目的：探讨超声乳化人工晶状体植入术治疗高度近视合并白内障患者的疗效。

方法：回顾性研究。收集2017-02/2019-01我院行超声乳化联合人工晶状体植入术的高度近视合并白内障患者42例42眼，并按1：1比例选取同期行超声乳化联合人工晶状体植入术的不合并高度近视的白内障患者42例42眼作为对照组。检查两组患者术前，术后1wk，1、3mo最佳矫正视力(BCVA)； 记录术前和术后3mo眼压、黄斑中心凹视网膜厚度(CMT)、角膜曲率、角膜散光、前房深度、前房角、房角开放距离、角膜内皮细胞计数、六角细胞比例及手术并发症发生情况。

结果：两组患者术后1wk，1、3mo BCVA比较有差异(均P<0.001)； 术前、术后3mo，高度近视合并白内障组CMT、前房深度、房角开放距离、前房角均高于对照组(P<0.001)，两组手术前后眼压比较无差异(P>0.05)； 术后3mo，高度近视合并白内障患者后表面鼻上角膜曲率较术前增大(P<0.001)，对照组后表面中心、颞下角膜曲率较术前大(P<0.001)，高度近视合并白内障患者后表面中心、后表面颞下角膜曲率低于对照组(均P<0.05)； 两组患者术后3mo前表面、后表面角膜散光均上升(均P<0.001)，后表面逆规散光较术前增多(P<0.05)，但组间比较差异无统计学意义(P>0.05)； 两组患者术后3mo角膜内皮细胞计数、六角细胞比例均较同组术前降低(P<0.05)，高度近视合并白内障术后3mo角膜内皮细胞计数、六角细胞比例低于对照组(均P<0.05)； 高度近视合并白内障并发症发生率高于对照组，但组间比较无差异(P>0.05)。

结论：高度近视合并白内障患者超声乳化联合人工晶状体植入术后视力可获益，但改善效果不及不合并高度近视的白内障患者，高度近视合并白内障患者术后CMT较不合并高度近视的白内障患者更高，后表面散光有所增加，术后前房形态改变更明显，角膜内皮细胞受损更重，但相对安全可靠。

METHODS: A retrospective study was conducted. A total of 42 cataract patients(42 eyes)with high myopia who had undergone phacoemulsification combined with intraocular lens implantation from February 2017 to January 2019 were recruited as myopia group. Meanwhile,in a 1:1 ratio, 42 cataract patients(42 eyes)without myopia treated with phacoemulsification combined with intraocular lens implantation during the same period were selected as the control group. The best corrected visual acuity(BCVA)of both groups was measured before surgery and at 1wk, 1 and 3mo after surgery. Changes of intraocular pressure(IOP)and central macular thickness(CMT)were measured before surgery and at 3mo after surgery. Changes of anterior segment parameters such as corneal curvature, corneal astigmatism, anterior chamber depth, anterior chamber angle and angle open distance before surgery and at 3mo after surgery were recorded. Changes of corneal endothelial cell counts and hexagonal cell ratios in both groups before surgery and at 3mo after surgery were determined. The incidence of surgical complications in the two groups were statistically analyzed.

RESULTS: There were differences in postoperative BCVA of patients in the two groups at 1wk, 1 and 3mo after surgery(all P<0.001); The CMT, anterior chamber depth, angle open distance and anterior chamber angle of myopia group were larger than those of the control group before surgery and at 3mo after surgery(P<0.001), but there was no statistically significant difference in IOP between the two groups before and after surgery(P>0.05). The posterior supra-nasal corneal curvature of the myopia group at 3mo after surgery was larger than that before surgery(P<0.001), and the posterior center, corneal curvature under the temporal of the control group at 3mo after surgery was larger than that before surgery(P<0.001). The corneal curvature of posterior center and posterior infratemporal in myopia group was lower than that of the control group at 3mo after surgery(all P<0.05). The anterior and posterior corneal astigmatism of the two groups increased at 3mo after surgery(all P<0.001), and posterior retrograde astigmatism of both groups increased at 3mo after surgery(P<0.05), but there was no statistically significant difference between groups(P>0.05). The corneal endothelial cell counts and hexagonal cell ratios in both groups at 3mo after surgery were lower than those in the same group before surgery(P<0.05). Besides, the corneal endothelial cell counts and hexagonal cell ratio in myopia group were lower than those in the control group at 3mo after surgery(all P<0.05); The incidence of surgical complications in the myopia group was higher than that in the control group, but there was no statistical difference between the groups(P>0.05).

CONCLUSION: Phacoemulsification combined with intraocular lens implantation is beneficial to the visual acuity of patients with high myopia complicated with cataract, but the effect is not as good as that in patients with cataract alone. The postoperative CMT of patients with high myopia complicated with cataract is larger than that of patients without myopia, and there is an increase in the posterior astigmatism. The changes of anterior chamber morphology are more obvious, and corneal endothelial cells aremore severely damaged, but it is relatively safe and reliable.