Study On Refractive Error In The Operation Of Vitrectomy Combined With Phacoemulsification And Intraocular Lens Implantation

Objective:To investigate the predictive errors of intraocular lens(IOL)on different kinds of fundus diseases(retinal vascular diseases and vitreous macular interface disease)undergoing phacovitrectomy and IOL implantation.Methods:It’s a retrospective study.According to the including and excluding criteria,two hundreds and sixteen eyes of 216 patients with phacovitrectomy and IOL implantation in He Eye Specialists Hospital from January 2017 to June 2020 were enrolled in the study group,one hundred and ten cataract eyes of 110 patients treated with phacoemulsification and IOL implantation were as control.The study group was divided into group A and group B.One hundred and seven eyes of 107 patients with diabetic retinopathy,hypertensive retinopathy,or retinal vein occlusion were in group A(retinal vascular disease group),one hundred and nine eyes of 109 people with macular hole,epiretinal membrane,vitreous macular traction syndrome were in group B(vitreous macular interface disease group).Best corrected visual acuity(BCVA),intraocular pressure,flat corneal curvature(K1),steep corneal curvature(K2),axial length(AL),biological measurement methods,vitreous tamponade,and the equivalent spherical degree at baseline and 3 months after surgery were recorded.The difference between preoperative prediction and actual postoperative equivalent spherical degree was defined as predictive error(PE),and the absolute value of PE was defined as absolute refractive error(ARE).The differences of PE and ARE between the study group and the control group were analysed,the influencing factors of ARE value were also analysed by using regression analysis.SPSS26.0 software was used for statistical analysis,P<0.05 was considered as statistically significant.Results:The PE of the group A and group B were(-0.39±0.92)D and(-0.48±0.77)D respectively,and ARE were(0.76±0.64)D and(0.70±0.58)D.The PE and ARE of control group was(-0.11±0.58)D and(0.47±0.35)D.The PE and ARE among three groups were significantly different(P<0.001).PE and ARE in group A or group B were significant compared to that in the control group(PPA=0.025,PPB<0.001;PAA<0.001,PAB=0.002),but there was no significant difference between group A and group B(P>0.05).According to the vitreal tamponade,the patients in the study group were divided into BSS group,gas group and silicone oil group.The PE(-0.60±0.76 D vs.-0.11 ±0.58D,P=0.020;-0.43±0.90D vs.-0.11±0.58D,P=0.005)and ARE(0.80±0.53D vs.0.47±0.35D,P=0.026;0.76±0.65D vs.0.47±0.35D,P<0.001)in silicone oil group and gas group were all significant compared to that in control group,but the PE(-0.37±0.73D vs.-0.11±0.58D,P=0.178)and ARE(0.63±0.50D vs.0.47±0.35D,P=0.233)of BSS eyes were not significantly different from that in the control group.In multiple linear regression analysis,ARE was positively correlated with biometric methods(β=0.212,P=0.009),corneal curvature K(β=0.077,P=0.006)and age(β=0.0.045,P=0.012).The correlation with gender,eye sides,AL,with/without vitreous hemorrhage,vitreal tamponade,preoperative BCVA,preoperative IOP,and types offundus diseases wao not found.Conclusion:Phacovitrectomy with IOL implantation in retinal vascular diseases or macular interface diseases will cause significant IOL calculated errors,which usually tends myopic.The predictive errors were not significant between retinal vascular diseases and vitreous macular interface diseases.Gas or silicone oil vitreal tamponade could make myopic deviation.Older age,steeper corneal curvature and A-ultrasound measuring AL are associated with the accuracy of IOL prediction.