Bai Haiqing, Yao Lin, Wang Haitao
Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Qingdao Xinshijie Eye Hospital, Qingdao, China.
J Ophthalmol. 2020 Feb 12;2020:1317249. doi: 10.1155/2020/1317249. eCollection 2020.
This retrospective cohort study investigated the occurrence rate, correlative factors, and prognosis of posterior capsule rupture (PCR) in phacoemulsification operations conducted by surgery trainees. This study assessed the first 200 phacoemulsification surgeries performed by six surgery trainees between August 2016 and December 2018. Cases were divided into two groups depending on whether they fell within the first 100 surgeries performed by a trainee (first 100 cases group) or the last 100 surgeries (last 100 cases group). The following clinical data were analyzed: the occurrence rate of PCR, whether this complication arose in the phaco or irrigation/aspiration (IA) phase, the occurrence of vitreous loss, retinal detachment, and dropped nucleus, the site of intraocular lens (IOL) implantation, and postoperative visual acuity. Thirty-nine of the 1200 cases (3.25%) experienced PCR. The occurrence rates of PCR and vitreous loss were higher in the first 100 cases group than in the last 100 cases group (=0.015 and =0.017). PCR occurred more frequently in the phaco phase in the first 100 cases group and in the IA phase in the last 100 cases group (=0.012). There was no difference between the two groups in terms of site of IOL implantation, the occurrence of retinal detachment or dropped nucleus, and postoperative visual acuity. With a supervising surgeon and the selection of suitable cases, the occurrence rate of PCR in phacoemulsification operations performed by surgery trainees could be controlled to the desired level. The phase in which PCR most frequently occurred and the likelihood of vitreous loss differed depending on the level of surgical experience of the trainees. It is a lengthy process for surgery trainees to reach the stage at which they can manage PCR and complex cataract surgery independently.
这项回顾性队列研究调查了手术学员进行白内障超声乳化手术时后囊破裂（PCR）的发生率、相关因素及预后情况。本研究评估了2016年8月至2018年12月期间6名手术学员所进行的前200例白内障超声乳化手术。根据病例是否属于学员所做的前100例手术（前100例组）或后100例手术（后100例组）分为两组。分析了以下临床数据：PCR的发生率、该并发症是在超声乳化阶段还是灌注/抽吸（IA）阶段出现、玻璃体丢失、视网膜脱离及晶状体核坠落的发生情况、人工晶状体（IOL）植入部位以及术后视力。1200例病例中有39例（3.25%）发生了PCR。前100例组的PCR和玻璃体丢失发生率高于后100例组（P = 0.015和P = 0.017）。前100例组中PCR在超声乳化阶段更频繁发生，而后100例组中在IA阶段更频繁发生（P = 0.012）。两组在IOL植入部位、视网膜脱离或晶状体核坠落的发生情况以及术后视力方面无差异。在有指导医师并选择合适病例的情况下，手术学员进行白内障超声乳化手术时的PCR发生率可控制在理想水平。PCR最常发生的阶段以及玻璃体丢失的可能性因学员的手术经验水平而异。手术学员达到能够独立处理PCR和复杂白内障手术的阶段是一个漫长的过程。
