Study On Correlation Between Cataract Phacoemulsification With Intraocular Lens Implantation And Age-related Macular Degeneration

Objective:To explore the morbidity of age-related macular degeneration(AMD) after cataract phacoemulsification with non-foldable intraocular lens (IOL) implantation and to analysis influence factors of postoperative visual acuity and whether operations effect on AMD.Methods:Retrospective analysized300eyes of cataract phacoemulsification combined with non-foldable IOL implantation from January2009to February2012in our hospital. Successful operation was achieved in all patients. The uncorrected visual acuity, anterior and posterior segment were checked on1day,1week,1month and3months postoperativly and the best corrected visual acuity (BCVA) was examined when necessary. BCVA of all patients were examined after3months.The visual acuity, complications and fundus check were recorded. Disease definition and classification of AMD were done in accordance with the Preferred Practice Pattern(PPP) guidelines of America in2008. Fundus fluorescein angiography(FFA) were performed when patients were diagnosed or suspected with AMD. Indocyanine green angiography(ICGA) and/or optical coherence tomography(OCT) should be examined if needed. The association studies were performed with SPSS13.0. Count data was expressed in absolute number and relative number. Intergroup comparison was detemined by four tables or rows and list chi-squared test. Analysis of association between two variables were finished with chi-squared linear trend test or Spearman rank correlation analysis and multiple groups of rank data were detemined by non-parametric Kruskal-Wallis test. P<0.05was statistically significant difference.Results:1. In300eyes following phacoemulsification with non-foldable IOL implantation,there were61eyes (20.33%) appeared corneal edema on1st day after surgery and23eyes (7.67%) occurred mild uveitis, which disappeared altogether after7days. They were not appeared that posterior capsule rupture, endophthalmitis, IOL deviation, macular edema and other serious complications.2. Compared the BCVA among the300eyes after operation,45eyes (15%) worse0.3and255eyes (85%) had0.3or better, thereinto,46eyes (15.33%) had0.5or better at1day after operation.18eyes(6%) worse0.3and282eyes (94%) had0.3or better, thereinto,263eyes (87.67%) had0.5or better with3months after surgery.3. Among the300eyes after operation,215eyes (71.67%) had normal fundus,56eyes (18.67%) had AMD;13eyes (4.33%) had diabetic retinopathy,7eyes (2.33%) had high myopia retinopathy;3eyes (1%) had retinal vein occlusion; retinal pigment degeneration and optic atrophy, each with2eyes (0.67%); macular hole and epiretinal membrane of macula, each with1eye (0.33%).4.The morbidities of AMD in males and females were19.42%and18.27%, which showed no statistically significant differences (χ2=0.058, P=0.05). The morbidity of AMD in different ages was different. The prevalence rates in<50,50～59,60～69,70～79,80～89and>90years old group of AMD were0%,6.90%,11.24%,20.33%,34.69%and66.67%separately, but the difference was statistically significant (χ2=13.065, P=0.023).5. Early and intermediate AMD after cataract surgery was common and advanced AMD was rarely (15.52%). Some of the patients showed mild visual impairment or low vision, but visual acuity was improvement comparing preoperation.6.11eyes were diagnosed with AMD before cataract surgery,in which there were6eyes with early AMD,3eyes with intermediate AMD and2eyes with advanced AMD.1eye developed from early AMD to intermediate stage and the rest did not change obviously. The difference was not statistically significant (χ2=0.234,P=0.890).Conclusion:1. AMD was the main disease of the fundus which affected later vision restoration after cataract phacoemulsification and IOL implantation, followed by DR and high myopia retinopathy. Corneal edema was the main factor which effected early visual recovery postoperativly.2. The morbidity of AMD was18.67%, which was the most common in early and intermediate stage after cataract surgery.3. Cataract operation had no significant effect on the development of AMD and improved the visual acuity.