Bai Ling, Wang Yan-Fen, Tariq Farheen, Zheng Yu-Ping, Feng Hai-Xiao, Wang Feng, Zhang Shu
Department of Ophthalmology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China.
Experimental Teaching Center for Clinical Skills, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China.
Int J Ophthalmol. 2021 Nov 18;14(11):1735-1740. doi: 10.18240/ijo.2021.11.13. eCollection 2021.
To introduce a simple iris hook assisted phacoemulsification (PE) procedure and evaluate the safety and efficacy of it in completely vitrectomized eyes.
A single centre study which included 65 previously completely vitrectomized eyes of 62 patients who underwent cataract surgery. Patients were randomly divided into 3 groups. Patients received PE, and intraocular lens (IOL) implantation with the assistance of iris hook (Synergeties™) as group A (25 eyes); patients who received PE assisted with a 25G pars plana irrigation as group B (20 eyes), and patients who received PE performed without the help of any instrument as group C (20 eyes). Main outcome measures were surgery duration, Ultrasound (U/S) total time, endothelial cell density (ECD), cumulative dissipated energy (CDE) and complications of the procedures.
With the help of iris hook, the patients in group A had the lowest ECD loss rate (0.07±0.03, 0.09±0.03, and 0.10±0.03, <0.05), shortest CDE (12.2±4.1, 15.8±6.0, and 16.0±6.0, <0.05) and U/S total time (36.6±13.0s, 46.3±16.4s, and 47.6±16.1s, <0.05), and minimal incidence of complications. The longest surgery duration was in group B (19.4±1.6min) and maximum complications rate in group C (20% miosis, 10% posterior capsular tears, 5% zonular dialysis, 5% cystoid macular edema). While best-corrected visual acuity (BCVA), intraocular pressure (IOP) and ECD did not show a significant difference among the three groups.
Without prolonged surgery duration, the iris hook assistant method can minimize heat generation during surgery and incidence of complications, which transfer the challenged PE in vitrectomized eyes into a regular surgery. It does not need any change in the hydrodynamic parameters and in the bag PE technique, easy to operate even for junior surgeons.
介绍一种简单的虹膜钩辅助白内障超声乳化吸除术（PE），并评估其在完全玻璃体切除眼中的安全性和有效性。
一项单中心研究，纳入62例接受白内障手术的患者的65只先前已完全玻璃体切除的眼睛。患者被随机分为3组。A组（25只眼）患者在虹膜钩（Synergeties™）辅助下接受PE及人工晶状体（IOL）植入；B组（20只眼）患者接受25G经平坦部灌注辅助的PE；C组（20只眼）患者在无任何器械辅助下接受PE。主要观察指标为手术时间、超声（U/S）总时间、内皮细胞密度（ECD）、累积耗散能量（CDE）及手术并发症。
在虹膜钩的帮助下，A组患者的ECD损失率最低（分别为0.07±0.03、0.09±0.03和0.10±0.03，P<0.05），CDE最短（分别为12.2±4.1、15.8±6.0和16.0±6.0，P<0.05），U/S总时间最短（分别为36.6±13.0秒、46.3±16.4秒和47.6±16.1秒，P<0.05），并发症发生率最低。B组手术时间最长（19.4±1.6分钟），C组并发症发生率最高（20%瞳孔缩小、10%后囊膜破裂、5%悬韧带离断、5%黄斑囊样水肿）。而三组之间的最佳矫正视力（BCVA）、眼压（IOP）和ECD无显著差异。
虹膜钩辅助法在不延长手术时间的情况下，可使手术中热量产生及并发症发生率降至最低，将玻璃体切除眼中具有挑战性的PE转变为常规手术。它无需改变流体动力学参数及囊袋内PE技术，即使是初级外科医生也易于操作。
