Wang Dandan, Shi Jingyi, Guan Weichen, Zhu Minying, Lou Xicong, Zhao Yinying, Chang Pingjun, Zhao Yune
Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China.
Ophthalmol Ther. 2023 Dec;12(6):3323-3336. doi: 10.1007/s40123-023-00814-w. Epub 2023 Oct 9.
During phacoemulsification, the infusion pressure can cause the liquefied vitreous fluid to escape through the ciliary fiber interspace in highly myopic eyes, leading to reduced vitreous cavity pressure similar to vitrectomized eyes. This study assessed the probability of low intraocular pressure (IOP) in high myopic eyes with different axial length (AL) group undergoing cataract surgery, as well as the impact of balanced salt solution (BSS) supplementation and the optimal IOP value for such supplementation.
The control group consisted of cataract eyes with normal AL (group 1: 22 mm ≤ AL < 24.5 mm), while cataract eyes with high axial myopia were categorized into three groups (group 2: 26 mm ≤ AL < 28 mm, group 3: 28 mm ≤ AL < 30 mm, group 4: AL ≥ 30 mm). IOP was measured using the iCare pro tonometer intraoperatively. BSS supplementation was performed to raise IOP in cases of low IOP, before intraocular lens (IOL) implantation and before the end of surgery. The probability of low IOP was calculated, and the IOP before and after supplementation were compared.
Ninety-five eyes were included. The total probability of low IOP in groups 2, 3, and 4 was 56.52, 62.50, and 70.83%, respectively, significantly higher than that in group 1 (16.67%). Similarly, the probability of low IOP before IOL implantation was significantly higher in groups 2, 3, 4 (43.48, 41.67, and 62.50%) compared to group 1 (4.17%, P < 0.05). The IOP before and after the first BSS supplementation in three high myopia groups were statistically significant (P < 0.05), increasing from 12.10 mmHg (range, 6.0-24.9 mmHg) to 16.60 mmHg (range, 10.2-34.4 mmHg). After the second BSS supplementation before the end of surgery, the IOP of high myopia groups increased from 12.60 mmHg (range, 7.0-25.3 mmHg) to 14.60 mmHg (range, 9.8-25.3 mmHg).
The condition of highly myopic eyes seems more likely to develop low IOP during cataract surgery. There is an observed correlation: as AL increases, the total probability of low IOP rises. In patients with IOP < 9.5 mmHg intraoperatively, fluid supplementation via a side-port incision can effectively raise IOP to about 16 mmHg before IOL implantation and about 14 mmHg after incision sealing, facilitating smoother IOL implantation and reducing the risk of postoperative low IOP.
NCT, NCT05201677. Registered 23 November 2021-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05201677 .
在超声乳化白内障吸除术中，输注压力可导致高度近视眼液化的玻璃体液通过睫状纤维间隙逸出，导致玻璃体腔压力降低，类似于玻璃体切除术后的眼睛。本研究评估了不同眼轴长度（AL）组的高度近视眼在白内障手术中发生低眼压（IOP）的可能性，以及平衡盐溶液（BSS）补充的影响和这种补充的最佳眼压值。
对照组为眼轴正常的白内障眼（第1组：22mm≤AL<24.5mm），而高度轴性近视的白内障眼分为三组（第2组：26mm≤AL<28mm，第3组：28mm≤AL<30mm，第4组：AL≥30mm）。术中使用iCare眼压计测量眼压。在低眼压情况下，于人工晶状体（IOL）植入前及手术结束前进行BSS补充以提高眼压。计算低眼压的概率，并比较补充前后的眼压。
共纳入95只眼。第2、3、4组低眼压的总发生率分别为56.52%、62.50%和70.83%，显著高于第1组（16.67%）。同样，与第1组（4.17%，P<0.05）相比，第2、3、4组人工晶状体植入前低眼压的发生率显著更高（分别为43.48%、41.67%和62.50%）。三个高度近视组首次BSS补充前后的眼压有统计学差异（P<0.05），从12.10mmHg（范围6.0 - 24.9mmHg）升至16.60mmHg（范围10.2 - 34.4mmHg）。手术结束前第二次BSS补充后，高度近视组的眼压从12.60mmHg（范围7.0 - 25.3mmHg）升至14.60mmHg（范围9.8 - 25.3mmHg）。
高度近视眼在白内障手术期间似乎更易发生低眼压。观察到一种相关性：随着眼轴增加，低眼压的总发生率上升。对于术中眼压<9.5mmHg的患者，通过侧切口补充液体可有效将眼压在人工晶状体植入前提高至约16mmHg，切口封闭后提高至约14mmHg，有助于更顺利地植入人工晶状体并降低术后低眼压的风险。
NCT，NCT05201677。2021年11月23日注册 - 回顾性注册，https://clinicaltrials.gov/ct2/show/NCT05201677 .
