左心室辅助装置支持下的白内障手术。

Cataract surgery in patients with left ventricular assist device support.

机构信息

From the Department of Ophthalmology (Eghrari, Alkharashi, Rajaii, Sikder) and the Department of Anesthesia and Critical Care (Rivers, Nyhan), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

出版信息

J Cataract Refract Surg. 2014 Apr;40(4):675-8. doi: 10.1016/j.jcrs.2014.01.024. Epub 2014 Feb 22.

DOI:10.1016/j.jcrs.2014.01.024

PMID:24568720

Abstract

UNLABELLED

Left ventricular assist devices (LVADs) have been increasingly used for 20 years in terminally ill patients with advanced heart failure or awaiting cardiac transplantation. Despite improvement in morbidity and mortality from use of these devices, quality of life may be limited by cataract. Access to cataract surgery in this predominantly elderly population is essential but limited by unfamiliarity with these devices. We describe phacoemulsification and intraocular lens implantation in 2 patients with LVADs. The patients had extensive preoperative cardiology evaluations and were instructed to continue warfarin through the day of surgery. Monitored sedation was used with fentanyl and midazolam. Both patients experienced significant improvement in visual acuity and quality of life. Neither experienced intraoperative hemodynamic instability. Cataract surgery may be safely performed in patients with LVAD support when adequate monitoring resources are available.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

摘要

目的：在过去的 20 年中，左心室辅助装置（LVAD）在终末期心力衰竭或等待心脏移植的晚期心脏病患者中得到了越来越多的应用。尽管使用这些设备的发病率和死亡率有所改善，但生活质量可能会受到白内障的限制。在这个主要由老年人组成的人群中，获得白内障手术的机会至关重要，但由于对这些设备不熟悉，手术机会有限。我们描述了 2 例 LVAD 患者的超声乳化白内障吸除术和人工晶状体植入术。这两名患者均接受了广泛的术前心脏病学评估，并被指示继续服用华法林直至手术当天。采用舒芬太尼和咪达唑仑进行监测镇静。两名患者的视力和生活质量均有显著改善。两名患者均未出现术中血流动力学不稳定。当有足够的监测资源时，LVAD 支持下的白内障手术是安全的。