Turalba Angela, Payal Abhishek R, Gonzalez-Gonzalez Luis A, Cakiner-Egilmez Tulay, Chomsky Amy S, Vollman David E, Baze Elizabeth F, Lawrence Mary, Daly Mary K
Ophthalmology Department, Veterans Affairs Boston Healthcare System, Jamaica Plains, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Ophthalmology Department, Veterans Affairs Boston Healthcare System, Jamaica Plains, Massachusetts.
Am J Ophthalmol. 2015 Oct;160(4):693-701.e1. doi: 10.1016/j.ajo.2015.07.020. Epub 2015 Jul 22.
To compare visual acuity outcomes, vision-related quality of life, and complications related to cataract surgery in eyes with and without glaucoma.
Retrospective cohort study.
Cataract surgery outcomes in cases with and without glaucoma from the Veterans Affairs Ophthalmic Surgical Outcomes Data Project were compared.
We identified 608 glaucoma cases and 4306 controls undergoing planned cataract surgery alone. After adjusting for age, pseudoexfoliation, small pupil, prior ocular surgery, and anterior chamber depth, we found that glaucoma cases were more likely to have posterior capsular tear with vitrectomy (odds ratio [OR] 1.8, P = .03) and sulcus intraocular lens placement (OR 1.65, P = .03) during cataract surgery. Glaucoma cases were more likely to have postoperative inflammation (OR 1.73, P < .0001), prolonged elevated intraocular pressure (OR 2.96, P = .0003), and additional surgery within 30 days (OR 1.92, P = .03). Mean best-corrected visual acuity (BCVA) and Visual Function Questionnaire (VFQ) scores significantly improved after cataract surgery in both groups (P < .0001), but there were larger improvements in BCVA (P = .01) and VFQ composite scores (P < .0001) in the nonglaucoma vs the glaucoma group. A total of 3621 nonglaucoma cases (94.1%) had postoperative BCVA 20/40 or better, compared to 466 glaucoma cases (89.6%) (P = .0003).
Eyes with glaucoma are at increased risk for complications and have more modest visual outcomes after cataract surgery compared to eyes without glaucoma. Despite this, glaucoma patients still experience significant improvement in vision-related outcomes after cataract extraction. Further study is needed to explore potential factors that influence cataract surgery outcomes in glaucomatous eyes.
比较有青光眼和无青光眼患者白内障手术的视力结果、与视力相关的生活质量以及并发症情况。
回顾性队列研究。
比较退伍军人事务部眼科手术结果数据项目中有青光眼和无青光眼患者的白内障手术结果。
我们确定了608例青光眼患者和4306例仅接受计划性白内障手术的对照者。在对年龄、假性剥脱、小瞳孔、既往眼部手术和前房深度进行调整后，我们发现青光眼患者在白内障手术期间更有可能发生后囊膜撕裂伴玻璃体切除术（优势比[OR]1.8，P = 0.03）和沟内人工晶状体植入（OR 1.65，P = 0.03）。青光眼患者更有可能出现术后炎症（OR 1.73，P < 0.0001）、眼压长期升高（OR 2.96，P = 0.0003）以及在30天内进行额外手术（OR 1.92，P = 0.03）。两组白内障手术后平均最佳矫正视力（BCVA）和视觉功能问卷（VFQ）评分均显著改善（P < 0.0001），但非青光眼组的BCVA改善幅度更大（P = 0.01），VFQ综合评分改善幅度也更大（P < 0.0001）。共有3621例非青光眼患者（94.1%）术后BCVA达到20/40或更好，而青光眼患者为466例（89.6%）（P = 0.0003）。
与无青光眼的眼睛相比，有青光眼的眼睛白内障手术后并发症风险增加，视力改善程度较小。尽管如此，青光眼患者白内障摘除术后与视力相关的结果仍有显著改善。需要进一步研究以探索影响青光眼患者白内障手术结果的潜在因素。
