Herrmann W, Helbig H, Heimann H
Klinik und Poliklinik für Augenheilkunde, Universität Regensburg.
Klin Monbl Augenheilkd. 2011 Mar;228(3):195-200. doi: 10.1055/s-0029-1246116. Epub 2011 Mar 3.
Modern phacoemulsification has established itself as a safe and very rewarding surgical procedure. Patients and surgeons may not associate late complications with the initial surgery. However, recent studies have demonstrated that such a causal relationship may persist for many years after the cataract procedure and that there is a significant increase in the risk for developing a retinal detachment during the postoperative years. The mean time period between cataract surgery and pseudophakic retinal detachment is between 3 and 4 years. Even uncomplicated cataract surgery alters the physiological processes within the eye and can lead to progressive destruction of the vitreous for many years after the surgery. Therefore, the risk for a retinal detachment is increased for at least 10 years after the initial procedure. In recent epidemiological studies, the most important risk factors for pseudophakic retinal detachment were myopia, younger age and male gender. If all factors are combined, the cumulative risk for developing a retinal detachment after cataract surgery may rise to 20 %. Additional factors that may increase this risk are additional intraoperative complications, for example, rupture of the posterior capsule, vitreous loss or dropped nucleus. Compared to phakic retinal detachments, pseudophakic patients on average present with a shorter history of visual symptoms, are older, more commonly male and display fewer, smaller and more anteriorly located retinal breaks that frequently are only detected during surgery. The anatomic success rates have improved significantly over the past years, in particular through the advances and increasing popularity of primary vitrectomy. However, functional results are still disappointing. Only about half of the patients will achieve reading ability without low vision aids. The increased and long-term risk for pseudophakic retinal detachment should be part of the preoperative consent process of any cataract surgery, in particular, in young myopic males.
现代超声乳化术已成为一种安全且回报丰厚的外科手术。患者和外科医生可能不会将晚期并发症与初次手术联系起来。然而，最近的研究表明，这种因果关系可能在白内障手术后持续多年，并且术后数年发生视网膜脱离的风险会显著增加。白内障手术与人工晶状体性视网膜脱离之间的平均时间间隔为3至4年。即使是无并发症的白内障手术也会改变眼内的生理过程，并可能在手术后多年导致玻璃体的渐进性破坏。因此，初次手术后至少10年内视网膜脱离的风险都会增加。在最近的流行病学研究中，人工晶状体性视网膜脱离最重要的危险因素是近视、年轻和男性性别。如果将所有因素综合起来，白内障手术后发生视网膜脱离的累积风险可能会升至20%。可能增加这种风险的其他因素包括术中的额外并发症，例如后囊破裂、玻璃体丢失或晶状体核掉落。与晶状体性视网膜脱离相比，人工晶状体性视网膜脱离患者的视觉症状病史平均较短，年龄较大，男性更为常见，视网膜裂孔较少、较小且位置更靠前，这些裂孔通常仅在手术期间才能检测到。在过去几年中，解剖学上的成功率有了显著提高，特别是由于原发性玻璃体切除术的进展和越来越普及。然而，功能结果仍然令人失望。只有大约一半的患者在没有低视力辅助工具的情况下能够获得阅读能力。人工晶状体性视网膜脱离增加的长期风险应成为任何白内障手术术前知情同意过程的一部分，特别是对于年轻的近视男性患者。
