Arbisser Lisa Brothers
Curr Opin Ophthalmol. 2004 Feb;15(1):33-9. doi: 10.1097/00055735-200402000-00007.
This article surveys the literature from 2002 and 2003 and addresses a variety of complications that may arise during cataract surgery. Modern surgical techniques and technology contribute to the decreased incidence of complications. Surgeon experience, early recognition of potential complications, and optimal handling of events lead to better outcomes.
Recognizing eyes preoperatively that are particularly at risk for having dysgenesis of the capsular bag, cortical-capsular adhesions, low endothelial cell reserve, dropped nucleus, and bag-lens dislocation will allow for contingency planning and appropriate tailoring of techniques. Capsular tension rings are indispensable for achieving in-the-bag implantation in the presence of weak zonules and zonulolysis. Viscolevitation to rescue sinking implants, avoidance of foldable lens complications, and proper lens placement with an open capsule are discussed. High-frequency ultrasound biomicroscopy is a useful diagnostic tool. Noninjection sub-Tenon anesthesia is not benign. Complications have been documented that include traumatic optic neuropathy. Immediate diagnosis and a trial of corticosteroids could be vision saving. Mastering topical anesthesia is a worthy goal. In some cases, faulty instruments result in complications. Routine inspection of reusable instruments, or the use of disposable instruments is warranted. Though there is no FDA-recognized use, at the time of this writing, for trypan blue dye, it has become the world standard for intraocular staining because of its safety and efficacy. Clear corneal self-sealing incisions are increasingly mainstream and, when properly constructed, are extremely secure. The most significant trend for successful management of intraoperative complications this year is the increasing use of pars plana anterior vitrectomy. The ability to identify prolapsed vitreous by intracameral Kenalog staining is an invaluable tool. Surgeons depend on a team of nurses and technicians for optimal outcomes.
With new technology and techniques highlighted by capsular tension rings, Kenalog vitreous identification, and fourth-generation fluoroquinolones, even complicated cataract surgery can result in optimal outcomes.
本文综述了2002年和2003年的文献，探讨了白内障手术期间可能出现的各种并发症。现代手术技术和科技有助于降低并发症的发生率。术者经验、对潜在并发症的早期识别以及对各种情况的最佳处理可带来更好的手术效果。
术前识别出囊袋发育异常、皮质 - 囊膜粘连、内皮细胞储备低、晶状体核掉落以及囊袋 - 晶状体脱位风险特别高的眼睛，将有助于进行应急规划并适当调整手术技术。在悬韧带薄弱和悬韧带溶解的情况下，囊袋张力环对于实现囊袋内植入必不可少。讨论了利用粘弹剂悬浮技术挽救下沉的人工晶状体、避免折叠式人工晶状体并发症以及在开放囊袋状态下正确植入人工晶状体的方法。高频超声生物显微镜是一种有用的诊断工具。非注射式球周麻醉并非毫无风险。已记录到包括外伤性视神经病变在内的并发症。立即诊断并试用皮质类固醇可能挽救视力。掌握表面麻醉是一个值得追求的目标。在某些情况下，器械故障会导致并发症。有必要对可重复使用的器械进行常规检查，或使用一次性器械。虽然在撰写本文时锥蓝染料尚未获得美国食品药品监督管理局（FDA）的认可用途，但因其安全性和有效性，它已成为眼内染色的全球标准。透明角膜自闭式切口越来越成为主流，并且如果构建得当，非常安全。今年术中并发症成功处理的最显著趋势是越来越多地使用前段玻璃体切除术。通过前房内注射曲安奈德染色来识别脱出的玻璃体是一项非常宝贵的技术。术者依赖护士和技术人员团队以获得最佳手术效果。
借助囊袋张力环、曲安奈德玻璃体识别技术和第四代氟喹诺酮类药物等新技术和新方法，即使是复杂的白内障手术也能取得最佳效果。
