NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
Institute of Ophthalmology, University College London, London, UK.
Eye (Lond). 2021 Sep;35(9):2482-2498. doi: 10.1038/s41433-021-01548-4. Epub 2021 Apr 29.
The aim of this review was to discuss frequently encountered themes such as cataract surgery in presence of age-related macular degeneration (AMD), dementia, Immediate Sequential Bilateral Cataract Surgery (ISBCS), discussing non-standard intraocular lens (IOL) options during consultation in the National Health Services (NHS) and the choice of the biometric formulae based on axial length. Individual groups of authors worked independently on each topic. We found that cataract surgery does improve visual acuity in AMD patients but the need for cataract surgery should be individualised. In patients with dementia, cataract surgery should be considered 'sooner rather than later' as progression may prevent individuals presenting for surgery. This should be planned after discussion of patients' best interests with any carers; multifocal IOLs are not proven to be the best option in these patients. ISBCS gives comparable outcomes to delayed sequential surgeries with a low risk of bilateral endophthalmitis and it can be cost-saving and efficient. Patients are entitled to know all suitable IOL options that can improve their quality of life. Deliberately withholding this information or pressuring patients to choose a non-standard IOL is inappropriate. However, one should be mindful of the not spending inappropriate amounts of time discussing these in the NHS setting which may affect care of other NHS patients. Evidence suggests Hoffer Q, Haigis, Hill-RBF and Kane formulae for shorter eyes; Barrett Universal II (BU II), Holladay II, Haigis and Kane formulae for longer eyes and BU II, Hill-RBF and Kane formulae for medium axial length eyes.
本文旨在讨论一些常见的主题，如年龄相关性黄斑变性（AMD）合并白内障手术、痴呆症、即刻序贯双侧白内障手术（ISBCS），并讨论在国民保健制度（NHS）中咨询时非标准人工晶状体（IOL）的选择以及基于眼轴的生物测量公式的选择。各作者小组独立负责每个主题。我们发现白内障手术确实可以提高 AMD 患者的视力，但白内障手术的需求应因人而异。对于痴呆症患者，应“尽早”考虑白内障手术，因为病情进展可能会使患者无法接受手术。这应在与任何护理人员讨论患者的最佳利益后进行计划；多焦点 IOL 并不能证明是这些患者的最佳选择。ISBCS 可获得与延迟序贯手术相当的结果，且发生双眼眼内炎的风险较低，还可以节省成本和提高效率。患者有权了解所有可改善生活质量的合适 IOL 选择。故意隐瞒这些信息或向患者施压以选择非标准 IOL 是不合适的。然而，应注意避免在 NHS 环境中花费过多时间讨论这些问题，以免影响其他 NHS 患者的护理。有证据表明，Hoffer Q、Haigis、Hill-RBF 和 Kane 公式适用于短眼轴；Barrett Universal II（BU II）、Holladay II、Haigis 和 Kane 公式适用于长眼轴；BU II、Hill-RBF 和 Kane 公式适用于中眼轴。
