Elgohary M A, McCluskey P J, Towler H M A, Okhravi N, Singh R P, Obikpo R, Lightman S S
Moorfields Eye Hospital, London EC1V 2PD, UK.
Br J Ophthalmol. 2007 Jul;91(7):916-21. doi: 10.1136/bjo.2007.114801. Epub 2007 Jan 17.
To examine the visual outcome and identify risk factors for postoperative uveitis, macular oedema and neodymium-doped yttrium aluminium garnet (Nd:YAG) capsulotomy after phacoemulsification and intraocular lens (IOL) implantation in patients with uveitis.
This is a retrospective review of the medical records of 101 eyes of 101 patients. One eye was randomly selected for inclusion in patients who had bilateral surgery. Patients with juvenile arthritis, keratouveitis and lymphoma-associated uveitis were excluded.
At the first postoperative and final visits, visual acuity was significantly better (p<0.001), and 64.4% and 71.3% of patients, respectively, had achieved >or=2 Snellen's lines of visual improvement. The cumulative probability of doubling of the visual angle was 52% over 6 years of follow-up, and this occurred at a higher rate in the presence of preoperative retinal or optic nerve lesions (HR (95% CI) 4.49 (1.41 to 14.29)). Within 3 months after operation, uveitis was more likely to develop in female patients (OR (95% CI) 6.21 (1.41 to 27.43)) and in the presence of significant intraoperative posterior synechiae (OR (95% CI) 8.43 (1.09 to 65.41)); macular oedema was more likely to develop in patients who developed postoperative uveitis (OR (95% CI) 7.45 (1.63 to 34.16)). Nd:YAG capsulotomy occurred at a higher rate in patients aged <or=55 years (HR (95% CI) 2.28 (1.06, 4.93)) and in those with hydrogel IOLs (HR (95% CI) 3.71 (1.04 to 13.20)), and occurred at a lower rate in patients who had prophylactic systemic corticosteroids (HR (95% CI) 0.25 (0.11 to 0.59)), with plate-haptic silicone IOLs (HR (95% CI) 0.23 (0.08 to 0.64)) and three-piece silicone IOLs (HR (95% CI) 0.19 (0.05 to 0.74)) in comparison to those with polymethylmethacrylate IOLs.
Most patients with uveitis achieve improved visual acuity after phacoemulsification, but an increasing rate of visual loss is observed in those with pre-existent macular or optic nerve lesions. Identifying patients who are at risk of postoperative complications should help in patient counselling and to pre-empt these complications by using preoperative prophylactic corticosteroids, careful IOL selection and postoperative intensive corticosteroids.
研究葡萄膜炎患者白内障超声乳化吸除联合人工晶状体植入术后的视力转归，并确定术后葡萄膜炎、黄斑水肿及钕钇铝石榴石（Nd:YAG）激光后囊膜切开术的危险因素。
对101例患者的101只眼进行回顾性病历分析。双眼手术患者随机选取一眼纳入研究。排除幼年型关节炎、角膜葡萄膜炎及淋巴瘤相关葡萄膜炎患者。
术后首次及末次随访时，视力显著提高（p<0.001），分别有64.4%和71.3%的患者视力提高≥2行。随访6年，视角翻倍的累积概率为52%，术前存在视网膜或视神经病变的患者发生率更高（风险比（95%可信区间）4.49（1.41至14.29））。术后3个月内，女性患者（优势比（95%可信区间）6.21（1.41至27.43））及术中存在明显后粘连的患者（优势比（95%可信区间）8.43（1.09至65.41））更易发生葡萄膜炎；发生术后葡萄膜炎的患者更易发生黄斑水肿（优势比（95%可信区间）7.45（1.63至34.16））。年龄≤55岁的患者（风险比（95%可信区间）2.28（1.06，4.93））及植入水凝胶人工晶状体的患者（风险比（95%可信区间）3.71（1.04至13.20））Nd:YAG激光后囊膜切开术发生率更高，而预防性全身应用糖皮质激素的患者（风险比（95%可信区间）0.25（0.11至0.59））、植入平板襻硅胶人工晶状体的患者（风险比（95%可信区间）0.23（0.08至0.64））及三片式硅胶人工晶状体的患者（风险比（95%可信区间）0.19（0.05至0.74））与植入聚甲基丙烯酸甲酯人工晶状体的患者相比发生率更低。
大多数葡萄膜炎患者白内障超声乳化吸除术后视力改善，但术前存在黄斑或视神经病变的患者视力丧失率增加。识别术后并发症风险患者有助于患者咨询，并通过术前预防性应用糖皮质激素、谨慎选择人工晶状体及术后强化应用糖皮质激素预防这些并发症。
