Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
Br J Ophthalmol. 2012 Jun;96(6):846-51. doi: 10.1136/bjophthalmol-2011-301233. Epub 2012 Mar 9.
To examine the impact of bilateral or unilateral cataract surgery on visual functioning.
The Singapore Malay Eye Study is a population-based study of 3280 Singapore Malay patients aged 40-80 years, of which 3225 had data available for inclusion. Cataracts were graded from digital lens photographs according to the Wisconsin scale. Study subjects were categorised as having: bilateral cataract surgery performed; unilateral cataract surgery performed with minimal cataract in the fellow eye; unilateral cataract surgery performed with significant cataract in the fellow eye; and bilateral cataract. Visual functioning was assessed using the modified VF-9 scale culturally adapted for Singaporean individuals, validated by Rasch analysis. The overall Rasch-modified vision-specific functioning score was compared across the four groups after adjusting for confounders such as age, gender, ocular and systemic comorbidities.
Persons with bilateral cataract had poorer visual functioning than those who had bilateral cataract surgery (mean visual functioning scores 3.38 vs 3.11, respectively, p=0.029). When compared with bilateral surgery, visual functioning improvements among patients with unilateral cataract surgery depended on the status of the fellow eye, with improvements only seen if the fellow eye had significant cataract (mean visual functioning scores 2.81 vs 3.25, p=0.019) or poor visual acuity (mean visual functioning scores 2.78 vs 3.25, p=0.018) after adjusting for confounders.
Bilateral cataract surgery was associated with greater visual functioning over unilateral cataract surgery when the fellow eye had a significant cataract or poor presenting visual acuity, supporting the current practice of second eye surgery depending on the fellow eye's cataract status and visual acuity.
研究双眼或单眼白内障手术对视觉功能的影响。
新加坡马来人眼研究是一项基于人群的研究，共纳入 3280 名 40-80 岁的新加坡马来患者，其中 3225 名患者的数据可用于纳入分析。白内障根据威斯康星分级系统从数字晶状体照片中分级。研究对象分为：行双侧白内障手术；对侧眼存在少量白内障而行单侧白内障手术；对侧眼存在大量白内障而行单侧白内障手术；以及双眼均有白内障。使用经文化适应的新加坡个体验证的改良 VF-9 量表评估视觉功能。在调整年龄、性别、眼部和全身合并症等混杂因素后，比较四组人群的整体改良后的 Rasch 视觉特定功能评分。
双眼白内障患者的视觉功能较行双侧白内障手术的患者差（平均视觉功能评分分别为 3.38 和 3.11，p=0.029）。与双侧手术相比，单侧白内障手术患者的视觉功能改善情况取决于对侧眼的状态，如果对侧眼存在大量白内障（平均视觉功能评分分别为 2.81 和 3.25，p=0.019）或视力较差（平均视觉功能评分分别为 2.78 和 3.25，p=0.018），则可观察到视觉功能改善，在调整混杂因素后。
当对侧眼存在大量白内障或视力较差时，双侧白内障手术与单侧白内障手术相比，视觉功能更好，支持目前根据对侧眼白内障状况和视力进行第二眼手术的实践。
