Engstrom Robert E, Goldenberg David T, Parnell Jeffrey R, Barnhart Lisa A, Holland Gary N
Ocular Inflammatory Disease Center, Jules Stein Eye Institute, University of California at Los Angeles School of Medicine, 100 Stein Plaza, Los Angeles, CA 90095-7000, USA.
Ophthalmology. 2002 Apr;109(4):666-73. doi: 10.1016/s0161-6420(01)01051-x.
To assess the outcomes of clear lens extraction with intraocular lens (IOL) implantation during repair of retinal detachment by vitrectomy with silicone oil tamponade in patients with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis.
Retrospective, noncomparative case series.
Twelve eyes of 10 patients with AIDS, CMV retinitis, and retinal detachment.
All patients underwent phacoemulsification with posterior chamber IOL placement at the time of vitrectomy with silicone oil tamponade for repair of retinal detachment. A targeted postoperative refractive error of -5.00 diopters (D) to -3.00 D was chosen in an attempt to counteract the hyperopic effect of silicone oil.
The following factors were evaluated: postoperative visual acuity, refractive error, and intraoperative and postoperative complications.
Median follow-up was 7 months (range, 1-46 months). For patients without macular necrosis, median best-corrected preoperative visual acuity was 20/75 (range, 20/20-20/800), and median best postoperative visual acuity was 20/50 (range, 20/20-20/400). Median final visual acuity was 20/140 (range, 20/25 to count fingers at 1 foot). The median postoperative refractive error (spherical equivalent) was -1.00 D (range, -4.00 D to +7.88 D). Reoperation was required in 3 of 12 eyes for recurrent macular detachment (1 with silicone oil underfill; 2 with proliferative vitreoretinopathy). The macula was attached in all eyes at last follow-up. Reattachment of the peripheral retina was achieved in 10 of 12 eyes. There were no anterior segment complications.
Clear lens extraction with IOL placement during repair of retinal detachment with silicone oil tamponade does not seem to increase complications and may improve long-term visual rehabilitation, improve retinitis management by allowing better posterior segment visualization throughout the postoperative course, and decrease overall cost and morbidity associated with cataract extraction as a second procedure.
评估在获得性免疫缺陷综合征（AIDS）和巨细胞病毒（CMV）视网膜炎患者中，通过玻璃体切除联合硅油填充治疗视网膜脱离时，行透明晶状体摘除及人工晶状体（IOL）植入术的效果。
回顾性、非对照病例系列。
10例患有AIDS、CMV视网膜炎和视网膜脱离患者的12只眼。
所有患者在玻璃体切除联合硅油填充修复视网膜脱离时，均行超声乳化白内障吸除术并植入后房型人工晶状体。为抵消硅油的远视效应，选择术后目标屈光不正为-5.00屈光度（D）至-3.00 D。
评估以下因素：术后视力、屈光不正以及术中及术后并发症。
中位随访时间为7个月（范围1 - 46个月）。对于黄斑未坏死的患者，术前最佳矫正视力中位数为20/75（范围20/20 - 20/800），术后最佳视力中位数为20/50（范围20/20 - 20/400）。最终视力中位数为20/140（范围20/25至1英尺数指）。术后屈光不正（等效球镜）中位数为-1.00 D（范围-4.00 D至+7.88 D）。12只眼中有3只眼因复发性黄斑脱离需要再次手术（1只眼硅油填充不足；2只眼增殖性玻璃体视网膜病变）。在最后一次随访时，所有眼的黄斑均已附着。12只眼中有10只眼周边视网膜重新附着。无前节并发症。
在硅油填充修复视网膜脱离时行透明晶状体摘除及人工晶状体植入术似乎不会增加并发症，且可能改善长期视力康复，通过在术后全程允许更好的后节可视化来改善视网膜炎的管理，并降低作为二期手术的白内障摘除相关的总体成本和发病率。
