Elhousseini Zine, Lee Edward, Williamson Tom H
*Department of Ophthalmology, Royal Free Hospital, London, United Kingdom;†Department of Ophthalmology, Epsom and St. Helier University Hospitals, United Kingdom; and‡Department of Ophthalmology, Guy's and St Thomas' Hospital, London, United Kingdom.
Retina. 2016 Apr;36(4):825-9. doi: 10.1097/IAE.0000000000000779.
To determine the incidence of lens touch during pars plana vitrectomy (PPV) and evaluate cataract surgery complications after lens touch.
One thousand three hundred and ninety nine phakic patients who underwent PPV during the period from 2001 to 2013 were included in the study. Data of the PPV and lens touch (excluding lens bite) complications were reviewed from an electronic database (VITREOR). Subsequent cataract surgery data and intraoperative complications were reviewed. A control group consisted of 149 cases of phakic patients who underwent PPV with no lens touch then subsequent cataract surgery. All surgeries were performed by senior surgeons, and no cataract was present before the PPV.
The incidence of lens touch was 3.7% (52 of 1,399 phakic patients). The Demographics and presenting complaints of the patients were not significantly associated with lens touch, but retinal detachment with proliferative vitreoretinopathy, the use of silicone oil and use of relaxing retinectomy were associated with more lens touch. Cataract developed in 49 patients of whom 45 underwent cataract surgery. Nuclear sclerosis developed in 22 patients, 16 had posterior subcapsular, 8 had mixed lens opacities, and 3 had white cataract. The median duration between PPV and cataract surgery was 4 months in the lens touch group, which was significantly shorter than the median of 8 months in the control group (P = 0.001). During the subsequent cataract surgery in the lens touch group, 5 patients (11%) had a posterior capsule rupture, whereas the control group had only 2 cases of posterior capsule rupture 1.4% (P = 0.008). Final visual acuity was 0.3 LogMar or better in 22 patients (44%).
Lens touch is a frequent complication of PPV in a phakic eye. It is more common in patients having surgery for proliferative vitreoretinopathy. Care should be taken when performing subsequent cataract surgery on an eye with lens touch as it carries a significantly increased chance of posterior capsule rupture.
确定玻璃体切割术（PPV）期间晶状体触碰的发生率，并评估晶状体触碰后白内障手术的并发症。
本研究纳入了2001年至2013年期间接受PPV的1399例有晶状体患者。从电子数据库（VITREOR）中回顾了PPV和晶状体触碰（不包括晶状体咬切）并发症的数据。随后回顾了白内障手术数据和术中并发症。对照组由149例接受PPV且无晶状体触碰随后进行白内障手术的有晶状体患者组成。所有手术均由资深外科医生进行，且在PPV前无白内障。
晶状体触碰的发生率为3.7%（1399例有晶状体患者中的52例）。患者的人口统计学特征和主诉与晶状体触碰无显著相关性，但伴有增殖性玻璃体视网膜病变的视网膜脱离、硅油的使用和松解性视网膜切除术的使用与更多的晶状体触碰相关。49例患者发生白内障，其中45例接受了白内障手术。22例患者出现核硬化，16例出现后囊下混浊，8例出现混合性晶状体混浊，3例出现白色白内障。晶状体触碰组PPV与白内障手术之间的中位间隔时间为4个月，明显短于对照组的中位间隔时间8个月（P = 0.001）。在晶状体触碰组随后的白内障手术中，5例患者（11%）发生后囊破裂，而对照组仅2例发生后囊破裂（1.4%）（P = 0.008）。22例患者（44%）的最终视力为0.3 LogMar或更好。
晶状体触碰是有晶状体眼PPV的常见并发症。在患有增殖性玻璃体视网膜病变的患者中更常见。对有晶状体触碰的眼睛进行后续白内障手术时应谨慎，因为其发生后囊破裂的几率会显著增加。
