Scott Ingrid U, Flynn Harry W, Smiddy William E, Murray Timothy G, Moore Jeffrey K, Lemus Dagmar R, Feuer William J
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida 33101, USA.
Ophthalmology. 2003 Aug;110(8):1567-72. doi: 10.1016/S0161-6420(03)00488-3.
To investigate the clinical features, visual acuity outcomes, and adverse events in patients with retained lens fragments managed by pars plana vitrectomy (PPV).
Retrospective, noncomparative, consecutive case series.
Medical records of all patients who underwent PPV for retained lens fragments at Bascom Palmer Eye Institute during the 12-year interval between January 1, 1990, and December 31, 2001, were reviewed.
The study included 343 eyes of 343 patients, with a median age of 76 years and a median follow-up after PPV of 8 months. The median interval between cataract surgery and PPV was 12 days. Visual acuity was >or=20/40 in 29 (9%) patients preoperatively and 190 (56%) at last follow-up (P < 0.001). Visual acuity was <or=20/200 in 224 (66%) patients preoperatively and 67 (20%) at last follow-up (P < 0.001). An intraocular pressure (IOP) >or=30 mmHg was present in 87 (25%) eyes preoperatively and 7 (2%) at last follow-up (P < 0.001); the number of patients on antiglaucoma medications at these two time points was 135 (40%) and 96 (29%), respectively (P = 0.001). Among the 148 (44%) patients with final vision <20/40, the primary cause of visual impairment was cystoid macular edema (CME) in 41 (29%), preexisting ocular disease in 34 (24%), corneal edema in 22 (15%), history of retinal detachment (RD) in 19 (13%), epiretinal membrane in 6 (4%), and other causes in 21 (15%). Significant predictors of better final visual acuity include better presenting visual acuity (P < 0.001), presence of an intraocular lens (i.e., no aphakia) before PPV (P = 0.026), no suprachoroidal hemorrhage (P = 0.010), no serous choroidal detachment (P = 0.037), no RD (P = 0.005), no CME (P = 0.038), and no additional surgery after the PPV (P < 0.001). Timing of PPV (i.e., <or=1 week versus >1 to <or=4 weeks versus >4 to <or=12 weeks versus >12 weeks between cataract surgery and PPV) was not significantly associated with final visual acuity or IOP outcome; there was also no significant difference in acuity or IOP outcome between patients who underwent PPV on the same day as cataract surgery compared with all other patients.
The most important predictor of final visual acuity after PPV for retained lens fragments is a less complicated clinical course (e.g., no suprachoroidal hemorrhage, no RD, no CME, and no additional surgery after PPV). The most common cause of decreased final vision was CME.
研究经扁平部玻璃体切除术（PPV）治疗的晶状体碎片残留患者的临床特征、视力预后及不良事件。
回顾性、非对照、连续病例系列研究。
回顾了1990年1月1日至2001年12月31日期间在巴斯科姆·帕尔默眼科研究所接受PPV治疗晶状体碎片残留的所有患者的病历。
该研究纳入了343例患者的343只眼，中位年龄为76岁，PPV术后中位随访时间为8个月。白内障手术与PPV之间的中位间隔时间为12天。术前29例（9%）患者视力≥20/40，末次随访时为190例（56%）（P<0.001）。术前224例（66%）患者视力≤20/200，末次随访时为67例（20%）（P<0.001）。术前87只眼（25%）眼压≥30 mmHg，末次随访时为7只眼（2%）（P<0.001）；这两个时间点使用抗青光眼药物的患者数量分别为135例（40%）和96例（29%）（P=0.001）。在最终视力<20/40的148例（44%）患者中，视力损害的主要原因是黄斑囊样水肿（CME）41例（29%）、既往眼部疾病34例（24%）、角膜水肿22例（15%）、视网膜脱离（RD）病史19例（13%）、视网膜前膜6例（4%）以及其他原因21例（15%）。最终视力较好的显著预测因素包括初始视力较好（P<0.001）、PPV术前存在人工晶状体（即无无晶状体眼）（P=0.026）、无脉络膜上腔出血（P=0.010）、无浆液性脉络膜脱离（P=0.037）、无RD（P=0.005）、无CME（P=0.038）以及PPV术后无额外手术（P<0.001）。PPV的时机（即白内障手术与PPV之间≤1周、>1至≤4周、>4至≤12周、>12周）与最终视力或眼压结果无显著相关性；与所有其他患者相比，在白内障手术当天接受PPV的患者在视力或眼压结果方面也无显著差异。
PPV治疗晶状体碎片残留后最终视力的最重要预测因素是临床过程较简单（如无脉络膜上腔出血、无RD、无CME以及PPV术后无额外手术）。最终视力下降的最常见原因是CME。
