Department of Ophthalmology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York, USA.
Cataract and IOL Services, Aravind Eye Hospital, Chennai, India.
Ophthalmic Epidemiol. 2022 Jun;29(3):271-278. doi: 10.1080/09286586.2021.1923756. Epub 2021 May 12.
To determine incidence, risk factors for, and outcomes of dropped nucleus (DN) during cataract surgery.
This is a matched case-control study at the Aravind Eye Hospital in Madurai, India. Out of 184 consecutive DN cases, 171 were included. The case immediately preceding the DN case by the same surgeon served as matched concurrent control. The proportion of cataract surgeries with DN was calculated with a 95% confidence interval (CI). Conditional logistic regression was used to generate odds ratios for potential risk factors.
Among 415,487 consecutive cataract surgeries, incidence risk of DN was 0.044% [95% CI 0.038%, 0.051%], or 0.44 per 1,000 surgeries in 52 months. Significant preoperative risk factors were posterior polar cataract (adjusted odds ratio [aOR] 21.73, = .003); suspected loose zonules (aOR 8.85, < .001); older age (aOR 1.57, = .001); and presence of diabetes mellitus (aOR 1.79, = .03). Associated intraoperative complications included zonular dialysis (OR 34.49, < .001), vitreous disturbance (OR 193.36, < .001), and posterior capsule rent (OR 384.39, < .001). Phacoemulsification and manual small incision cataract surgery did not significantly differ in DN incidence. DN most commonly occurred during nucleus removal (35.1%) or during/immediately following hydrodissection (24.0%). Visual outcomes of DN were worse than controls on average, but 51.9% achieved visual acuity 20/40 or better at 1 month.
DN occurred rarely, with low absolute risk even when a strong risk factor was present. Nearly all cases followed posterior capsular rent or zonular dialysis, usually with observed vitreous loss. In spite of increased risk of postoperative complications in the DN group, the majority achieved favorable results.
确定白内障手术中 dropped nucleus（DN）的发生率、危险因素和结局。
这是在印度马杜赖的 Aravind 眼科医院进行的一项匹配病例对照研究。在 184 例连续的 DN 病例中，有 171 例被纳入研究。与 DN 病例由同一位外科医生进行的前一个病例被选为同期匹配对照。DN 病例的比例通过 95%置信区间（CI）计算。条件逻辑回归用于生成潜在危险因素的优势比。
在 415,487 例连续白内障手术中，DN 的发病率为 0.044%（95%CI 0.038%，0.051%），即 52 个月内每 1,000 例手术中有 0.44 例发生。术前显著的危险因素包括后极性白内障（调整优势比[aOR] 21.73， = 0.003）；疑似松动悬韧带（aOR 8.85， < 0.001）；年龄较大（aOR 1.57， = 0.001）；和糖尿病（aOR 1.79， = 0.03）。术中相关并发症包括悬韧带松解（OR 34.49， < 0.001）、玻璃体干扰（OR 193.36， < 0.001）和后囊破裂（OR 384.39， < 0.001）。超声乳化白内障吸除术和手动小切口白内障手术在 DN 发生率方面无显著差异。DN 最常见于核块切除期间（35.1%）或在水分离期间/之后（24.0%）。DN 组的平均视力结果较对照组差，但 51.9%在 1 个月时达到 20/40 或更好的视力。
DN 的发生率较低，即使存在强烈的危险因素，其绝对风险也较低。几乎所有病例都出现后囊破裂或悬韧带松解，通常伴有玻璃体丢失。尽管 DN 组术后并发症风险增加，但大多数患者仍取得良好的结果。
