Vitreoretinal Service, Moorfields Eye Hospital, London, United Kingdom.
School of Graduate Studies, Queen's University, Kingston, Canada.
Am J Ophthalmol. 2020 Nov;219:271-283. doi: 10.1016/j.ajo.2020.05.028. Epub 2020 May 29.
To provide data on visual acuity (VA) outcomes and prognostic factors of microincision (23-gauge) vitrectomy surgery (MIVS) for retained lens fragments after complicated cataract surgery.
Retrospective, interventional case series from 2012 to 2017.
Precataract surgery and intraoperative (vitrectomy) parameters, postvitrectomy complications, and best-corrected visual acuities (BCVAs) were identified. Vitrectomy was performed as early as corneal clarity permitted. Univariate and multivariate logistic regression were used to characterize factors associated with achieving VA better than 20/40, or worse than 20/200 at 6 months.
This study included 291 consecutive eyes (291 patients). LogMAR BCVA improved from 0.73 ± 0.70 before cataract surgery to 0.46 ± 0.63 (P < .001) after vitrectomy. The previtrectomy VA was 1.43 ± 0.79. At 6 months, 183 (62.9%) and 45 patients (15.5%) achieved BCVAs better than 20/40 and worse than 20/200, respectively. Most frequent complications were de novo ocular hypertension (29 eyes, 10%) and transient cystoid macular edema (25 eyes, 8.6%). Postvitrectomy retinal detachment occurred in 9 eyes (3.1%). Final VA of 20/40 or better was independently associated only with better precataract surgery VA, age <75 years, absence of preexisting diabetic macular edema (DME) or postvitrectomy persistent cystoid macular edema (P < .05). Only poorer precataract surgery VA, delaying vitrectomy to later than 2 weeks, and final aphakic status were independently predictive of 20/200 or worse VA (P < .05).
Contemporary VA outcomes of 23-gauge vitrectomy for retained lens fragments are comparable with that of prior predominantly non-MIVS cohorts, but fall short of benchmarks for uncomplicated cataract surgery. IOL type or timing of placement do not impact final VA.
提供有关复杂白内障手术后残留晶状体碎片的 23 号微创玻璃体切除术（MIVS）视力结果和预后因素的数据。
回顾性，2012 年至 2017 年的干预性病例系列。
确定术前白内障手术和术中（玻璃体切除术）参数、玻璃体切除术后并发症和最佳矫正视力（BCVA）。一旦角膜清晰，即可尽早进行玻璃体切除术。使用单变量和多变量逻辑回归来描述与术后 6 个月时达到 20/40 或更差的视力（20/200）相关的因素。
这项研究包括 291 只连续眼（291 例患者）。术后 BCVA 从白内障术前的 0.73 ± 0.70 提高到 0.46 ± 0.63（P<.001）。术前视力为 1.43 ± 0.79。术后 6 个月，183 只眼（62.9%）和 45 只眼（15.5%）的 BCVA 分别优于 20/40 和差于 20/200。最常见的并发症是新发眼高压（29 只眼，10%）和短暂性黄斑囊样水肿（25 只眼，8.6%）。术后发生视网膜脱离 9 只眼（3.1%）。仅术前白内障手术更好的视力、年龄<75 岁、无术前糖尿病性黄斑水肿（DME）或术后持续性黄斑囊样水肿（P<.05）与术后 20/40 或更好的视力独立相关。仅术前白内障手术视力较差、玻璃体切除术延迟至 2 周后以及最终无晶状体状态与 20/200 或更差的视力独立相关（P<.05）。
与之前主要为非 MIVS 队列相比，23 号微创玻璃体切除术后的当代视力结果相当，但不及单纯白内障手术的基准。人工晶状体类型或放置时间不影响最终视力。
