轴长大于 33mm 的白内障手术结果。
Outcomes of Cataract Surgery in Eyes With Axial Length > 33 mm.
机构信息
Eye Institute, Eye and Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; NHC Key Laboratory of Myopia (Fudan University) (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Shanghai Key Laboratory of Visual Impairment and Restoration (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China.
Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital (A.W.), Nagoya, Aichi, Japan.
出版信息
Am J Ophthalmol. 2024 Sep;265:137-146. doi: 10.1016/j.ajo.2024.04.020. Epub 2024 May 1.
PURPOSE
To evaluate the visual outcomes and perioperative complications for cataract surgery in eyes with axial length (AL) >33.0 mm.
DESIGN
Prospective clinical cohort study.
METHODS
One hundred twenty-two eyes with moderate high myopia (26.0 mm ≤ AL < 28.0 mm, control group), and 118 eyes with extreme high myopia (AL > 33.0 mm, EHM group) were followed up after cataract surgery (1 week and 1 year post-op). Myopic maculopathy grading according to ATN system, best-corrected visual acuity (BCVA), and complications were compared.
RESULTS
Postoperatively, BCVA in the EHM group improved significantly at both visits (both P < .001), despite being worse than that of the control group (both P < .05). The EHM group exhibited greater hyperopic refractive errors (P < .001), which were found to be associated with more severe T grade, longer AL, poorer second follow-up BCVA, and smaller anterior capsular opening (ACO) area. A higher incidence of retinal detachment and a more constricted ACO were observed in the EHM group (P = .030 and <.001, respectively), with the latter being significantly associated with longer AL and the absence of capsular tension ring (both P < .05). No difference in BCVA was found between the aphakic and pseudophakic eyes in the EHM group at both visits (both P > .05).
CONCLUSION
Cataract surgery improves vision of eyes with AL >33 mm, yet the increased risk of perioperative complications requires attention. Leaving these eyes aphakic might be effective and safe in the long term.
目的
评估眼轴长度（AL）＞33.0mm 白内障手术的术后视力结果和围手术期并发症。
设计
前瞻性临床队列研究。
方法
对 122 只中度高度近视眼（26.0mm≤AL＜28.0mm，对照组）和 118 只高度近视眼（AL＞33.0mm，EHM 组）进行白内障手术后（术后 1 周和 1 年）随访。比较近视性黄斑病变分级、最佳矫正视力（BCVA）和并发症。
结果
EHM 组术后两次随访 BCVA 均明显提高（均 P＜.001），但均差于对照组（均 P＜.05）。EHM 组表现出更大的远视屈光不正（P＜.001），这与更严重的 T 级、更长的 AL、较差的第二次随访 BCVA 和更小的前囊开口（ACO）面积有关。EHM 组视网膜脱离发生率较高，ACO 较窄（P=.030 和＜.001），后者与更长的 AL 和缺乏囊张力环明显相关（均 P＜.05）。EHM 组在两次随访中，无晶状体眼和人工晶状体眼的 BCVA 均无差异（均 P＞.05）。
结论
白内障手术可改善 AL＞33.0mm 眼的视力，但围手术期并发症风险增加需要引起关注。长期保持无晶状体状态可能是有效且安全的。
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