摘要
目的了解不同年龄患者白内障手术时机的选择及变化趋势。方法横断面研究。选取2019年1月至2019年4月于北京大学第三医院眼科接受白内障超声乳化联合人工晶状体植入术的患者900例(900只眼)进行研究。根据联合国世界卫生组织制订的年龄划分标准,分为45~59岁组、60~74岁组及75~89岁组三组。应用分层抽样法,在每组中各随机抽取50例(50只眼)。采用国际标准对数视力表检查术眼裸眼视力,根据晶状体混浊分类系统Ⅲ(LOCSⅢ)对术眼晶状体混浊程度进行分级,并采用视功能相关生命质量量表(NEI-VFQ-25)中文版评价术眼主观视功能。通过万方数据库及中国知网数据库,检索2005年以来不同年龄白内障患者选择手术时机的相关文献。采用R软件进行统计学分析,三组比较采用单因素方差分析,组间两两比较采用Tukey法。结果 45~59岁组患者术眼最小分辨角对数(LogMAR)视力为0.6±0.3,60~74岁组患者术眼的LogMAR视力为0.8±0.3,75~89岁组患者术眼的LogMAR视力为0.8±0.4,三组比较差异有统计学意义(F=8.373,P<0.05);其中,45~59岁组患者术眼的LogMAR视力低于60~74岁组和75~89岁组患者(DF=0.202,0.260;P<0.05)。根据LOCSⅢ,45~59岁组术眼晶状体混浊程度分级为(2.4±0.5)级,60~74岁组术眼晶状体混浊程度分级为(2.7±1.0)级,75~89岁组术眼晶状体混浊程度分级为(3.4±0.9)级。三组比较,差异有统计学意义(F=14.870,P<0.05);45~59岁组、60~74岁术眼组晶状体混浊程度分级低于75~89岁组患者,差异有统计学意义(DF=0.920,0.640;P<0.05)。根据NEI-VFQ-25量表,三组患者的整体健康状况评分、近距离活动评分、远距离活动评分、精神健康评分、社会角色限制评分、依赖程度评分、驾车评分、色觉评分及周边视力评分比较,差异均有统计学意义(F=21.580, 9.912, 5.069, 17.570, 10.440, 20.800, 3.749, 3.145, 9.292;P<0.05)。45~59岁组患者的整体健康状况评分、近距离活动评分及周边视力评分高于60~74岁组、75~89岁组患者,差异有统计学意义(DF=-19.500,-22.000,-11.000,-14.916,-9.500,-14.500;P<0.05)。45~59岁组患者的远距离活动评分、驾车评分及色觉评分高于75~89岁组患者,差异有统计学意义(DF=-11.750,1.320,-6.500;P<0.05)。45~59岁组和60~74岁组患者的精神健康评分、社会角色限制评分高于75~89岁组患者,差异有统计学意义(DF=-16.750,-11.000,-19.250,-19.000;P<0.05)。三组患者依赖程度评分的两两比较,差异均有统计学意义(F=20.800,P<0.05),年龄越大,依赖程度越重。本研究中选择白内障手术治疗的患者平均年龄为(70.3±9.8)岁,60~69岁的患者占比为29.78%。与2005-2015年各研究数据相比,本研究中患者的平均年龄更小,60~69岁患者占比更高。结论不同年龄患者选择白内障手术时机不同,相比高年龄患者,低年龄患者白内障严重程度更轻,但手术时机较早,与既往调查相比手术年龄有前移的趋势。这可能与低年龄患者对视力要求高、高年龄患者受限于身体条件有关。
Objective The aim of this study was to investigate cataract surgery timing and change trend in patients of different ages. Methods This study was cross-sectional . 900 patients ( 900 eyes) who underwent phacoemulsification and intraocular lens implantation in the Department of Ophthalmology, the Third Hospital of Peking University from January 2019 to April 2019 were collected. According to the age division of the World Health Organization, the patients were divided into three groups: 45 to 59 age group, 60 to 74 age group and 75 to 89 age group. 50 cases ( 50 eyes) were selected from each group by stratified sampling. Operating eyes were examined by international standard logarithmic visual acuity chart;lens opacity was graded according to Lens Opacities Classification System III ( LOCS DI );the subjective visual function was assessed by National Eye Institute 25-Item Visual Function Questionnaire ( Chinese verson, NEI-VFQ-25 ). In Wanfang and CNKI database, literatures on the cataract surgery timing in patients of different ages since 2005 were retrieved. All the data were analyzed by R statistical software. One-way ANOVA was used to comparise differents among three groups and Tukey method was used to comparise differents between two groups. Results The logarithm of minimal angle of resolution (logMAR) visual acuity of 45 to 59 age group was 0. 6 ± 0. 3 , 60 to 74 age group was 0.8 ±0. 3 , 75 to 89 age group was 0. 8 ± 0. 4 , the difference was statistically significant ( F = 8. 373;P < 0. 