Zare Mohammad, Javadi Mohammad-Ali, Einollahi Bahram, Baradaran-Rafii Ali-Reza, Feizi Sepehr, Kiavash Victoria
Labbafinejad Medical Center, Shahid Beheshti University, MC, Tehran, Iran.
J Ophthalmic Vis Res. 2009 Oct;4(4):208-12.
To determine the rate and risk factors of vitreous loss during phacoemulsification in patients with cataracts operated by ophthalmology residents and fellows at Labbafinejad Medical Center.
This prospective descriptive study included consecutive patients with cataracts undergoing phacoemulsification over a one year period. All patients were operated under local or general anesthesia using the divide and conquer technique. Preoperatively, all patients underwent a complete ocular examination including measurement of visual acuity, slitlamp biomicroscopy, intraocular pressure measurement, and dilated funduscopy. Main outcome measures included the rate of posterior capsular rupture and vitreous loss as well as associated risk factors such as surgical experience, ocular and systemic conditions, and type and severity of the cataract.
Overall, 767 eyes of 767 patients with mean age of 63.7±10.3 (range, 25-91) years were operated. The overall rate of vitreous loss was 7.9% which was 5-fold greater in the hands of residents as compared to fellows. Among different factors, older age, female sex, small pupil, small capsulorrhexis, presence of pseudoexfoliation, and high myopia were significantly associated with vitreous loss. The highest rate of vitreous loss occurred in patients with dense nuclear cataracts.
Considering the higher rate of vitreous loss in patients operated by ophthalmology residents; patients with known risk factors for vitreous loss should better be operated by more experienced surgeons.
确定在拉巴菲内贾德医疗中心由眼科住院医师和进修医师为白内障患者进行超声乳化手术时玻璃体丢失的发生率及危险因素。
这项前瞻性描述性研究纳入了在一年期间连续接受超声乳化手术的白内障患者。所有患者均在局部或全身麻醉下采用分而治之技术进行手术。术前，所有患者均接受了全面的眼部检查，包括视力测量、裂隙灯显微镜检查、眼压测量和散瞳眼底检查。主要观察指标包括后囊破裂和玻璃体丢失的发生率以及相关危险因素，如手术经验、眼部和全身状况以及白内障的类型和严重程度。
总体而言，对767例平均年龄为63.7±10.3（范围25 - 91）岁患者的767只眼进行了手术。玻璃体丢失的总体发生率为7.9%，住院医师手术时的发生率是进修医师的5倍。在不同因素中，年龄较大、女性、瞳孔小、连续环形撕囊小、存在假性剥脱和高度近视与玻璃体丢失显著相关。玻璃体丢失发生率最高的是核性白内障致密的患者。
考虑到眼科住院医师手术患者的玻璃体丢失发生率较高；已知有玻璃体丢失危险因素的患者最好由经验更丰富的外科医生进行手术。
