Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, NY, USA.
Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
Graefes Arch Clin Exp Ophthalmol. 2023 Aug;261(8):2307-2314. doi: 10.1007/s00417-023-06027-y. Epub 2023 Mar 16.
To evaluate the association of capsular dye and/or a pupil expansion device (PED) usage on the rate of major complication in resident-performed cataract extraction.
Resident cataract surgeries between 2016 and 2019 were included. The primary outcomes were anterior or posterior vitrectomy (AVx and PPVx). Cases were grouped by the use of a PED and/or capsular staining along with additional preoperative risk factors.
Of the 1,348 cases, 371 (27.5%) documented capsular staining ("Dye-only"), 91 (6.8%) required pupil expansion ("PED-only"), and 100 (7.4%) used both capsular stain and a PED ("Both"). The remainder of cases (n=786, 58.3%) were classified as "Routine." Compared to the "Routine" group, "PED-only" and "Both" had significantly higher odds of an AVx (OR=2.90, 95% CI 1.27-6.19, P=0.01) and/or a PPVx (OR=2.33, 95% CI 1.07-5.12, P=0.04). Among the PPVx cases, the "PED-only" group has significantly higher odds than "Routine" and "Dye-only" (OR=4.64, 95% CI 1.68-12.79, P=0.01; and OR=6.48, 95% CI 1.7-25.0, P=0.005, respectively). In case-control analysis, vision, intraocular pressure, anterior chamber depth, axial length, cataract type, or severity had no significant overall association with complication. When compared to nuclear sclerotic cataract, posterior subcapsular (OR=7.86, 95% CI 1.46-42.47, P=0.017) and white/mature cataracts (OR=3.05, 95% CI 1.1-8.43, P=0.032) had increased odds of complication.
Resident-performed cataract surgery frequently required capsular staining and/or a PED, and intuitively, these cases had a higher overall complication rate compared to routine cases. However, the use of a PED independently was associated with significantly higher odds of a major complication requiring an unplanned vitrectomy independent of predisposing factors.
评估囊袋染色和/或瞳孔扩张装置（PED）的使用与住院医师施行白内障摘除术后主要并发症发生率之间的关联。
纳入 2016 年至 2019 年期间住院医师施行的白内障手术。主要结局是前玻璃体切除术（AVx）和后玻璃体切除术（PPVx）。根据 PED 的使用情况以及术前的其他危险因素对病例进行分组。
在 1348 例病例中，371 例（27.5%）记录有囊袋染色（“仅染色”），91 例（6.8%）需要瞳孔扩张（“仅 PED”），100 例（7.4%）使用囊袋染色和 PED（“两者都用”）。其余 786 例（58.3%）病例被归类为“常规”。与“常规”组相比，“仅 PED”和“两者都用”发生 AVx 和/或 PPVx 的可能性明显更高（OR=2.90，95%CI 1.27-6.19，P=0.01）。在发生 PPVx 的病例中，“仅 PED”组发生的可能性明显高于“常规”和“仅染色”组（OR=4.64，95%CI 1.68-12.79，P=0.01；OR=6.48，95%CI 1.7-25.0，P=0.005）。在病例对照分析中，视力、眼内压、前房深度、眼轴长度、白内障类型或严重程度与并发症无明显总体相关性。与核硬化性白内障相比，后囊下白内障（OR=7.86，95%CI 1.46-42.47，P=0.017）和白色/成熟白内障（OR=3.05，95%CI 1.1-8.43，P=0.032）发生并发症的可能性更高。
住院医师施行白内障手术常需进行囊袋染色和/或使用 PED，直观地说，与常规病例相比，这些病例的总体并发症发生率更高。然而，PED 的使用与主要并发症（需要计划外玻璃体切除术）的发生显著相关，且独立于易患因素。
