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  • 张春建,吴晋晖.超声乳化白内障吸除术中晶状体后囊膜破裂的危险因素分析[J].第二军医大学学报,2020,41(2):226-229    [点击复制]
  • ZHANG Chun-jian,WU Jin-hui.Risk factors of lens posterior capsular rupture in phacoemulsification[J].Acad J Sec Mil Med Univ,2020,41(2):226-229   [点击复制]
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超声乳化白内障吸除术中晶状体后囊膜破裂的危险因素分析
张春建1,2,吴晋晖3*
0
(1. 海军军医大学(第二军医大学)长海医院眼科, 上海 200433;
2. 上海市奉贤区中医医院眼科, 上海 201499;
3. 海军军医大学(第二军医大学)东方肝胆外科医院眼科, 上海 200438
*通信作者)
摘要:
目的 探讨超声乳化白内障吸除术中发生晶状体后囊膜破裂(PCR)的危险因素。方法 回顾性分析2011年1月至2017年12月在上海市奉贤区中医医院行超声乳化白内障吸除联合人工晶状体植入术的5 415例患者(5 743只眼)资料,将术中发生晶状体PCR的120眼(105例患者)纳入观察组,按照1 ∶ 4的比例随机选取未发生PCR的480眼(452例患者)纳入对照组。对两组患者的基本信息(性别、年龄)、全身危险因素(高血压病史、糖尿病史、心血管疾病史、糖皮质激素服用史、吸烟史、饮酒史)、眼科基本信息及眼科危险因素(视力、眼压、青光眼史、高度近视史、角膜病变史、葡萄膜炎病变史、白内障类型、玻璃体积血、玻璃体手术史)和白内障晶状体核硬度进行比较,分析超声乳化白内障吸除术中发生PCR的危险因素。结果 观察组患眼术前视力<20/200 [89.2%(107/120)vs 58.1%(279/480)]、玻璃体积血[10.8%(13/120)vs 2.3%(11/480)]、玻璃体手术史[20.8%(25/120)vs 4.8%(23/480)]占比均高于对照组,差异有统计学意义(P<0.05)。观察组和对照组分别有111眼和459眼进行了晶状体核硬度分级,观察组Ⅰ~Ⅴ级者分别为9眼(8.1%)、11眼(9.9%)、10眼(9.0%)、46眼(41.4%)和35眼(31.5%),对照组Ⅰ~Ⅴ者分别为88眼(19.2%)、82眼(17.9%)、109眼(23.7%)、97眼(21.1%)和83眼(18.1%),两组比较差异有统计学意义(P<0.05)。观察组logMAR视力由术前2.11±0.98恢复到术后1.07±0.44(P<0.05),对照组由术前1.37±0.90恢复到术后0.72±0.37(P<0.05);观察组术前和术后的logMAR视力均较对照组差(P<0.05)。结论 术前视力<20/200、玻璃体积血、玻璃体手术史和晶状体核硬度分级是超声乳化白内障吸除术中发生PCR的危险因素。
关键词:  白内障  超声乳化术  晶状体  后囊膜破裂
DOI:10.16781/j.0258-879x.2020.02.0226
投稿时间:2020-01-16修订日期:2020-02-16
基金项目:国家自然科学基金(81371044),上海市浦江人才计划(17PJD041).
Risk factors of lens posterior capsular rupture in phacoemulsification
ZHANG Chun-jian1,2,WU Jin-hui3*
(1. Department of Ophthalmology, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China;
2. Department of Ophthalmology, Fengxian District Hospital of Traditional Chinese Medicine, Shanghai 201499, China;
3. Department of Ophthalmology, Eastern Hepatobiliary Surgery Hospital, Naval Medical University(Second Military Medical University), Shanghai 200438, China
*Corresponding author)
Abstract:
Objective To analyze the risk factors of posterior capsular rupture (PCR) in phacoemulsification. Methods A total of 5 415 patients (5 743 eyes) who underwent phacoemulsification combined with intraocular lens implantation in Shanghai Fengxian District Hospital of Traditional Chinese Medicine from January 2011 to December 2017 were selected in this retrospective study. A total of 120 eyes from 105 patients with intraoperative lens PCR were assigned to observation group, and 480 eyes from 452 patients were randomly selected as control group. The data was compared between 2 groups, including general information (gender, age), systemic risk factors (hypertension, diabetes, cardiovascular disease, history of glucocorticoid use, smoking, drinking), basic ophthalmic information and risk factors (vision, intraocular pressure, history of glaucoma, history of high myopia, history of keratopathy, history of uveitis, cataract type, vitreous hemorrhage, history of vitreous surgery), and cataract nucleus hardness. Results The ratios of eyes with preoperative visual acuity<20/200 (89.2%[107/120] vs 58.1%[279/480]), vitreous hemorrhage (10.8%[13/120] vs 2.3%[11/480]), and vitreous operation history (20.8%[25/120] vs 4.8%[23/480]) in observation group were significantly higher than those in control group (P<0.05). The lens nucleus hardness was classified in 111 eyes in the observation group and 459 eyes in the control group. There was significant difference in the hardness of lens nucleus between the observation group (9 eyes[8.1%] of grade Ⅰ, 11 eyes[9.9%] of grade Ⅱ, 10 eyes[9.0%] of grade Ⅲ, 46 eyes[41.4%] of grade Ⅳ and 35 eyes[31.5%] of grade Ⅴ) and the control group (88 eyes[19.2%] of grade Ⅰ, 82 eyes[17.9%] of grade Ⅱ, 109 eyes[23.7%] of grade Ⅲ, 97 eyes[21.1%] of grade Ⅳ and 83 eyes[18.1%] of grade Ⅴ) (P<0.05). The visual acuity of logMAR was restored from 2.11±0.98 to 1.07±0.44 in the observation group (P<0.05), and from 1.37±0.90 to 0.72±0.37 in the control group (P<0.05). LogMAR visual acuity of the patients before and after operation was poor in the observation group versus the control group (both P< 0.05). Conclusion Preoperative visual acuity<20/200, vitreous hemorrhage, history of vitreous surgery and lens nucleus hardness classification are the risk factors of PCR in phacoemulsification.
Key words:  cataract  phacoemulsification  lens  posterior capsular rupture