影响白内障手术累积耗散能量水平和术后视力结果的因素。
Factors impacting cumulative dissipated energy levels and postoperative visual acuity outcome in cataract surgery.
机构信息
Department of Ophthalmology, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA.
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
出版信息
BMC Ophthalmol. 2021 Dec 20;21(1):439. doi: 10.1186/s12886-021-02205-w.
PURPOSE
To determine factors impacting cumulative dissipated energy (CDE) and postoperative best-corrected visual acuity (BCVA) in phacoemulsification.
DESIGN
Review of 1102 cases at University of California, San Francisco (UCSF) and at Zhongshan Ophthalmic Center (ZOC), China.
SUBJECTS
Patients who underwent cataract surgery at UCSF 03/2014-03/2019 and at ZOC 10/2018-05/2019.
METHODS
Patient demographics, medical history, routine ocular examination, and surgical information, including disassembly method, complications, and surgeon training level were recorded. Univariable and multivariable regression models were used to determine factors associated with CDE and good postoperative BCVA (20/40 or better) at 1 month.
OUTCOME MEASURES
CDE, postoperative BCVA.
RESULTS
In multivariable analysis, patient age at time of surgery, diabetes, degree of nuclear sclerosis (NS), white-to-white corneal diameter, disassembly method, preoperative BCVA, surgeon training level, and surgical center were significantly associated with CDE. LogCDE increased by 0.20-0.31 for patient age ≥ 70 years, by 0.07 if the patient had diabetes, by 0.12-0.41 for NS grade ≥ 2, by 0.48 per 10 mm increase in white-to-white corneal diameter, by 0.34-0.47 for disassembly method other than non-stop chop, by 0.16 per unit increase in preoperative logMAR BCVA, and by > 0.09 when phacoemulsification was performed by residents early in their training. LogCDE was 0.33 higher at UCSF than ZOC. In multivariable analysis, worse baseline visual acuity and age above 90 years at time of surgery decreased the odds of good BCVA (OR = 0.26 per unit increase in preoperative logMAR BCVA; OR = 0.12 for age > 90); comorbid retinal issues decreased the odds of good postoperative BCVA (OR = 0.13-0.39); greater anterior chamber depth (ACD) or shorter axial length (AL), increased the odds of good postoperative outcome (OR = 2.64 per 1 mm increase ACD, OR = 0.84 per 1 mm increase AL).
CONCLUSIONS
Cataract grade determined by slit lamp exam and, for the first time, older patient age, were noted to be important predictors of high CDE. CDE was not a risk factor for postoperative BCVA measured at postoperative 1 month. When surgery was performed by trainees under supervision, lower training level was associated with higher CDE, but not with worse postoperative BCVA.
目的
确定影响白内障超声乳化术中累积耗散能量（CDE）和术后最佳矫正视力（BCVA）的因素。
设计
对加利福尼亚大学旧金山分校（UCSF）和中山大学中山眼科中心（ZOC）的 1102 例患者进行回顾性研究。
受试者
UCSF 于 2014 年 3 月至 2019 年 3 月，ZOC 于 2018 年 10 月至 2019 年 5 月接受白内障手术的患者。
方法
记录患者人口统计学资料、病史、常规眼部检查和手术信息，包括拆卸方法、并发症和外科医生培训水平。采用单变量和多变量回归模型确定与 CDE 和术后 1 个月良好 BCVA（20/40 或更好）相关的因素。
结果
多变量分析显示，手术时患者年龄、糖尿病、核硬化程度（NS）、角膜直径、拆卸方法、术前 BCVA、外科医生培训水平和手术中心与 CDE 显著相关。与年龄≥70 岁的患者相比，患者年龄每增加 10 岁，logCDE 增加 0.20-0.31；糖尿病患者增加 0.07；NS 等级≥2 级增加 0.12-0.41；角膜直径每增加 10mm，logCDE 增加 0.48；非停切法拆卸方法增加 0.34-0.47；术前 logMAR BCVA 每增加 1 个单位，logCDE 增加 0.34-0.47；在培训早期，住院医师进行的超声乳化术增加>0.09。与 ZOC 相比，UCSF 的 logCDE 高 0.33。多变量分析显示，基线视力较差和手术时年龄超过 90 岁会降低术后良好 BCVA 的几率（每增加 1 个单位术前 logMAR BCVA，OR=0.26；年龄>90 岁，OR=0.12）；合并视网膜疾病会降低术后良好 BCVA 的几率（OR=0.13-0.39）；前房深度（ACD）或眼轴长度（AL）增加会增加术后良好结局的几率（ACD 每增加 1mm，OR=2.64；AL 每增加 1mm，OR=0.84）。
结论
裂隙灯检查确定的白内障分级，以及患者年龄，是 CDE 的重要预测因素。CDE 不是术后 1 个月测量的术后 BCVA 的危险因素。当手术由受训者在监督下进行时，较低的培训水平与较高的 CDE 相关，但与术后 BCVA 较差无关。
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