Hillenmayer Anna, Wertheimer Christian M, Koenig Susanna F, Hartmann Lennart M, Freisenich Tim, Begaj Dorian, Wolf Armin, Vounotrypidis Efstathios
Department of Ophthalmology, University Hospital Ulm, Prittwitzstr. 43, Ulm 89075, Germany.
Department of Ophthalmology, University Hospital Ulm, Ulm, Germany.
Ther Adv Ophthalmol. 2025 Oct 6;17:25158414251378632. doi: 10.1177/25158414251378632. eCollection 2025 Jan-Dec.
BACKGROUND/OBJECTIVES: To evaluate the effect of macular status and fixation, as determined by chord alpha, on refractive outcomes following combined phacovitrectomy for retinal detachment. Although an optical biometer can be used to calculate the required dioptric power of the intraocular lens, loss of central fixation can introduce errors into the biometric parameters.
Retrospective single-center observational study.
Patients with retinal detachment and cataract who underwent combined phacoemulsification and vitrectomy following swept-source optical coherence tomography-based biometry (ZEISS IOLMaster 700) were included, and their preoperative macular status, chord-alpha length, and resulting refractive error at the final follow-up appointment were recorded.
A total of 305 eyes were evaluated, of which 150 had macular detachment. There was a statistically significantly higher rate of refractive error in eyes with macular detachment compared to eyes without ( < 0.001). Absolute refractive prediction error of more than 1 diopter was found in 31% of eyes with detached maculae, compared to 12% of eyes without macular involvement. Eyes with a detached macula showed a significantly longer chord alpha (right eye: = 0.01; left eye: < 0.0001), and linear regression analysis revealed that a longer chord alpha was associated with a myopic refractive error. The presence of other factors that also correlated with refractive error underscores the multifactorial pathogenesis of refractive prediction error.
Compared to non-macular involvement, macular detachment led to worse refractive outcomes in combined phacovitrectomy, and chord alpha, as a marker for central fixation, might serve as an explanation. Further research is needed to determine whether combined phacoemulsification and vitrectomy should be performed in patients with macular detachment.
背景/目的：评估视网膜脱离联合晶状体玻璃体切除术后，由视轴α角所确定的黄斑状态和注视对屈光结果的影响。尽管光学生物测量仪可用于计算人工晶状体所需的屈光度，但中心注视丧失会给生物测量参数带来误差。
回顾性单中心观察性研究。
纳入在基于扫频光学相干断层扫描的生物测量（蔡司IOLMaster 700）后接受晶状体超声乳化和玻璃体切除术的视网膜脱离合并白内障患者，记录其术前黄斑状态、视轴α角长度以及最终随访时的屈光不正情况。
共评估305只眼，其中150只存在黄斑脱离。与无黄斑脱离的眼相比，黄斑脱离的眼中屈光不正发生率在统计学上显著更高（<0.001）。黄斑脱离的眼中31%的绝对屈光预测误差超过1屈光度，而无黄斑受累的眼中这一比例为12%。黄斑脱离的眼视轴α角明显更长（右眼：=0.01；左眼：<0.0001），线性回归分析显示视轴α角越长与近视性屈光不正相关。其他与屈光不正相关的因素的存在强调了屈光预测误差的多因素发病机制。
与无黄斑受累相比，黄斑脱离在联合晶状体玻璃体切除术中导致更差的屈光结果，视轴α角作为中心注视的一个指标，可能是一个解释。需要进一步研究以确定黄斑脱离患者是否应进行晶状体超声乳化和玻璃体切除术联合手术。
