相对小眼球中的白内障手术

Cataract surgery in relative anterior microphthalmos.

作者信息

Nihalani Bharti R, Jani Urvi D, Vasavada Abhay R, Auffarth Gerd U

机构信息

Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India.

出版信息

Ophthalmology. 2005 Aug;112(8):1360-7. doi: 10.1016/j.ophtha.2005.02.027.

DOI:10.1016/j.ophtha.2005.02.027

PMID:15964630

Abstract

PURPOSE

To determine the prevalence of relative anterior microphthalmos (RAM) and evaluate intraoperative performance and surgical outcome in eyes with RAM undergoing cataract surgery.

DESIGN

Nested case-control series.

PARTICIPANTS

One thousand four hundred consecutive patients undergoing cataract surgery were evaluated to determine the prevalence of RAM. Relative anterior microphthalmos is defined as horizontal corneal diameter (HCD) < or =11 mm, anterior chamber depth (ACD) < or =2.2 mm, and axial length (AL) >20 mm, with no other morphologic malformation.

METHODS

Patients were examined preoperatively for HCD, ACD, and AL. Horizontal corneal diameter was measured with calipers. Anterior chamber depth and AL were measured with immersion shell with water. Associated ocular pathologic conditions were recorded. Two control groups were identified. Group I (normal eyes; n = 84) had HCD >11 mm, ACD >2.2 mm, and AL >20 mm. Group II (eyes with small corneal diameter; n = 84) had HCD < or =11 mm, ACD >2.2 mm, and AL >20 mm.

MAIN OUTCOME MEASURES

Patients with RAM and controls were evaluated for intraoperative performance and postoperative outcome. The 2-tailed Fisher exact test was applied to compare the performance of RAM with each of the control groups. The odds ratio (OR) with 95% confidence intervals (95% CI) was determined.

RESULTS

The prevalence of RAM was 6% (84 of 1400 eyes; 95%CI, 0.048-0.074). Relative anterior microphthalmos was associated with the presence of small pupil, 34 (40.48%); corneal guttae, 31 (36.9%); glaucoma, 29 (34.5%); and pseudoexfoliation, 6 (7.14%). Intraoperatively, RAM was associated with overall surgical difficulty because of less working space in 59 eyes (70.24%; OR, 63.7; 95% CI, 18.3-221; P<0.001) compared with control groups I and II; uveal trauma in 12 (14.28%); Descemet's detachment in 5 (5.95%); and posterior capsule rupture in 2 (2.38%). Postoperatively, RAM was associated with transient corneal edema in 63 eyes (75%; OR, 9.0; 95% CI, 4.4-18.0; P<0.001; OR, 5.4; 95% CI, 2.7-10.5; P<0.001) on the first postoperative day.

CONCLUSIONS

The prevalence of RAM was 6%. Relative anterior microphthalmos with its associations posed significant intraoperative difficulties. The occurrence of transient corneal edema was frequent.

摘要

目的

确定相对前部小眼球（RAM）的患病率，并评估接受白内障手术的RAM患者的术中表现和手术结果。

设计

巢式病例对照研究。

参与者

对1400例连续接受白内障手术的患者进行评估，以确定RAM的患病率。相对前部小眼球定义为水平角膜直径（HCD）≤11mm，前房深度（ACD）≤2.2mm，眼轴长度（AL）>20mm，且无其他形态学畸形。

方法

术前检查患者的HCD、ACD和AL。用卡尺测量水平角膜直径。用水浸式超声测量前房深度和AL。记录相关的眼部病理情况。确定两个对照组。第一组（正常眼；n = 84）HCD>11mm，ACD>2.2mm，AL>20mm。第二组（角膜直径小的眼；n = 84）HCD≤11mm，ACD>2.2mm，AL>20mm。

主要观察指标

对RAM患者和对照组进行术中表现和术后结果评估。应用双侧Fisher精确检验比较RAM与每个对照组的表现。确定比值比（OR）及95%置信区间（95%CI）。

结果

RAM的患病率为6%（1400眼中的84眼；95%CI，0.048 - 0.074）。相对前部小眼球与小瞳孔存在相关，占34例（40.48%）；角膜小滴，31例（36.9%）；青光眼，29例（34.5%）；假性剥脱，6例（7.14%）。术中，由于工作空间较小，59眼（70.24%；OR，63.7；95%CI，18.3 - 221；P<0.001）的RAM与总体手术难度相关，与对照组I和II相比；12眼（14.28%）发生葡萄膜损伤；5眼（5.95%）发生Descemet膜脱离；2眼（2.38%）发生后囊破裂。术后，RAM与术后第1天63眼（75%；OR，9.0；95%CI，4.4 - 18.0；P<0.001；OR，5.4；95%CI，2.7 - 10.5；P<0.001）的短暂性角膜水肿相关。