Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Curr Opin Ophthalmol. 2019 Jan;30(1):3-8. doi: 10.1097/ICU.0000000000000535.
To provide a consolidated update regarding preoperative evaluation for cataract surgery.
Visual acuity alone is a poor gauge of cataract disability. Modalities such as wave front aberrometry, lens densitometry, and light-scatter assessments can quantify optical aspects of cataract and may prove clinically useful in surgical evaluation. Advances in biometry are driving improvements in refractive outcomes, which in turn have increased patient expectations. Future advances in biometry technology may include three-dimensional imaging of the cornea and lens. Screening for ocular comorbidities has become increasingly important, particularly to guide lens selection. Risk stratification systems can help guide surgical decisions and may decrease intraoperative complication rate. A comprehensive medical history and physical is currently mandated for all Medicare patients undergoing cataract surgery but may be of limited utility for low-risk patients.
Rising patient expectations and a growing number of surgical choices have expanded the cataract preoperative evaluation. A systematic and comprehensive examination which includes identifying any ocular comorbidity is essential for surgical planning and counseling on visual prognosis. New technologies will continue to inform, but not replace, sound clinical judgment.
提供白内障术前评估的最新信息。
视力是评估白内障致盲的一个很差的指标。波前像差、晶状体密度和光散射评估等方法可以定量评估白内障的光学方面，并且在手术评估中可能具有临床应用价值。生物测量学的进步推动了屈光手术效果的改善，进而提高了患者的期望。生物测量学技术的未来发展可能包括角膜和晶状体的三维成像。对眼部合并症的筛查变得越来越重要，尤其是可以指导晶状体的选择。风险分层系统有助于指导手术决策，并可能降低术中并发症的发生率。目前，所有接受白内障手术的 Medicare 患者都需要进行全面的病史和体格检查，但对于低风险患者来说，这种检查的作用可能有限。
患者期望的提高和越来越多的手术选择扩大了白内障术前评估的范围。系统和全面的检查，包括识别任何眼部合并症，对于手术计划和视觉预后的咨询至关重要。新技术将继续提供信息，但不能替代良好的临床判断。
