Departments of Ophthalmology (S-CL, AG, GTL, RAA, KSS, AGH, AGR, MAT) and Neurology (S-CL, GTL, RAA, KSS, AGH, MAT), University of Pennsylvania, Philadelphia, Pennsylvania.
J Neuroophthalmol. 2023 Sep 1;43(3):359-363. doi: 10.1097/WNO.0000000000001792. Epub 2023 Jan 25.
To identify the frequency and etiologies of visual disturbances after cataract surgery in patients referred to Neuro-ophthalmology.
This study is a retrospective chart review. Records of patients 18 years and older referred to neuro-ophthalmology clinics for new-onset visual disturbances within 6 months of cataract surgery were reviewed. Those with pre-existing neuro-ophthalmic disorders, combined intraocular procedures with cataract surgery, or inadequate follow-up were excluded. The main outcome measures were frequency and etiologies of visual disturbances after cataract surgery. Secondary analyses of a cohort of patients who had cataract surgery at our institution were performed to determine the frequency and etiology of visual disturbances after uneventful cataract surgery.
One hundred seventy-three patients met the inclusion criteria (internal referral: 36/173, from outside surgeons: 137/173). Sixty-one percent (106/173) were newly diagnosed with neuro-ophthalmic etiologies, including 21% (36/173) with afferent and 40% (70/173) with efferent disorders. Thirty-six percent (62/173) of patients had non neuro-ophthalmic causes and 3% (5/173) had systemic conditions responsible for visual disturbances postoperatively. Decompensated strabismus causing diplopia was the most common neuro-ophthalmic diagnosis after cataract surgery (50%, 53/106). Of the 13,715 patients who had cataract surgery performed at our institution over a 9-year period, 20 of 36 patients referred for visual disturbances were identified with neuro-ophthalmic etiologies of which 85% (17/20) had postoperative diplopia.
In our study, decompensated strabismus causing diplopia was the most common neuro-ophthalmic visual disturbance after cataract surgery. Detailed history and ocular alignment should be assessed before cataract surgery to identify patients with the risk.
为了确定在神经眼科就诊的白内障手术后发生视觉障碍的频率和病因。
本研究为回顾性图表分析。对白内障手术后 6 个月内新出现视觉障碍并转诊至神经眼科的 18 岁及以上患者的病历进行了回顾。排除了有神经眼科既往疾病、白内障手术合并眼内手术或随访不充分的患者。主要观察指标为白内障手术后视觉障碍的频率和病因。对在我院行白内障手术的患者队列进行了二次分析，以确定无并发症白内障手术后视觉障碍的频率和病因。
173 例患者符合纳入标准（内部转诊：36/173，外部外科医生转诊：137/173）。61%（106/173）新诊断为神经眼科病因，包括 21%（36/173）为传入障碍和 40%（70/173）为传出障碍。36%（62/173）的患者有非神经眼科病因，3%（5/173）的患者有术后导致视觉障碍的系统性疾病。术后复视导致代偿性斜视是白内障手术后最常见的神经眼科诊断（50%，53/106）。在我院 9 年期间进行白内障手术的 13715 例患者中，有 36 例因视觉障碍转诊，其中 20 例被诊断为神经眼科病因，其中 85%（17/20）有术后复视。
在我们的研究中，白内障手术后导致复视的代偿性斜视是最常见的神经眼科视觉障碍。白内障手术前应详细评估病史和眼球对齐情况，以识别有风险的患者。
