Department of Ophthalmology, Gil Medical Center, College of Medicine, Gachon University, Incheon, Korea.
Department of Ophthalmology, Korea University Ansan Hospital, Gyeonggi-Do; Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.
Indian J Ophthalmol. 2023 Mar;71(3):757-762. doi: 10.4103/IJO.IJO_2723_22.
The aim of this study was to evaluate the efficacy of the illuminated chopper-assisted cataract surgery in terms of shortening the surgical time and reducing the use of pupil expansion devices in eyes with iris challenges.
This was a retrospective case series of a university hospital. Four hundred forty-three eyes of 433 consecutive patients who underwent illuminated chopper-assisted cataract surgery were included in this study. Cases with preoperative or intraoperative miosis, iris prolapse, and intraoperative floppy iris syndrome were included in the iris challenge group. Use of tamsulosin, iris hooks, pupil size, surgical time, and improved visibility (100/surgical time × pupil size) were compared between eyes with and without iris challenges. Mann-Whitney U test, Pearson's Chi-square test, and Fisher's exact test were used for statistical analysis.
Of 443 eyes, 66 were included in the iris challenge group (14.9%). Tamsulosin use was more common in patients with iris challenges and iris hooks were used more frequently (9.1% vs. 0%, P < 0.001) in patients with iris challenges than in those without iris challenges. Pupil size was smaller in patients with iris challenges (6.01 vs. 7.64 mm, P < 0.001). However, surgical time was not different (16.9 vs. 16.5 min, P = 0.064) between the two groups. As a result, improved visibility was calculated to be higher in patients with iris challenges (1.05 vs. 0.81, P < 0.001).
In terms of surgical time and improved visibility, using the illuminated chopper simplified cataract surgery involving iris challenges. The use of an illuminated chopper is expected to be a good solution for challenging cataract surgeries.
本研究旨在评估照明刀辅助白内障手术在缩短手术时间和减少瞳孔扩张器械使用方面的疗效，特别是在虹膜挑战的眼中。
这是一项大学医院的回顾性病例系列研究。本研究纳入了 433 例连续患者的 443 只眼，这些患者均接受了照明刀辅助白内障手术。术前或术中瞳孔缩小、虹膜脱出和术中软晶状体综合征的病例被纳入虹膜挑战组。比较了有和无虹膜挑战的眼中他莫昔芬的使用、虹膜钩、瞳孔大小、手术时间和改善的可视度（100/手术时间×瞳孔大小）。采用 Mann-Whitney U 检验、Pearson Chi-square 检验和 Fisher 确切检验进行统计学分析。
在 443 只眼中，有 66 只眼被纳入虹膜挑战组（14.9%）。虹膜挑战患者更常使用他莫昔芬，虹膜挑战患者更常使用虹膜钩（9.1%比 0%，P <0.001）。虹膜挑战患者的瞳孔较小（6.01 比 7.64mm，P <0.001）。然而，两组间的手术时间无差异（16.9 比 16.5 分钟，P =0.064）。因此，虹膜挑战患者的改善可视度更高（1.05 比 0.81，P <0.001）。
在手术时间和改善可视度方面，使用照明刀简化了涉及虹膜挑战的白内障手术。使用照明刀有望成为解决挑战性白内障手术的良好方法。