05 );the logMAR visual acuity of 45 to 59 age group was lower than that of 60 to 74 age group and 75 to 89 age group, the difference was statistically significant ( DF = 0. 202,0. 260;P < 0. 05 ). The LOCS DI of nuclear turbidity in 45 to 59 age group was 2.4 ±0.5. In 60 to 74 age group, that was 2.7 ± 1. 0. In 75 to89 age group, that was 3. 4 ± 0. 9. The difference was statistically significant ( F = 14. 870;P < 0. 05 );the LOCS DI of nuclear turbidity in 45 to 59 age group and 60 to 74 age group was less than that of 75 to 89 age group, the difference was statistically significant ( DF = 0. 920 , 0. 640;P < 0. 05 ). There were statistically significant differences in overall health status score, short-range activity score, long-distance activity score, mental health score, social role limitation score, dependence score, driving score, color vision score and peripheral visual acuity score among three groups (F = 21.580, 9. 912, 5. 069, 17. 570, 10. 440, 20. 800, 3. 749, 3. 145, 9. 292;P <0. 05 ). The overall health status score, short-range activity score and peripheral visual acuity score of 45 to 59 age group were higher than those of 60 to 74 age group and 75 to 89 age group, with statistical significance ( DF =- 19. 500,-22.000,- 11.000 ,-14.916,-9. 500,- 14. 500;P < 0. 05 ). The scores of long-distance activity, driving and color vision in 45 to 59 age group were higher than those in 75 to 89 age group, with statistical significance ( DF =-11. 750, 1. 320,-6. 500;P < 0. 05 ). The mental health score and social role limitation score of 45 to 59 age group and 60 to 74 age group were higher than those of 75 to 89 age group, with statistical significance ( DF =-16. 750 ,- 11.000 ,- 19. 250 ,- 19. 000;P < 0. 05 ). There was significant difference between two groups in the dependence degree score ( F = 20. 800 , P < 0. 05 ), the older the age, the heavier the dependence degree. Compared with the studies from 2005 to 2015 , the mean age of the patients in our study was younger, and the proportion of the patients aged 60 to 69 increased. Conclusions Cataract surgery timing was different from age to age. The cataract severity in the younger age group was lighter than that in the older age group, but the cataract surgery timing was relatively early, which has shown a forward trend compared with previous investigations. This was related to the high requirement for vision in the younger age group and the limitation of physical conditions in the older age group.
作者
赵黎明
王震宇
万雨
王银浩
敖明昕
李学民
Zhao Liming;Wang Zhenyu;Wan Yu;Wang Yinhao;Ao Mingxin;Li Xuemin(Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China;Department of Ophthalmology, Beijing Fengtai Hospital, Beijing 100070,China)
出处
《中华眼科医学杂志（电子版）》
2019年第3期146-152,共7页
Chinese Journal of Ophthalmologic Medicine(Electronic Edition)
基金
国家自然科学基金项目(81600760)
北京大学第三医院院种子基金(Y84496-01)
关键词
白内障手术时机
晶状体混浊分类系统Ⅲ
视功能相关生命质量量表
Cataract surgery timing
Lens opacities classification system Ⅲ
National Eye Institute 25-Item Visual Function Questionnaire
