1 day, 1 week, 1 month, and 3 months after operation(P<0.05), and the FAZ area decreased(P<0.001); the retinal thickness in the macular increased at 1 month and 3 months after operation compared with preoperative(P<0.05). There was no correlation between CDE and EPT and macular retinal structural changes(P>0.05), and postoperative best corrected visual acuity(BCVA)had no correlation with macular blood flow density, retinal thickness, FAZ area, CDE and EPT(P>0.05). Conclusion After phacoemulsification, the blood flow density and retinal thickness in the macular increased, and the FAZ area decreased. The surgical parameters were not the main factors that caused changes of the postoperative retinal structure. The changes in surgical parameters and retinal structure had no effect on postoperative visual acuity. We should further explore the reasons for the changes of postoperative retinal structure in the macular region and the factors affecting the recovery of postoperative visual acuity.

Key words: Optical coherence tomography angiography, Phacoemulsification, Senile cataract, Blood flow density, Retinal thickness, Foveal avascular zone

中图分类号: 

  • R776.1
[1] 齐跃东. 某居民区50岁及以上人群白内障情况调查[J]. 中华眼外伤职业眼病杂志, 2017, 39(1): 42-45. doi:10.3760/cma.j.issn.2095-1477.2017.01.012. QI Yuedong. Epidemiological survey on incidence of cataract in persons of 50 years or over in a resident district[J]. Chinese Journal of Ocular Trauma and Occupational Eye Disease, 2017, 39(1): 42-45. doi:10.3760/cma.j.issn.2095-1477.2017.01.012.
[2] Hilton EJ, Hosking SL, Gherghel D, et al. Beneficial effects of small-incision cataract surgery in patients demonstrating reduced ocular blood flow characteristics[J]. Eye(Lond), 2005, 19(6): 670-675. doi:10.1038/sj.eye.6701620.
[3] Zhao ZN, Wen W, Jiang CH, et al. Changes in macular vasculature after uncomplicated phacoemulsification surgery: optical coherence tomography angiography study[J]. J Cataract Refract Surg, 2018, 44(4): 453-458. doi:10.1016/j.jcrs.2018.02.014.
[4] Zhou YF, Zhou MW, Wang YL, et al. Short-term changes in retinal vasculature and layer thickness after phacoemulsification surgery[J]. Curr Eye Res, 2020, 45(1): 31-37. doi:10.1080/02713683.2019.1649703.
[5] 刘俊, 廖荣丰. 基于OCTA的白内障超声乳化术后黄斑区视网膜厚度和血管密度分析[J]. 眼科新进展, 2020, 40(4): 377-380. doi:10.13389/j.cnki.rao.2020.0087. LIU Jun, LIAO Rongfeng. Changes of macular retinal thickness and vessel density after phacoemulsification using optical coherence tomography angiography[J]. Recent Advances in Ophthalmology, 2020, 40(4): 377-380. doi:10.13389/j.cnki.rao.2020.0087.
[6] Pilotto E, Leonardi F, Stefanon G, et al. Early retinal and choroidal OCT and OCT angiography signs of inflammation after uncomplicated cataract surgery[J]. Br J Ophthalmol, 2019, 103(7): 1001-1007. doi:10.1136/bjophthalmol-2018-312461.
[7] 李锐, 李勇, 谢洪涛, 等. 眼压波动对人工晶体植入术患者眼底黄斑及视盘血流密度的影响分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 89-92. doi:10.6040/j.issn.1673-3770.0.2019.280. LI Rui, LI Yong, XIE Hongtao, et al. Effects of intraocular lens implantation and postoperative intraocular pressure fluctuations on the fundus macular and optic disc vascular density[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 89-92. doi:10.6040/j.issn.1673-3770.0.2019.280.
[8] Perente I, Utine CA, Ozturker C, et al. Evaluation of macular changes after uncomplicated phacoemulsification surgery by optical coherence tomography[J]. Curr Eye Res, 2007, 32(3): 241-247. doi:10.1080/02713680601160610.
[9] 施毓琳, 徐国兴. 白内障术后人工晶状体眼黄斑囊样水肿的研究进展[J]. 国际眼科杂志, 2020, 20(9): 1539-1542. doi:10.3980/j.issn.1672-5123.2020.9.14. SHI Yulin, XU Guoxing. Research progress of pseudophakic cystoid macular edema[J]. International Eye Science, 2020, 20(9): 1539-1542. doi:10.3980/j.issn.1672-5123.2020.9.14.
