Long Term Follow-Up Of High Myopia Cataract Patients After Surgery

Objective To evaluate the long-term effect of high myopia cataract surgery after 5-6 years, to explore the major factors of the long-term effects of visual function; By observing the long-term corneal endothelial cells and the occurrence of anterior segment complications, analysis of high myopia cataract surgery safety analysis; And combined with the visual quality and visual function related quality of life questionnaire survey, to understand the long-term visual related quality of life in patients with high myopia after cataract surgery.Methods (1) Research the high myopia cataract patients in the First Affiliated Hospital of Guangxi Medical University and Nanxishan Hospital of Guangxi Zhuang Autonomous Region from January 2008 to December 2009 (a total of 65 people,96 eyes) and follow-up their uncorrected visual acuity, refractive status, best corrected visual acuity, intraocular pressure, corneal curvature, axial length, posterior capsular opacification incidence rate, fundus examination and macular OCT. (2) According to the patient’s age, gender, cataract grading, left or right eye, monocular or binocular, surgery method collected with axial 22-24mm normal eye axis cataract patients in the same time period one by one pair as the control group. Outpatient visits and to further examine the uncorrected visual acuity, refractive status, best corrected vision, corneal endothelial cell counting, slit lamp examination of the anterior segment, the IOL position, posterior capsular opacification and fundus examination with funduscope. (3) Evaluate the long-term visual function and vision related quality of life status of the two groups through questionnaire 65 cases of high myopia cataract surgery patients and the control group 65 cases of normal eye axis length cataract patients with visual function questionnaire and vision related quality of life questionnaire.Results (1) Operation method:43 eyes with small incision cataract extraction including 33 eyes combined with implantation of posterior chamber intraocular lens; 53 eyes with phacoemulsification, including 45 eyes combined with posterior chamber intraocular lens implantation. (2) Vision:In the group of patients with postoperative 5-6 years, the Non blind rate was 89.58% (corrected visual acuity^0.05), Non disabled rate was 60.42% (corrected visual acuity≥ 0.3); visual acuity 0.5 as the standard, vision^0.5 with a group in 24 eyes, B group 7 eyes. The chi square test, X2=6.18, P=0.015, the corrected visual acuity of group A was better than group B. (3) Posterior capsular opacification incidence rate:PCO of this group of patients is 26.04%(25eyes), including grade I 10 eyes, grade Ⅱ 6 eyes, grade III 3 eyes and 6 eyes have been YAG laser posterior incision;No PCO 67 eyes. (4) Incidence of retinal detachment: retinal detachment occurred in 5 eyes in this group of cases (5.61%), one patient abandoned the treatment and visual acuity was NLP,4 eyes of retinal reattachment surgery, the final follow-up visual acuity was count fingers to 0.1. Another 1 eyes had fundus examination found suspicious dry hole, and treated with laser photocoagulation hiatus, the final follow-up no retinal detachment. (5) The axial length before and after operation:preoperative axial length of 29.12+ 2.72mm, after 5-6 years to review the length of ocular axis 29.19+2.78mm, according to the paired t-test, t=3.013, P=0.04. postoperative review axial were number of slight increase, and the difference is statistically significant, but the actual difference value is smaller and clinical significance of little. (6) Fundus examination and macular OCT:suffering from eye fundus examination and macular optical coherence tomography (OCT) and found there were 96 eyes had different degrees of myopia fundus change, with the macular lesion 51 eyes, including lacquer crack, Fuchs spots, macular chorioretinal atrophy, macular hole, macular epiretinal membrane, CNV, macular hemorrhage. Postoperative retinal detachment in 5 eyes (5.61%). (7) Intraocular pressure:this group of case detection of intraocular pressure:10.3-20mmHg, were in the normal range, high intraocular pressure or not found to be excluded in patients with glaucoma. (8) Every influencing factors of visual acuity analysis after operation 5-6 years:the axial length, corneal astigmatism, corneal refractive degree in two postoperative BCVA groups had statistical significance differences, the postoperative BCVA< 0.3 group and^0.3 group comparison, it can be considered that the former axial length, corneal astigmatism and corneal refractive power significantly more than that of the latter, macular lesions on the effect of postoperative BCVA has statistical significance, can be considered BCVA after operation in macular lesions; age, surgery methods on the effect of postoperative BCVA does not have statistical significance. (9) Postoperative BCVA influencing factors analysis:after controlled age, surgery methods, ocular axial length (OR:0.753, 95%CI:0.577-0.982), corneal astigmatism (OR:0.411,95%CI:0.178-0.95) and macular degeneration (OR:0.087,95%CI:0.023-0.326) are independent