Study On Preoperative Reserved Diopter,Postoperative Visual Quality And Short-Term Refractive Changes In Patients With Cataract And Myopia

Objective: To explore how to select preoperative reserved diopter when choosing monofocal intraocular lens implantation for patients with cataract and low,medium,high myopia,in order to provide more guidance and suggestions for clinical work by analyzing their postoperative visual quality and short-term refractive changes.Methods: Seventy-two(132 eyes)cataract patients with myopia who underwent phacoemulsification combined with monofocal intraocular lens implantation in our hospital from November 2020 to December 2022 were enrolled by retrospective analysis.According to the axial length,it is divided into group A: 24mm≤ axial length <26mm,group B: 26mm≤ axial length < 30 mm,group C: axial length≥ 30mm;preoperative reserved diopter was recorded,and postoperative optometry results,uncorrected distance visual acuity(UCDVA),uncorrected near visual acuity(UCNVA),best-corrected distance visual acuity(BCDVA),and best-corrected near visual acuity(BCNVA)were recorded at 1 week and 1 month after surgery.All patients completed Chinese Visual Function index-14(VF-14-CN)questionnaire at 3 months after surgery,besides,we collected the rate of spectacle independence and satisfaction,compared the differences of parameters between the groups.The i Trace Visual function analysis system was used to record high-order aberration,coma aberration,spherical aberration,trefoil aberration,depth of focus,pupil diameter,modulation transfer function(MTF)and strehl ratio(SR),we analyzed the differences between the three groups.According to the optometry results,the spherical equivalent was calculated,and the error of the postoperative measured diopter and the preoperative reserved diopter between the three groups was analyzed.The effects of age and axial length on postoperative visual quality were analyzed by statistical method.As for patients with high myopia(axial length≥26mm),according to the preoperative reserved diopter,patients were divided into groupⅠ:-0.5D～-1.5D,group Ⅱ: ≤-1.5D;the differences in postoperative visual acuity,postoperative visual quality,the rate of spectacle independence and satisfaction were compared in different reserved diopter.Results: There was statistically significant difference in the preoperative UCDVA,postoperative UCDVA,UCNVA,BCDVA and BCNVA between the three groups in 1month after surgery(P<0.05),the UCDVA in group A was better than that in group B and C;group B and C were better than group A in UCNVA because more preoperative reserved diopter.In postoperative life visual quality score,patients in group A had difficulty in doing close activity items(1,2,3,5)compared with group B and C,but patients in groups B and C were more difficult than those in group A when doing long-distance activity items(12,13,14),and there was no significant difference in the scores of other life items between the three groups.In the rate of spectacle independence and satisfaction,the two groups B and C were better than those in group A,there was statistically significant difference in those differences(P<0.05).In the state of natural pupillary,there were no significant difference in high-order aberration,coma aberration,trefoil aberration,depth of focus,pupil diameter,MTF and SR between the three groups,MTF and SR decreased with the increase of axial length,but there was no significant difference.MTF and SR under the simulated 2mm pupil diameter decreased with the increase of axial length,and the difference was statistically significant(P<0.05).There was statistically significant difference between the actual measured diopter and the preoperative reserved diopter in B and C groups(P<0.05),and the postoperative actual measured myopia degree was reduced compared with the preoperative reserved myopia degree,and the postoperative refractive state was mostly showed hyperopia drift;the longer the axial length,the greater the refractive error after cataract surgery.Axial length is an independent influencing factor of postoperative BCDVA,MTF,SR,and postoperative refractive error in cataract patients(P<0.05).As for patients with high myopia(axial length≥ 26mm),the postoperative UCNVA in group Ⅰ was worse than that of group Ⅱ,but it was better than that of group Ⅱ in UCDVA,and the difference between the two groups was statistically significant(P<0.05).Group Ⅰ had more difficulty in doing close activity items(1,2,3,5)than group Ⅱ,but group Ⅱ was more difficult than group Ⅰ when doing long-distance activity items(12,13),and the difference between the two groups was statistically significant(P<0.05).Group Ⅰ was lower than Group Ⅱ in the rate of spectacle independence and satisfaction,and the difference between the two groups was statistically significant(P<0.05).Conclusions: 1.Cataract combine low and moderate myopia(24mm≤ axial length<26mm)patients with higher near vision requirements in close range,preoperative reserved diopter in 0.27～-1.65 D may not enough,increasing the reserved diopter may increase the satisfaction of such patients and the rate of spectacle independence;2.For patients with cataract and high myopia(axial length ≥ 26mm),preoperative reserved diopter ≤-1.5D have better postoperative visual quality and satisfaction than the patients with reserved diopter in-0.5～-1.5D;3.Postoperative refractive error of cataract combine high myopia mostly showed hyperopia drift,the longer the axial length,the greater hyperopia drift.The preoperative reserved diopter should be appropriately increased before surgery;4.Myopia degree affects postoperative optical quality of cataract patients.The axial length is an independent influencing factor of postoperative BCDVA,MTF,SR,and postoperative refractive error in cataract patients,the longer the preoperative axial length,the worse the postoperative visual acuity,the lower the postoperative MTF and SR,the greater the postoperative refractive error.