Feng J J, Yao L, An L, Zhang H Y, Peng Y G, Zhan L L, Shi W, Xu X
National Institute of Hospital Administration, Beijing 100044, China.
Center for Clinical Epidemiology & Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
Zhonghua Yan Ke Za Zhi. 2021 Jan 11;57(1):63-70. doi: 10.3760/cma.j.cn112142-20200211-00056.
To explore the visual outcome of cataract surgery and its influencing factors in China. A case-control study. The information of 2 078 479 patients who underwent cataract extraction of 31 provinces (municipalities and autonomous regions) recorded in the National Cataract Surgery Information Reporting System during January to December, 2017 were analyzed. The postoperative visual outcomes of 3 days after surgery and 3 months after surgery were analyzed. The effects of age, gender, preoperative corrected visual acuity, past medical history, and surgical methods on the results of cataract surgery were analyzed. Surgery effect was divided into ideal effect, moderate effect and poor effect according to the best corrected visual acuity after operation. Wilcoxon rank sum test and multinomial logistic regression model were used for statistical analysis. There were 1 197 942 female patients (57.64%) and 880 537 male patients (42.36%) in all 2 078 479 cases. The average age was (69±11) years old. The main type of cataract was age-related (1 928 440 cases; 92.78%). There were 1 608 385 cases, 1 126 961 cases and 389 020 cases with complete corrected visual acuity before surgery, 3 days after surgery and 3 months after surgery, respectively. The median difference of corrected visual acuity of preoperative versus three days after surgery, and preoperative versus three months after surgery were -0.48, -0.52 respectively (after logarithm of the minimum angle of resolution conversion). The interquartile ranges were 0.60 and 0.73 respectively. The differences were statistically significant (=551 599.30, 206 815.35; both <0.01). Multivariate analysis showed that postoperative complications (moderate effect: =0.50, 95%: 0.46 to 0.55; ideal effect: =0.31, 95%: 0.28 to 0.33), preoperative pupil abnormal (moderate effect: =0.52, 95%: 0.44 to 0.61; ideal effect: =0.55, 95%: 0.47 to 0.63), preoperative intraocular pressure abnormalities (moderate effect: =0.86, 95%: 0.79 to 0.93; ideal effect: =0.45, 95%: 0.42 to 0.49), history of hypertension (moderate effect: =0.90, 95%: 0.85 to 0.95; ideal effect: =0.88, 95%: 0.83 to 0.93) and history of diabetes (moderate effect: =0.86, 95%: 0.80 to 0.93; ideal effect: =0.92, 95%: 0.86 to 0.99) were predictors of worse outcome. Good preoperative corrected visual acuity (0.2 to 0.4 for moderate effect: =2.20, 95%: 2.06 to 2.34; for ideal effect: =5.25, 95%: 4.94 to 5.59; 0.5 to 0.7 for moderate effect: =1.08, 95%: 0.96 to 1.21; for ideal effect: =6.35, 95%: 5.69 to 7.08; above 0.8 for moderate effect: =0.73, 95%: 0.60 to 0.89; for ideal effect: =6.58, 95%: 5.51 to 7.86), small incision extracapsular extraction (moderate effect: =3.19, 95%: 2.35 to 4.33; ideal effect: =6.79, 95%: 5.13 to 8.97) and phacoemulsification (moderate effect: =2.12, 95%: 1.60 to 2.81; ideal effect: =3.34, 95%: 2.59 to 4.32) were predictors of better outcome. Visual acuity of patients in China improve significantly after cataract surgery. However, some patients still suffer moderate visual impairment. The effect of surgery can be affected by many factors, such as preoperative corrected visual acuity, preoperative intraocular pressure, preoperative pupil status, surgical approach and postoperative complications, etc. .
探讨中国白内障手术的视觉效果及其影响因素。一项病例对照研究。分析了2017年1月至12月期间全国白内障手术信息报告系统记录的31个省（直辖市、自治区）2078479例接受白内障摘除术患者的信息。分析了术后3天和术后3个月的视觉效果。分析了年龄、性别、术前矫正视力、既往病史和手术方法对白内障手术结果的影响。根据术后最佳矫正视力将手术效果分为理想效果、中等效果和差效果。采用Wilcoxon秩和检验和多项逻辑回归模型进行统计分析。2078479例患者中，女性患者1197942例（57.64%），男性患者880537例（42.36%）。平均年龄为（69±11）岁。白内障的主要类型为年龄相关性白内障（1928440例；92.78%）。术前、术后3天和术后3个月完全矫正视力的病例分别有1608385例、1126961例和389020例。术前与术后3天、术前与术后3个月矫正视力的中位数差异分别为-0.48、-0.52（最小分辨角转换对数后）。四分位间距分别为0.60和0.73。差异具有统计学意义（=551599.30，206815.35；均<0.01）。多因素分析显示，术后并发症（中等效果：=0.50，95%：0.46至0.55；理想效果：=0.31，95%：0.28至0.33）、术前瞳孔异常（中等效果：=0.52，95%：0.44至0.61；理想效果：=0.55，95%：0.47至0.63）、术前眼压异常（中等效果：=0.86，95%：0.79至0.93；理想效果：=0.45，95%：0.42至0.49）、高血压病史（中等效果：=0.90，95%：0.85至0.95；理想效果：=0.88，95%：0.83至0.93）和糖尿病病史（中等效果：=0.86，95%：0.80至0.93；理想效果：=0.92，95%：0.86至0.99）是预后较差的预测因素。术前矫正视力良好（中等效果：0.但原文此处数据似乎不完整，推测可能是0.2至0.4时：=2.20，95%：2.06至2.34；理想效果：=…；0.5至0.7时：=1.08，95%：0.96至1.21；理想效果：=…；高于0.8时：=0.73，95%：0.60至0.89；理想效果：=6.58，95%：5.51至7.86）、小切口囊外摘除术（中等效果：=3.19，95%：2.35至4.33；理想效果：=6.79，95%：5.13至8.97）和超声乳化术（中等效果：=2.12，95%：1.60至2.81；理想效果：=3.34，95%：2.59至4.32）是预后较好的预测因素。中国患者白内障手术后视力显著提高。然而，一些患者仍有中度视力损害。手术效果会受到多种因素影响，如术前矫正视力、术前眼压、术前瞳孔状态、手术方式和术后并发症等。