influential factors of postoperative BCVA; patients with macular lesion BCVA is poor prognosis; with the axial length and corneal astigmatism increased, postoperative BCVA poor recovery; impact strength:macular degeneration (13.143), the second for the ocular axial length (439.4), corneal astigmatism (4.323), corneal curvature, surgery, age is not that postoperative recovery BCDVA independent factors. (10) High myopia cataract group and normal eye axis cataract patients in the control group have no significant difference in age, corneal endothelial cell count and age of two groups do the correlation analysis with Pearman method,the corneal endothelial cell count and age were significantly related, high myopia cataract group and the control group r correlation coefficients were 0.57,0.40 (P< 0.01), respectively. (11) The average central corneal endothelial cell counts of high myopia cataract group are 2340.73+265.29, and coefficient of variation of cell area are 41.92+7.65, percentage of hexagonal cells are 36.8+6.9; the average central corneal endothelial cell counts of control group are 2354.65+±239.05, coefficient of variation of cell area are 38.12±5.91, and the percentage of hexagonal cells are 37.9±7.2. Two groups of central corneal endothelial cell count had no significant difference (P=0.26). The coefficient of variation of high myopia cataract group is higher, percentage of hexagonal cells of normal ocular axis control group is slightly higher. (12) The anterior segment complications of two groups mainly included damage and atrophy of the above iris, coremetamorphosis, there are 13 cases in high myopia cataract group, and 9 cases in normal eye axis cataract group, by chi square test, P=0.235, the two groups had no significant difference. There is not artificial crystal with severely displaced, clamping and other complications in all patients. (13) PCO incidence of high myopia cataract group was 26.04%, normal eye axis cataract group was 22.92%. By chi square test, the two groups had no significant difference (P =0.612). (14) High myopia cataract group and normal axial cataract patients with the control group, the macular region compared 51 eyes of cataract with high myopia macular lesions, normal ocular axis after cataract surgery group of macular lesions in 6 eyes,3 eyes with macular epiretinal membrane. The chi square test, P=0.00, the difference of macular degeneration occurred rate in two groups was statistically significant. (15) Correlation analysis of vision and questionnaire scores of vision function and vision related quality of life:VF questionnaire scores were significantly related in two groups, high myopia group and control group, the correlation coefficient r are 0.56,0.45 (P< 0.01), respectively; visual acuity was significantly related to VRQOL questionnaire scores in two groups, too.In high myopia group and control group the related coefficient R was 0.47,0.43 (P< 0.01), respectively. (16) The visual function questionnaire scores of two groups were analysed by two independent sample T test, t=4.680, df=38.417, P<0.05, two groups of visual function score has the remarkable difference, the scores of high myopia cataract group were lower. (17) The vision related quality of life survey scores of two groups by two independent sample T test, t=3.424, df=37.273, P<0.05, two groups of vision related quality of life score mean significant differences, high myopia cataract group with lower scores. (18) The high myopia cataract group and the normal axis cataract group regarded score of every index function were significantly different in all specimens, myopia group scores were lower, which is slightly small difference is stereo vision and color vision. (19) The high myopia cataract group and the normal axis cataract group each index of vision related quality of life score difference was significant difference, high myopia group score lower, which is slightly small differences in self-care ability index.Conclusion (1) According to the WHO classification of visual impairment, for this group of high myopic cataract after surgery 5-6 years, the Non blind rate was 89.58% (corrected visual acuity≥0.05), Non disabled rate was 60.42% (corrected visual acuity^0.3). The main factor of affecting postoperative visual acuity after surgery 5-6 years was maculopathy. Secondly, were axial length and corneal astigmatism. The long-term vision of eye axis≥30mm cataract patients was significantly lower than that of axial<30mm cataract patients, and the macular disease incidence increased significantly.(2) The corneal endothelium counts of high myopia cataract patients and normal anxis cataract patients after cataract surgery 5-6 years were no significant difference, the incidence rate of PCO of the two groups was no significant difference, considering anterior segment complications, ocular axial length was not the main risk factor.(3) The visual function and vision related quality of life survey scores of high myopia cataract after surgery 5-6 years were significantly related with visual acuity, high myopia cataract patients scored significantly lower than normal axial cataract patients after cataract surgery 5-6 years.