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目的 探讨超高度近视并发白内障患者行超声乳化白内障摘出联合囊袋张力环植入术后治疗效果.方法 采用随机对照临床研究设计,收集2016年10月至2018年12月上海交通大学附属第六人民医院南院收治的超高度近视并发白内障患者48例48眼,采用随机数字表法将患者分为对照组和试验组,每组24例24眼.试验组超声乳化白内障摘出术中联合囊袋张力环植入,对照组仅行超声乳化白内障摘出术.术后随访3个月,观察并比较2个组术前及术后1周、1个月和3个月最佳矫正视力(BCVA)、眼压、角膜内皮细胞计数、人工晶状体(IOL)偏心量、主观视觉质量及术后IOL倾斜度、并发生发生情况.结果 2个组患者术后视力均较术前提高,差异均有统计学意义(均P＜0.05).2个组患者眼压比较差异无统计学意义(F--0.122,P=0.729).2个组患者角膜内皮细胞计数比较差异无统计学意义(F=0.006,P=0.939).术后1个月、3个月2个组患者IOL水平偏心量、垂直偏心量及总偏心量比较差异均无统计学意义(均P＞0.05).术后1个月试验组IOL在水平方向倾斜度和总倾斜度较对照组明显降低,差异均有统计学意义(均P＜0.05);术后3个月试验组IOL在垂直方向倾斜度和总倾斜度较对照组明显降低,差异均有统计学意义(均P＜0.05).试验组患者术后1周、1个月、3个月主观视觉质量评分分别为2.85±0.24、3.30±0.36和3.43±0.42,对照组分别为2.34±0.23、2.65±0.44和2.57±0.39,均较术前的1.31±0.22和1.19±0.17提高,差异均有统计学意义(均P＜0.01);术后1周、1个月和3个月试验组术后主观视觉质量评分均大于相应时间点对照组,差异均有统计学意义(均P＜0.01).结论 联合应用囊袋张力环治疗超高度近视并发白内障安全性好,疗效稳定,并能获得良好的视觉质量.

Objective To investigate the effect of phacoemulsification combined with capsular tension ring implantation in patients with ultra-high myopia and cataract.Methods A randomized-controlled study was performed.The clinical data of 48 eyes of 48 patients with ultra-high myopia and cataract were collected at Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus from October 2016 to December 2018.The patients were randomly divided into a control group and a clinical trial group using a random number table method,with 24.eyes in each group.The eyes in the control group underwent phacoemulsification,and capsular tension ring implantation was performed during the surgery in the trial group.The patients were followed up for 3 months.Best corrected visual acuity (BCVA),intraocular pressure,corneal endothelial cell count,intraocular lens (IOL) decentration,and subjective visual quality were observed and compared preoperatively and 1 week,1 month and 3 months postoperatively,and the postoperative inclination angle of the IOL and surgical complications were compared between the two groups.Written informed consent was obtained from each patient prior to entering the study cohort.This study conformed to the tenets of the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus (No.2016-KY-05).Results The operation procedure was successfully completed,and the IOL was implanted into capsular bag in all the eyes.The postoperative BCVA was higher than that before surgery in both groups,with significant differences between them (all at P＜0.05).There were no significant differences in intraocular pressure and the corneal endothelial cell count between the two groups (F=0.122,P=0.729;F=0.006,P=0.939).The level of IOL horizontal decentration,vertical decentration,or total decentration were not significantly different between the two groups at 1 month and 3 months after operation (all at P＞0.05).At 1 month after operation,the horizontal and total inclination angles of the IOL in the trial group were statistically significantly lower than those in the control group (P＜0.05).At 3 months after operation,the vertical and total inclination angles of the IOL were significantly lower than those in the control group (both at P＜0.05).The total inclination in the trail group was significantly lower than that of the control group (P＜0.05).The subjective visual quality scores of the patients in the trial group at 1 week,1 month,and 3 months after operation were 2.85 t 0.24,3.30± 0.36,and 3.43 ± 0.42,respectively,and those in the control group were 2.34±0.23,2.65 ±0.44,and 2.57 ± 0.39,respectively,both significantly improved over the preoperative 1.31 ± 0.22 and 1.19±0.17 (all at P＜0.01).Conclusions The use of a bag tension ring in phacoemulsification for ultra-high myopia with cataract is safe and effective,and can result in good visual quality.