葡萄膜炎患者白内障手术后的后囊膜混浊及YAG激光后囊膜切开术
Posterior capsular opacification and YAG laser capsulotomy in uveitis patients following cataract surgery.
作者信息
Levy-Clarke Grace A, Newcomb Craig W, Ying Gui-Shuang, Groth Sylvia L, Kothari Srishti, Payal Abhishek, Begum Hosne, Liesegang Teresa L, Foster C Stephen, Jabs Douglas A, Nussenblatt Robert, Rosenbaum James T, Sen H Nida, Suhler Eric B, Thorne Jennifer E, Bhatt Nirali P, Dreger Kurt A, Buchanich Jeanine M, Kempen John H, Gangaputra Sapna
机构信息
Department of Ophthalmology, West Virginia University Eye Institute, Morgantown, WV; Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD.
Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
出版信息
Can J Ophthalmol. 2025 Feb;60(1):e124-e132. doi: 10.1016/j.jcjo.2024.05.004. Epub 2024 May 27.
OBJECTIVE
To evaluate the incidence of visually significant posterior capsule opacification (PCO with visual acuity ≤20/50) and the incidence of Nd:YAG laser capsulotomy in the year following cataract surgery for uveitic eyes.
METHOD
Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study using a standardized chart review process.
RESULTS
Among 1,855 uveitic eyes of 1,370 patients who had undergone cataract surgery, visually significant PCO occurred in 297 eyes (16%), and YAG laser capsulotomy was done in 407 eyes (22%) within the first year following surgery. Higher odds of developing 20/50 visual acuity attributed to PCO were noted in children and young adults compared with adults older than 65 years of age (overall p = 0.03). Poorer preoperative visual acuity (overall p = 0.0069) and postoperative inflammation (odds ratio [OR] = 1.83; 95% CI, 1.37-2.45; p < 0.0001) were associated with PCO incidence. In multivariable analysis, risk factors for YAG laser capsulotomy were younger age groups compared with those older than 65 years of age at the time of surgery (adjusted OR [aOR] = 1.90-2.24; 95% CI, 1.90-2.24; overall p = 0.0007), female sex (aOR = 1.37; 95% CI, 1.03-1.82; p = 0.03), postoperative active inflammation (aOR = 165; 95% CI, 1.27-2.16; overall p < 0.0001), extracapsular cataract extraction compared with phacoemulsification (aOR = 1.70; 95% CI, 1.17-2.47; overall p < 0.0001), and insertion of an intraocular lens (aOR = 4.60; 95% CI, -2.29-9.25; p < 0.0001). Black race was associated with lower YAG laser capsulotomy incidence than Whites (aOR = 0.36; 95% CI, 0.24-0.52; overall p < 0.0001).
CONCLUSIONS
Vision-reducing (≤20/50) PCO is common, occurring in about one sixth of uveitic eyes within 1 year of cataract surgery; a higher number (22%) of eyes underwent YAG laser capsulotomy within the first year. Age and postoperative inflammation following cataract surgery are the variables most associated with the incidence of visually significant PCO and YAG laser capsulotomy.
目的
评估葡萄膜炎患者白内障手术后一年内视力显著下降的后囊膜混浊（PCO，视力≤20/50）的发生率以及钕钇铝石榴石（Nd:YAG）激光晶状体囊切开术的发生率。
方法
通过标准化的图表审查流程，从眼部疾病全身免疫抑制治疗（SITE）队列研究中识别患者。
结果
在1370例接受白内障手术的患者的1855只葡萄膜炎眼中，297只眼（16%）出现了视力显著下降的PCO，407只眼（22%）在术后第一年内进行了YAG激光晶状体囊切开术。与65岁以上的成年人相比，儿童和年轻人因PCO导致视力达到20/50的几率更高（总体p = 0.03）。术前视力较差（总体p = 0.0069）和术后炎症（比值比[OR]=1.83；95%置信区间，1.37 - 2.45；p < 0.0001）与PCO发生率相关。在多变量分析中，YAG激光晶状体囊切开术的危险因素包括手术时年龄小于65岁的年龄组（调整后OR[aOR]=1.90 - 2.24；95%置信区间，1.90 - 2.24；总体p = 0.0007）、女性（aOR = 1.37；95%置信区间，1.03 - 1.82；p = 0.03）、术后活动性炎症（aOR = 1.65；95%置信区间，1.27 - 2.16；总体p < 0.0001）、与超声乳化白内障吸除术相比的囊外白内障摘除术（aOR = 1.70；95%置信区间，1.17 - 2.47；总体p < 0.0001）以及人工晶状体植入（aOR = 4.60；95%置信区间， - 2.29 - 9.25；p < 0.0001）。黑人种族的YAG激光晶状体囊切开术发生率低于白人（aOR = 0.36；95%置信区间，0.24 - 0.52；总体p < 0.0001）。
结论
视力下降（≤20/50）的PCO很常见，在白内障手术后1年内约六分之一的葡萄膜炎眼中出现；第一年中有更高比例（22%）的眼睛接受了YAG激光晶状体囊切开术。年龄和白内障手术后的炎症是与视力显著下降的PCO和YAG激光晶状体囊切开术发生率最相关的变量。
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