[10] de Maria M, Iannetta D, Cimino L, et al. Measuring anterior chamber inflammation after cataract surgery: a review of the literature focusing on the correlation with cystoid macular edema[J]. Clin Ophthalmol, 2020, 14: 41-52. doi:10.2147/OPTH.S237405.
[11] Miyake K. Prostaglandins levels in the aqueous of vitreous tug syndrome and their changes by pars Plana vitrectomy(author's transl)[J]. Nippon Ganka Gakkai Zasshi, 1980, 84(10): 1461-1467. doi:10.1016/s0886-3350(02)01243-9.
[12] 丛玮霞, 张仲臣, 郝晓琳. 糖尿病患者白内障术后黄斑区厚度改变机制的现况研究[J]. 国际眼科杂志, 2017, 17(5): 888-890. doi:10.3980/j.issn.1672-5123.2017.5.21. CONG Weixia, ZHANG Zhongchen, HAO Xiaolin. Mechanism of the macular fovea thickness change after cataract surgery in diabetic patients[J]. International Eye Science, 2017, 17(5): 888-890. doi:10.3980/j.issn.1672-5123.2017.5.21.
[13] Liu J, Liu Q, Yu H, et al. Microvascular changes in macular area after phacoemulsification and its influencing factors assessed by optical coherence tomography angiography[J]. Ther Clin Risk Manag, 2021, 17: 405-414. doi:10.2147/TCRM.S309679.
[14] Vasavada AR, Praveen MR, Vasavada VA, et al. Impact of high and low aspiration parameters on postoperative outcomes of phacoemulsification: randomized clinical trial[J]. J Cataract Refract Surg, 2010, 36(4): 588-593. doi:10.1016/j.jcrs.2009.11.009.
[15] 旷琳, 杨蕾蕾. 白内障超声乳化人工晶状体植入术后黄斑中心凹视网膜厚度与最佳矫正视力的相关性研究[J]. 眼科新进展, 2014, 34(12): 1167-1169. doi:10.13389/j.cnki.rao.2014.0324. KUANG Lin, YANG Leilei. Relationship between macular foveal retinal thickness and BCVA after phacoemulsification and IOL implantation[J]. Recent Advances in Ophthalmology, 2014, 34(12): 1167-1169. doi:10.13389/j.cnki.rao.2014.0324.
[16] Jia XY, Wei YJ, Song H. Optical coherence tomography angiography evaluation of the effects of phacoemulsification cataract surgery on macular hemodynamics in Chinese normal eyes[J]. Int Ophthalmol, 2021, 41(12): 4175-4185. doi:10.1007/s10792-021-01987-8.
[17] 彭稚薇, 徐飞, 秦贤杰. OCTA技术在白内障术后黄斑微循环变化中的应用[J]. 影像科学与光化学, 2021, 39(6): 854-859. doi:10.7517/issn.1674-0475.210509. PENG Zhiwei, XU Fei, QIN Xianjie. Application of OCTA technique in macular microcirculation after cataract surgery[J]. Imaging Science and Photochemistry, 2021, 39(6): 854-859. doi:10.7517/issn.1674-0475.210509.
[18] Feng L, Azhati G, Li TT, et al. Macular vascular density changes following cataract surgery in diabetic patients: an optical coherence tomography angiography study[J]. J Ophthalmol, 2021, 2021: 6641944. doi:10.1155/2021/6641944.
[19] Gharbiya M, Cruciani F, Cuozzo G, et al. Macular thickness changes evaluated with spectral domain optical coherence tomography after uncomplicated phacoemulsification[J]. Eye(Lond), 2013, 27(5): 605-611. doi:10.1038/eye.2013.28.
[20] Balaratnasingam C, Inoue M, Ahn S, et al. Visual acuity is correlated with the area of the foveal avascular zone in diabetic retinopathy and retinal vein occlusion[J]. Ophthalmology, 2016, 123(11): 2352-2367. doi:10.1016/j.ophtha.2016.07.008.
[1] 张敏综述李艳审校. OCT及OCTA在阿尔茨海默病诊断中的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 157-162.
[2] 张昕雨综述雷春燕,张美霞审校. 运用OCT及OCTA观察硅油对视网膜脉络膜的影响[J]. 山东大学耳鼻喉眼学报, 2021, 35(5): 132-136.
[3] 王露萍综述黄映湘, 王艳玲审校. 眼缺血综合征研究进展[J]. 山东大学耳鼻喉眼学报, 2020, 34(4): 23-27.
[4] 李锐,李勇,谢洪涛,岳章显,刘钊臣,袁慧敏. 眼压波动对人工晶体植入术患者眼底黄斑及视盘血流密度的影响分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 89-92.
[5] 陈莹,李元彬. 先天性白内障治疗新进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 143-148.
[6] 高雪,郝琳琳,刘少华,张晗. 两种人工晶体计算公式预测闭角型青光眼合并白内障患者超声乳化手术后屈光度准确性的比较[J]. 山东大学耳鼻喉眼学报, 2018, 32(1): 68-71.
[7] 邓志峰. 改良白内障超声乳化术的临床研究[J]. 山东大学耳鼻喉眼学报, 2016, 30(3): 85-88.
[8] 房修岭, 姜虎林, 吴建霞, 韩旭巍, 张辽. 0.5%聚维酮碘冲洗结膜囊预防白内障术后眼内炎[J]. 山东大学耳鼻喉眼学报, 2014, 28(5): 66-67.
[9] 蔡婉婷,毕宏生,吴建峰,解孝锋,刘冬梅 . 超声乳化术治疗葡萄膜炎并发性白内障39例[J]. 山东大学耳鼻喉眼学报, 2008, 22(1): 10-12 .
[10] 司艳芳,关 娟,周 历,盛 豫 . 高龄白内障患者手术前后泪膜变化[J]. 山东大学耳鼻喉眼学报, 2008, 22(1): 13-16 .
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!