| Objective: To investigate whether the axial length(AL)changes of high myopia with cataract before and after Phacoemulsification with monofocal intraocular lens implantation,so as to provide a reference for preoperative ocular biometric measurement and intraocular lens power calculation.To evaluate the visual quality of the patients with high myopia and cataract after implantation of monofocal intraocular lens,and to judge the influence of different factors on the visual function of the patients,to explore the best diopter of intraocular lens in patients with high myopia and cataract,and the influence of mini-monovision approach on the visual quality of patients after operation.Methods: Part1: From October 2016 to October 2019,81 patients(116 eyes)who were diagnosed as cataract and performed phacoemulsification with monocular intraocular lens implantation in our hospital were divided into group A(22mm ? AL < 24mm)(25 eyes),group B(24mm ? AL < 26mm)(12 eyes),group C(26mm ? AL < 28mm)(19 eyes),group D(28mm ? AL < 30mm)(19 eyes),group E(30mm ?AL < 32mm)(23 eyes),group F(axial length ? 32mm)(18 eyes);the axial length of patients was measured by IOL master before operation,the 1st day after operation,the 7th day after operation,the first month,the third month,and the sixth month after operation.Part2: 30 patients(60 eyes)with high myopia who underwent binocular surgery of the first part were selected.The patients were followed up for the 7th day after operation,the first month,the third month after operation.The patients' binocular and monocular uncorrected distance,intermediate,near visual acuities and best-corrected visual acuities were measured,Vf-14-CN questionnaire survey and visual acuity recording were conducted in the third month after operation.According to the best corrected visual acuity in 3 months after operation,the patients were divided into good visual acuity group(BCVA > 0.5)in 24 cases(41 eyes),and low visual acuity group(BCVA ? 0.5)in 12 cases(19 eyes).The influence of gender,age and preoperative axial length on postoperative visual acuity was analyzed by statistics.According to the postoperative refraction after 3 months,the patients were divided into 3 groups: group A:-0.5d ? diopter <-1.5D;group B:-1 5 ? diopter <-2.5D;group C:-2.5D ? diopter <-3.5D,the difference of visual acuity and visual quality scores after operation in the three groups were followed up;according to the design of intraocular lens before operation,the patients were divided into routine group of 15 people;mini-monovision group of 15 people,the difference of visual acuity after operation in the two groups were followed up.Results: Part1: There was a significant difference in the axial length changes between the preoperative and postoperative eyes at different time points after operation,and the axial changes showed a decreasing trend with time(P < 0.01).The axial length of the eyes in group A,B,C and D had no significant difference in 7 days after operation compared with that in 1,3 and 6 months after operation(P > 0.05).The axial length of the eyes in group E and F had no significant difference in 1 months after operation compared with that in 3 and 6 months after operation(P > 0.05).There was a significant difference in the axial changes between groups A?B,C,D,E and F before and 6 months after surgery,and the axial changes between different groups showed an increasing trend.Part2: There were 41 eyes with the BCVA > 0.5 and 19 eyes with the BCVA ? 0.5,preoperative axial length was an independent factor affecting the postoperative BCVA(OR:18.412,95%CI:2.200~154.081);.There was no statistical difference in BCVA and UCIVA in group A,B and C;UCDNA in group A was better than that in group B and C,and UCNCA in group C was better than that in group A,and the difference was statistically significant;there was no difference in the total score of Vf-14-CN in group A,B and C,and the near vision function in group B and C was better than that in group A.There was no statistical difference in the remaining items.There was no significant difference in BCVA between routine group and mini-monovision group 3 months after operation;the difference was statistically significant in UCDVA,UCNVA and UCIVA between routine group and mini-monovision.There was a significant difference in the score of the Vf-14-CN between the two groups;the near vision function and visual adaptation of the mini-monovision group were better than the routine group;The rate of spectacle independence in the mini-monovision group was 60%,and that in the routine group was 13.3%,the difference was statistically significant.Statistical methods: All the analysis was completed on spss25.0.The measurement data obeyed the normal distribution and was expressed by means of mean ± standard deviation,and the comparison between groups was expressed by t test;the comparison among groups was expressed by variance analysis;the non-compliance was expressed by means of median(interquartile spacing).Frequency(percentage)was used for counting data,and chi square test or Fisher exact test was used for comparison between groups.Results P < 0.05 showed statistical significance.Conclusion: Part1: The axial length of the eyes is shortened after phacoemulsification combined with monocular intraocular lens implantation.With the increase of the axial length,the axial length of the eyes is shortened.The axial length of the eyes with axial length less than 30 mm is stable in one week,and the axial length of the eyes with axial length more than 30 mm is stable in one month.Part2: The preoperative axial length is an independent factor that affects the visual acuity recovery after phacoemulsification combined with monofocal intraocular lens surgery in patients with high myopia and cataract.The longer the preoperative axis,the worse the postoperative BCVA.In the patients with high myopia and cataract,the reserved diopter of IOL is-1.5 ~-3.5D,which can obtain a better visual effect.The mini-monovision approach can provide good vision and visual quality for patients with high myopia and cataract,and the patients have a high rate of spectacle independence. |
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