Moisseiev Elad, Kinori Michael, Glovinsky Yoseph, Loewenstein Anat, Moisseiev Joseph, Barak Adiel
Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Eur J Ophthalmol. 2011 Nov-Dec;21(6):741-7. doi: 10.5301/EJO.2011.6483.
To identify factors that determined the outcome of eyes that underwent pars plana vitrectomy for retained lens fragments after phacoemulsification.
A retrospective review of the records of 63 eyes that underwent vitrectomy for retained lens fragments after phacoemulsification. Fragments were defined as nuclear if they contained any nucleus component or non-nuclear if they contained only cortex and epinucleus. Nuclear fragments were further divided into large (at least 1/3 the size of the nucleus) or small.
A total of 67% of eyes had retained nuclear fragments and 33% had non-nuclear fragments. Of the eyes with nuclear fragments, 64% had large fragments and 36% had small fragments. Statistical analysis revealed that the lens fragment type was the major determinant of the final visual acuity (VA). Only 38.8% (14/36) of the eyes with nuclear fragments achieved final VA of 20/40 or better, compared with 77.7% (14/18) of eyes with non-nuclear fragments (p=0.007). All other parameters, including size of the nuclear fragment, were not correlated with final VA. The major complications encountered in this series were retinal detachment (12.6%), pseudophakic bullous keratopathy (6.3%), cystoid macular edema (15.8%), and glaucoma (15.8%).
The major finding of our study is that posterior dislocation of nuclear lens fragments is associated with worse visual outcome than that of non-nuclear fragments. This may be related to a more complicated course of the cataract surgery, direct mechanical damage to the retina, a stronger inflammatory response, or a more traumatic vitrectomy procedure.
确定影响白内障超声乳化术后晶状体碎片残留行扁平部玻璃体切割术患眼预后的因素。
回顾性分析63例白内障超声乳化术后晶状体碎片残留行玻璃体切割术患眼的病历资料。若碎片包含任何核成分则定义为核碎片，若仅包含皮质和核上物质则定义为非核碎片。核碎片进一步分为大碎片（至少为核大小的1/3）或小碎片。
共有67%的患眼残留核碎片，33%的患眼残留非核碎片。在残留核碎片的患眼中，64%为大碎片，36%为小碎片。统计分析显示，晶状体碎片类型是最终视力（VA）的主要决定因素。残留核碎片的患眼中只有38.8%（14/36）最终视力达到20/40或更好，而残留非核碎片的患眼中这一比例为77.7%（14/18）（p=0.007）。所有其他参数，包括核碎片大小，均与最终视力无关。该系列中遇到的主要并发症包括视网膜脱离（12.6%）、人工晶状体性大泡性角膜病变（6.3%）、黄斑囊样水肿（15.8%）和青光眼（15.8%）。
我们研究的主要发现是，核性晶状体碎片后脱位与非核碎片相比，视力预后更差。这可能与白内障手术过程更复杂、视网膜直接机械损伤、更强的炎症反应或更具创伤性的玻璃体切割手术有关。
