Clinical Study On The Effectiveness And Refractive Shifts Of Vitrectomy Combined With Cataract Surgery And Uncombined Surgery

Background And ObjectivesThe invention of vitrectomy system brought new hope to retinal diseases, manyretinal diseases can be cured through vitrectomy, but for patients, especially oldpatients, vitreoretinal diseases often associated with cataracts, vitrectomy is animportant factor to cataracts, it often induced or accelerate progress cataracts.Surgeryis the only effective means to cure cataracts and improve vision. Previous surgeryexperience has shown that more complications arise after vitectomy, because thevitreous is replaced by the aqueous humor and can’t support the posterior capsular oflens,in the surgery, affected the stability of the anterior chamber, increasing theactivity of the posterior capsular, improving the risk of rupture of the posteriorcapsular, causing the lens nucleus fall into the vitreous cavity. This may not onlydelay the treatment of diseases, but also increase the burden of mental patients andthe economy. Vitrectomy combined with cataract surgery was begun toconsidered,the short operative time，rapid recovery and low cost making thiscombined surgery restore visual function in order to adapt the needs of visual qualityrequirements.However，the equipment and the surgeon’s surgical skills requirements more stringent due to the complexity of the combined operation.when the surgicaltechnology is mature, physiological function and anatomical location restored, We aremore concerned about the quality of postoperative vision problems.This studyinvestigates the efficacy and refractive shifts of vitrectomy combined cataractphacoemulsification surgery and uncombined surgery. In the treatment of vitreoretinaldiseases associated with cataracts,it provide a reference to choose which surgery, howto determine intraocular lens(IOL) power, patients can get better visual effects.MethodsThe clinical date of the patients with cataract and vitreoretinal diseases in theSecond Affiliated Hospital of Zhengzhou University from March2010to March2013ere retrospective analyzed, including74cases(79eyes),male33cases(36eyes),female41cases(43eyes), the age distribution was39to76years, mean age (59.33±10.27)years old, were divided into three groups by the kind of surgery：one-stage combinedgroup, two-stage combined group and uncombined group；one-stage combined groupis implant IOL while vitrectomy combined cataract surgery, including17cases(18eyes), two-stage combined group vitrectomy combined cataract surgery and implantIOL after three months, including24cases(25eyes),uncombined group is firstvitrectomy, then cataract phacoemulsific ation and IOL implantation，including33cases(36eyes). Prior to the surgery, systemic examination should be carried out todetermine whether systemic conditions tolerate surgery, use slit lamp, tonometer,ophthalmoscope, visual electrophysiology and other equipment for eye specialistexamination, eye A super measured axial length, manual keratometry instrumentmeasured Corneal curvature, and seek pre-implanted IOL power according to relevantformulas. Patients were followed up for6months, re-measured axial length, use ofcomputers and artificial optometry patients get the best corrected visual acuity andcorrected spherical degree in the6months after IOL implantation.visual acuity andthe incidence of complications were compared in three groups, analyst of the surgicalresults of each group. The differences between predictive diopter and actual diopterwere compared in three groups, the refractive shifts were compared in each groups,analysis of the variation of refractive status. Results1. Preoperative situation in one-stage combined group, two-stage combinedgroup and uncombined group：AL(axial length) were(22.53±1.08) mm,(22.78±1.34) mm,(22.04±0.93) mm, differences in preoperative axial length of the threegroups was not statistically significant （F=0.591，P=0.557>0.05）; corneal curvaturewere (43.83±1.34) D,(43.20±0.71) D,(43.08±0.69) D, differences in preoperativecorneal curvature of the three groups was not statistically significant （F=0.335，P=0.726>0.05）.2. The differences among the distribution of visual acuity in one-stage combinedgroup, two-stage combined group and uncombined group was no statisticallysignificant(x2=0.636，P=0.966>0.05)，recovery of visual acuity in each group werebasically the same, the difference among the three groups was no statisticallysignificant (x2=0.686, P=0.710>0.05).3. Postoperative complications include： corneal edema、 anterior fibersexudation、posterior synechia、postoperative ocular hypertension、retinal detachmentsurgery again，these types of complications in one-stage combined group, two-stagecombined group and uncombined group are basically the same, the difference was notstatistically significant （x2=5.638，p=0.060>0.05; x2=1.946，p=0.378>0.05;x2=2.280，p=0.320>0.05; x2=5.064，p=0.080>0.05; x2=2.533，p=0.282>0.05）。4. Postoperative changes in axial length values of one-stage combined group,two-stage combined group and uncombined group were (0.92±0.58) mm,(-0.06±0.30) mm,(0.14±0.55) mm. In the one-stage group，the difference betweenpreoperative axial length and postoperative axial length was significant（t=6.761，P<0.001），in two-stage group and uncombined group，the difference betweenpreoperative axial length and postoperative axial length was not statisticallysignificant（t=-1.000，P=0.327>0.05；t=1.537，P=0.134>0.05）；patients underwentone-stage combined surgery showed a statistically significant axial length changescompared with those underwent two-stage combined surgery and uncombined surgery（t=7.251，P<0.001，t=7.360，P<0.001）, the axial length changes of two-stagegroup and uncombined group was no significant difference（t=0.100，P=0.921>0.05）.5. In one-stage combined group,PD(predictive diopter) was （-0.17±0.71）D,AD(actual diopter)was （-0.83±1.16）D, the difference between PD and AD was significan（tt=-3.809,P<0．05），in two-stage combined group and uncombined group，the PD were （-0.20±0.71）D、（-0.03±0.82），the AD were （-0.06±0.72）D、（0.12±0.54） D， the difference between PD and AD was no significant（t=1.654,P>0．05;t=1.537, P>0．05）in two-stage combined group and uncombinedgroup.6. The refractive shifts of one-stage combined group, two-stage combined groupand uncombined group were （-0.67±0.74）D、(0.17±0.51)D、（0.14±0.54）D，patientsunderwent one-stage combined surgery showed a statistically significant myopic shiftcompared with those underwent combined two-stage surgery and uncombined surgery（t=-4.536, P<0．05;t=-4.22，P<0．05）, the refractive shift of two-stage group anduncombined group was no significant difference（t=0.225,P>0．05）Conclusion1. In the treatment of vitreoretinal diseases associated with cataracts，vitrectomycombined cataract phacoemulsification surgery is safe and effective。2. The panretinal photocoagulatio in time and Intact posterior capsule of the lenscan effectively prevent the occurrence of iris neovascularization.3.For different vitreoretinal diseases, surgery can choose different waysaccording to the actual situation and the economic conditions in patients。4. Vitrectomy combined with phacoemulsification and intraocular lensimplantation, postoperative axial length will be longer than before surgery, causesare：preoperative proliferation of retinal membrane or macular edema, leading tomeasure axial length shorter than the actual value，may also be related to removal ofthe vitreous and high intraocular pressure。5. After vitrectomy combined cataract phacoemulsification and two-stageintraocular lens implantation surgery or uncombined surgery，patients can get a goodvisual acuity，but vitrectomy combined cataract phacoemulsification and one-stsgeintraocular lens implantation tends to shift the actual refractive status to myopia andneeded corrective glasses.6. When calculating IOL power of itrectomy combined cataractphacoemulsification and two-stage intraocular lens implantation surgery should beslightly larger than in accordance with the calculation of accordance with axial length and corneal curvature，to offset the refractive caused by myopia.