Elgohary Mostafa A, Dowler Jonathan G
Medical Retina Service, Moorfields Eye Hospital, London, UK, and Tanta Ophthalmology University Hospital, Egypt.
Clin Exp Ophthalmol. 2006 Aug;34(6):526-34. doi: 10.1111/j.1442-9071.2006.01263.x.
To estimate the cumulative incidence and identify the risk factors of posterior capsule opacification (PCO) that required Nd:YAG capsulotomy in non-diabetic and diabetic patients.
Retrospective case-note review of 806 consecutive patients that underwent phacoemulsification and intraocular lens (IOL) implantation, 327 (40.6%) of whom were diabetic.
The cumulative incidence of Nd:YAG capsulotomy were 10.6%, 14.8%, 21.2% and 28.6% in non-diabetic patients; and 9%, 9.4%, 15.3% and 5.3% in diabetic patients after 1, 2, 3 and 4 years, respectively. A multivariate Cox regression analysis showed that, over the follow-up period, diabetes mellitus was associated with a decreased risk of Nd:YAG capsulotomy (hazard ratio [HR]=0.69; 95% confidence interval [CI] 0.47-0.99; P=0.047), whereas age of 65 years or younger (HR=1.58; 95% CI 1.09-2.27; P=0.02), polymethylmethacrylate (PMMA) (HR=3.98; 95% CI 1.60-9.95; P=0.003) or plate-haptic silicone IOLs (HR=3.75; 95% CI 1.60-8.80; P=0.002) in comparison with three-piece silicone IOLs, postoperative inflammation (HR=2.62; 95% CI 1.56-4.42; P<0.001) and pars plana vitrectomy (HR=1.85; 95% CI 1.20-2.83; P=0.005) were associated with an increased risk. Subgroup analysis showed that in non-diabetic patients, male gender (HR=1.63; 95% CI 1.04-2.57; P=0.03) was an additional risk factor and in diabetic patients there was no significant association between diabetes type, duration or retinopathy grade and the risk of Nd:YAG capsulotomy.
Although diabetes mellitus appears to be associated with a lower long-term incidence and a decreased risk of Nd:YAG capsulotomy, younger age, pars plana vitrectomy, postoperative inflammation, plate-haptic silicone and PMMA IOLs in addition to male gender in non-diabetic patients appear to be associated with a greater risk. Estimation of the incidence and risk factors of PCO should help in patient counselling and to design methods to reduce or prevent its development.
评估非糖尿病和糖尿病患者后囊膜混浊（PCO）需要进行钕钇铝石榴石（Nd:YAG）晶状体囊切开术的累积发病率，并确定其危险因素。
对806例连续接受超声乳化白内障吸除术和人工晶状体（IOL）植入术的患者进行回顾性病例记录审查，其中327例（40.6%）为糖尿病患者。
非糖尿病患者在术后1、2、3和4年时Nd:YAG晶状体囊切开术的累积发病率分别为10.6%、14.8%、21.2%和28.6%；糖尿病患者分别为9%、9.4%、15.3%和5.3%。多因素Cox回归分析显示，在随访期间，糖尿病与Nd:YAG晶状体囊切开术风险降低相关（风险比[HR]=0.69；95%置信区间[CI]0.47 - 0.99；P=0.047），而65岁及以下年龄（HR=1.58；95%CI 1.09 - 2.27；P=0.02）、聚甲基丙烯酸甲酯（PMMA）人工晶状体（HR=3.98；95%CI 1.60 - 9.95；P=0.003）或平板襻硅胶人工晶状体（HR=3.75；95%CI 1.60 - 8.80；P=0.002）相比于三片式硅胶人工晶状体、术后炎症（HR=2.62；95%CI 1.56 - 4.42；P<0.001）和玻璃体平坦部玻璃体切除术（HR=1.85；95%CI 1.20 - 2.83；P=0.005）与风险增加相关。亚组分析显示，在非糖尿病患者中，男性（HR=1.63；95%CI 1.04 - 2.57；P=0.03）是另外一个危险因素，而在糖尿病患者中，糖尿病类型、病程或视网膜病变分级与Nd:YAG晶状体囊切开术风险之间无显著关联。
尽管糖尿病似乎与较低的长期发病率和Nd:YAG晶状体囊切开术风险降低相关，但年龄较小、玻璃体平坦部玻璃体切除术、术后炎症、平板襻硅胶和PMMA人工晶状体以及非糖尿病患者中的男性似乎与更高风险相关。评估PCO的发病率和危险因素应有助于患者咨询，并设计减少或预防其发生的方法。
