Hui Jennifer I, Fishler Jane, Karp Carol L, Shuler Magdalena F, Gedde Steven J
Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida 33136, USA.
Ophthalmology. 2006 Nov;113(11):1949-53. doi: 10.1016/j.ophtha.2006.03.066. Epub 2006 Aug 28.
To review the clinical features and treatment of patients with retained nuclear fragments in the anterior chamber (AC).
Single-center, retrospective, noncomparative, consecutive case series.
Sixteen patients with a diagnosis of retained nuclear fragments in the AC.
Retrospective review of the medical records at Bascom Palmer Eye Institute in Miami, Florida, to identify all patients with a diagnosis of retained nuclear fragments in the AC after phacoemulsification surgery without rupture of the posterior capsule. Charts were reviewed and patient characteristics, ocular history, clinical findings, treatment (medical and surgical), and visual outcomes were recorded.
Visual outcome and visual acuity at last follow-up visit.
Most patients presented with corneal edema and anterior segment inflammation. All patients proved refractory to medical management, and surgical extraction of the retained lens fragment was required. Ten patients were myopic or had long axial lengths and/or steep keratometry readings. Three patients underwent penetrating keratoplasty for intractable corneal edema. One patient required a second surgery for fragment removal after a previous unsuccessful attempt at removal. Visual outcomes for the patients without macular disease who had lens fragment removal alone ranged from 20/20 to 20/40. Of the 2 patients without macular disease who underwent penetrating keratoplasty, the visual outcomes were 20/50 and 20/30.
Retention of nuclear fragments in the AC may occur after phacoemulsification. This complication was associated with myopia in a majority of patients in this series, and we hypothesize that small fragments may hide in the posterior chamber in these larger eyes. Surgical removal was associated with a good visual outcome in patients without macular disease.
回顾前房内残留晶状体核碎片患者的临床特征及治疗情况。
单中心、回顾性、非对照、连续病例系列研究。
16例诊断为前房内残留晶状体核碎片的患者。
对佛罗里达州迈阿密巴斯科姆·帕尔默眼科研究所的病历进行回顾性分析，以确定所有在白内障超声乳化手术后前房内残留晶状体核碎片且后囊膜未破裂的患者。查阅病历并记录患者特征、眼部病史、临床检查结果、治疗（药物和手术）及视力转归情况。
末次随访时的视力转归及视力。
大多数患者出现角膜水肿和前段炎症。所有患者药物治疗均无效，需要手术取出残留的晶状体碎片。10例患者为近视或眼轴长和/或角膜曲率读数陡峭。3例患者因顽固性角膜水肿接受了穿透性角膜移植术。1例患者在先前一次取出碎片的尝试失败后需要再次手术取出碎片。仅接受晶状体碎片取出术且无黄斑疾病的患者视力结果在20/20至20/40之间。2例接受穿透性角膜移植术且无黄斑疾病的患者视力结果分别为20/50和20/30。
白内障超声乳化术后可能发生前房内晶状体核碎片残留。在本系列研究的大多数患者中，这种并发症与近视有关，我们推测在这些较大的眼中，小碎片可能隐藏在后房内。对于无黄斑疾病的患者，手术取出与良好的视力结果相关。
