Ergun Şule Berk, Kocamış Sücattin İlker, Çakmak Hasan Basri, Çağıl Nurullah
Department of Ophthalmology, Numune Training and Research Hospital, Ankara, Turkey.
Department of Ophthalmology, Faculty of Medicine, Hitit University, Çorum, Turkey.
Int Ophthalmol. 2018 Oct;38(5):1851-1861. doi: 10.1007/s10792-017-0667-3. Epub 2017 Aug 29.
To determine and quantify the risk factors for disruption of lens capsule integrity during phacoemulsification.
The medical records of the patients who had undergone phacoemulsification cataract surgery and had a complication associated with lens capsule were reviewed. Consecutive cases were also reviewed in reverse chronological order as a control group. The exclusion criteria were pediatric cataracts, traumatic cataracts and lens dislocation. As a result, 403 uncomplicated and 83 complicated eyes were analyzed. The differences between the complication group and the group without complications regarding the risk factors were shown by employing the Chi-square test and Fischer's exact test. The variables having the level of significance (p < 0.25) after the Chi-square test and Fischer's exact test were enrolled into the multiple stepwise logistic regression analysis.
Age (60-69/≤80) (p = 0.017), male gender (p = 0.006), pupil size ≤3 mm (p = <0.001), mature-brunescent cataract (p = <0.001), anterior chamber depth <2.5 mm (p = 0.001), posterior polar cataract (p = 0.006), diabetic retinopathy(p = <0.001), coronary artery disease (p = 0.098) and surgeon factor (junior resident/senior resident, p = 0.015; senior resident/specialist in ophthalmology, p = 0.026; junior resident/specialist in ophthalmology, p = 0.020) were among the factors significantly related to a capsule complication. An Excel program has been developed according to these results to predict the probability of capsule complication.
Higher-risk cases can be predicted preoperatively, thus allowing surgeons to take appropriate precautions, better informing the patient and better selecting the cases especially for trainee surgeons.
确定并量化超声乳化白内障吸除术中晶状体囊膜完整性破裂的危险因素。
回顾接受超声乳化白内障手术且发生与晶状体囊膜相关并发症的患者的病历。按时间倒序回顾连续病例作为对照组。排除标准为儿童白内障、外伤性白内障和晶状体脱位。结果，分析了403只无并发症眼和83只有并发症眼。采用卡方检验和费舍尔精确检验显示并发症组与无并发症组在危险因素方面的差异。将卡方检验和费舍尔精确检验后具有显著性水平（p < 0.25）的变量纳入多步逻辑回归分析。
年龄（60 - 69岁/≤80岁）（p = 0.017）、男性（p = 0.006）、瞳孔直径≤3 mm（p < 0.001）、成熟 - 棕色白内障（p < 0.001）、前房深度<2.5 mm（p = 0.001）、后极性白内障（p = 0.006）、糖尿病视网膜病变（p < 0.001）、冠状动脉疾病（p = 0.098）以及术者因素（初级住院医师/高级住院医师，p = 0.015；高级住院医师/眼科专科医师，p = 0.026；初级住院医师/眼科专科医师，p = 0.020）是与囊膜并发症显著相关的因素。根据这些结果开发了一个Excel程序来预测囊膜并发症的概率。
术前可预测高风险病例，从而使手术医生能够采取适当的预防措施，更好地告知患者并更好地选择病例，特别是对于实习医生。
