Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA.
Am J Ophthalmol. 2013 Jul;156(1):82-88.e2. doi: 10.1016/j.ajo.2013.02.002. Epub 2013 Apr 28.
To examine surgical outcomes in patients with retinitis pigmentosa (RP) undergoing phacoemulsification cataract extraction.
Retrospective observational case series.
In this single-institution study of consecutive RP patients who underwent phacoemulsification cataract extraction and intraocular lens implantation by a single surgeon between 2002 and 2012, preoperative, intraoperative, and postoperative records were analyzed with attention to best-corrected visual acuity (BCVA), lens and zonular status, capsular tension ring use, incidence of posterior capsular opacification and neodymium-doped yttrium-aluminum-garnet (YAG) laser capsulotomy, and surgical complications.
Eighty eyes of 47 RP patients (21 male) underwent cataract surgery during the study period at an average age of 48.9 years (range, 31-78 years). Mean follow-up time was 23.3 months (range, 1 day - 95 months). Posterior subcapsular cataracts were present in 97.5% of patients. Mean BCVA improved from 20/340 (logarithm of the minimal angle of resolution [logMAR] 1.23) to 20/129 (0.81) within 3 months of surgery, P < .0001. Eyes with a preoperative vision of 20/40 to 20/200 (47 eyes) improved from a mean of 20/81 (logMAR 0.61) preoperatively to 20/43 (0.33), P < .0001, postoperatively. Posterior capsule opacification occurred in 66 eyes (82.5%), and 42 eyes (52.5%) underwent a YAG laser capsulotomy at a mean of 10.8 months after surgery. Fifteen eyes (18.8%) of 10 patients (21.3%) had signs of phacodonesis (3 eyes noted preoperatively, 8 intraoperatively, and 4 postoperatively). One patient had bilateral dislocated in-the-bag intraocular lenses at 5.5 years and 6 years after surgery.
Cataract surgery yields significantly improved Snellen visual acuity in a majority of RP patients with a preoperative vision of 20/200 or better. Conversely, patients with a preoperative visual acuity of 20/400 or worse generally have more limited objective improvements, likely because of macular involvement, but usually report noticeable subjective improvement. A high prevalence of zonular instability is seen in RP patients undergoing cataract extraction. It is therefore important to conduct a careful preoperative assessment of lens stability with preparation for adjunctive methods that augment intraoperative and postoperative lens stabilization.
研究行白内障超声乳化吸除术的色素性视网膜炎（RP）患者的手术结果。
回顾性观察性病例系列。
在这项由一名外科医生进行的 2002 年至 2012 年间连续进行白内障超声乳化吸除术和人工晶状体植入术的 RP 患者的单中心研究中，分析了术前、术中及术后记录，重点关注最佳矫正视力（BCVA）、晶状体和悬韧带状态、囊袋张力环的使用、后发性白内障和钕掺杂钇铝石榴石（YAG）激光后囊切开术的发生率，以及手术并发症。
研究期间，47 例（21 例男性）RP 患者的 80 只眼接受了白内障手术，平均年龄为 48.9 岁（范围，31-78 岁）。平均随访时间为 23.3 个月（范围，1 天-95 个月）。97.5%的患者存在后发性白内障。术后 3 个月内，BCVA 从 20/340（最小分辨角对数[logMAR]1.23）提高到 20/129（0.81），P<0.0001。术前视力为 20/40 至 20/200（47 只眼）的眼术后从平均 20/81（logMAR 0.61）提高到 20/43（0.33），P<0.0001。66 只眼（82.5%）发生后发性白内障，42 只眼（52.5%）于术后平均 10.8 个月行 YAG 激光后囊切开术。10 例（21.3%）10 只眼（18.8%）出现白内障后囊混浊（术前 3 只眼，术中 8 只眼，术后 4 只眼）。1 例患者术后 5.5 年和 6 年时双侧人工晶状体囊袋内脱位。
在术前视力为 20/200 或更好的大多数 RP 患者中，白内障手术可显著提高 Snellen 视力。相反，术前视力为 20/400 或更差的患者客观改善通常更有限，这可能是由于黄斑受累所致，但通常会报告明显的主观改善。在接受白内障摘除术的 RP 患者中，后囊膜的稳定性较差。因此，重要的是在术前仔细评估晶状体的稳定性，并准备好辅助方法以增强术中及术后晶状体的稳定性。
