The Retina Group of Washington, Chevy Chase, Maryland, USA.
Retina. 2011 Sep;31(8):1534-40. doi: 10.1097/IAE.0b013e31821800fc.
To evaluate whether performing same-day pars plana vitrectomy versus delayed pars plana vitrectomy affects visual outcomes and ocular morbidity of patients with retained lens fragments after a complicated cataract surgery.
Retrospective, comparative case series of 172 eyes of 171 patients with retained lens fragments undergoing 3-port pars plana vitrectomy using 20-, 23-, or 25-gauge instrumentation between 2005 and 2008. Outcome measures included best-corrected visual acuity at 6 months, final best-corrected visual acuity, and postoperative complications such as cystoid macular edema, intraocular pressure elevation, retinal detachment, vitreous hemorrhage, choroidal hemorrhage, and endophthalmitis.
The median age was 75 ± 0.8 years. The mean time to vitrectomy for the delayed group was 15 ± 2 days. The preoperative logarithm of the minimum angle of resolution best-corrected visual acuity for immediate vitrectomy was 0.73 ± 0.09 versus 0.72 ± 0.06 for delayed vitrectomy. Six-month logarithm of the minimum angle of resolution acuity was 0.44 ± 0.09 for same-day vitrectomy compared with 0.44 ± 0.05 for delayed vitrectomy (P = 0.97, 2-tailed t-test). Of 59 eyes undergoing immediate vitrectomy, 17 (29%) experienced postoperative complications, while 38 of 113 eyes (34%), experienced complications if undergoing delayed vitrectomy (Fisher exact test, P = 0.61). Overall, the most common complication was cystoid macular edema occurring in 25 of 172 eyes (15%).
The outcomes of same-day pars plana vitrectomy appear to be similar to non-same-day pars plana vitrectomy. The risks and benefits related to the timing of vitrectomy after a complicated cataract surgery should be carefully discussed with each patient. Further investigation is warranted to establish an optimal time for surgical planning.
评估在复杂白内障手术后有晶状体碎片残留的患者中，行即刻或延迟行巩膜平坦部玻璃体切除术对视力结果和眼部发病率的影响。
回顾性、比较病例系列研究，纳入了 2005 年至 2008 年期间因有晶状体碎片残留而接受 3 端口巩膜平坦部玻璃体切除术的 171 例 172 只眼患者。研究结果包括术后 6 个月的最佳矫正视力、最终最佳矫正视力和术后并发症，如黄斑囊样水肿、眼压升高、视网膜脱离、玻璃体积血、脉络膜出血和眼内炎。
患者的中位年龄为 75 ± 0.8 岁。延迟手术组的平均手术时间为 15 ± 2 天。即刻玻璃体切除术组术前最佳矫正视力的最小分辨角对数为 0.73 ± 0.09，延迟玻璃体切除术组为 0.72 ± 0.06。即刻玻璃体切除术组术后 6 个月的最小分辨角对数视力为 0.44 ± 0.09，而延迟玻璃体切除术组为 0.44 ± 0.05（双侧 t 检验，P = 0.97）。59 只眼行即刻玻璃体切除术，17 只眼（29%）出现术后并发症，113 只眼（34%）行延迟玻璃体切除术出现并发症（Fisher 确切概率检验，P = 0.61）。总体而言，最常见的并发症是黄斑囊样水肿，共 25 只眼（15%）发生。
即刻行巩膜平坦部玻璃体切除术的结果似乎与非即刻行巩膜平坦部玻璃体切除术相似。对于复杂白内障手术后何时行玻璃体切除术，应与每位患者仔细讨论手术的风险和获益。还需要进一步的研究来确定手术计划的最佳时机。
