Department of Ophthalmology, Chi Mei Medical Center, Chia Li, Tainan City, Taiwan.
Department of Public Health, Kaohsiung Medical University, College of Health Sciences, Kaohsiung, Taiwan.
Sci Rep. 2020 Feb 7;10(1):2159. doi: 10.1038/s41598-020-59160-7.
This nationwide retrospective case-control study was aimed at elucidating the risk from cataract surgery in end-stage renal disease (ESRD) patients. Cataract surgery patients were identified using the diagnostic and procedural codes for International Classification of Diseases, 9 Revision, Clinical Modification from Taiwan's National Health Insurance Research Database. ESRD patients were selected as cases, while propensity scores for age, sex, comorbidities and year-of-surgery-matched patients without chronic kidney disease constituted the controls. Patients who had undergone eye surgery within 3 years before cataract surgery were excluded. The main outcome measures were target cataract surgery-related complications within 3 months after surgery. A total of 352 cases and 1,760 controls were analysed. Patients with ESRD had a 5.06-fold (95% CI: 2.36-10.87; p < 0.001) risk of vitreous haemorrhage and a 2.74-fold (95% CI: 1.20-6.27; p = 0.017) risk of re-operation for dropped nucleus or vitreous complications. Non-diabetic ESRD patients had a 3.49-fold (95% CI: 1.36-8.91; p = 0.009) risk of corneal oedema. In conclusion, ESRD patients have a higher risk of vitreous haemorrhage, re-operation for dropped nucleus or vitreous complications and corneal oedema (non-diabetic patients) after cataract surgery. Pre-surgery corneal examination, surgery procedure and medication adjustment, closer and longer post-surgery follow-up may lower the risk and improve the visual outcome.
这项全国性回顾性病例对照研究旨在阐明终末期肾病 (ESRD) 患者行白内障手术后的风险。白内障手术患者通过使用台湾全民健康保险研究数据库中的国际疾病分类第 9 版临床修订版的诊断和程序代码来确定。将 ESRD 患者选为病例，而年龄、性别、合并症和手术年份匹配的无慢性肾脏病患者的倾向评分则构成对照。排除白内障手术前 3 年内接受过眼部手术的患者。主要观察指标是手术后 3 个月内的目标白内障手术相关并发症。共分析了 352 例病例和 1760 例对照。ESRD 患者发生玻璃体积血的风险是 5.06 倍 (95% CI：2.36-10.87；p<0.001)，发生因核下或玻璃体并发症而再次手术的风险是 2.74 倍 (95% CI：1.20-6.27；p=0.017)。非糖尿病 ESRD 患者发生角膜水肿的风险是 3.49 倍 (95% CI：1.36-8.91；p=0.009)。总之，白内障手术后，ESRD 患者发生玻璃体积血、因核下或玻璃体并发症而再次手术以及角膜水肿（非糖尿病患者）的风险更高。术前进行角膜检查、调整手术程序和药物、密切和延长术后随访可能会降低风险并改善视力结果。
