Elhusseiny Abdelrahman M, Toma Joseph, Fouad Yousef A, Soliman Mohamed K, Ibrahim S Nazem, Shakarchi Ahmed F, Ellabban Abdallah A, Yang Yit C, Sallam Ahmed B
Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AS, USA.
Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt.
Curr Eye Res. 2025 Mar;50(3):258-263. doi: 10.1080/02713683.2024.2421929. Epub 2024 Oct 30.
To compare the visual outcomes, rate of cystoid macular edema (CME), and additional associated complications in eyes that exhibited zonular dialysis (ZD) during phacoemulsification to a reference group of uneventful phacoemulsification eyes.
A retrospective multicenter comparative database study. We pooled data from 8 United Kingdom sites between 2003 and 2015. The main outcome measures were the mean postoperative visual acuity (VA) at 12-24 weeks and the rates of CME and additional associated complications.
We included 1074 eyes in the ZD group and 112,479 in the reference group. Logistic regression analysis showed that pseudoexfoliation was the strongest associated factor of ZD (OR: 6.1), followed by previous glaucoma surgery (OR: 4.4). Mean logMAR preoperative VA was 0.8 ± 0.6 in the ZD group vs. 0.6 ± 0.5 in the reference group ( < 0.001). Mean postoperative VA was worse in the ZD group ( < 0.001); 0.4 ± 0.6 vs. 0.2 ± 0.3 and 0.5 ± 0.6 vs. 0.2 ± 0.3 at 4-12 weeks and 12-24 weeks, respectively. At 12-24 weeks, the proportions of eyes that gained ≥0.3 logMAR units were 50% in the ZD group vs. 62% in the reference group ( < 0.001). In the ZD group, the most common intraoperative complication was vitreous loss (34.3%), followed by posterior capsular rupture (PCR) (11.1%). Postoperative CME occurred in 2.3% vs. 1.4% ( = 0.01), and 9.3% of eyes required surgery for correction of aphakia, intraocular lens decentration, or dropped lens figments removal.
The occurrence of ZD was associated with worse postoperative vision, an increased rate of vitreous loss and PCR, and a higher risk of CME.
比较在白内障超声乳化手术过程中出现晶状体悬韧带断裂（ZD）的眼睛与未发生并发症的白内障超声乳化手术对照组眼睛的视觉效果、黄斑囊样水肿（CME）发生率及其他相关并发症。
一项回顾性多中心比较数据库研究。我们汇总了2003年至2015年间来自英国8个地点的数据。主要观察指标为术后12 - 24周的平均视力（VA）以及CME和其他相关并发症的发生率。
我们将1074只眼睛纳入ZD组，112479只眼睛纳入对照组。逻辑回归分析显示，假性剥脱是与ZD关联最强的因素（比值比：6.1），其次是既往青光眼手术（比值比：4.4）。ZD组术前平均logMAR视力为0.8±0.6，而对照组为0.6±0.5（P<0.001）。ZD组术后平均视力较差（P<0.001）；在4 - 12周和12 - 24周时分别为0.4±0.6和0.5±0.6，而对照组分别为0.2±０.3和0.2±０.3。在12 - 24周时，视力提高≥0.3 logMAR单位的眼睛比例在ZD组为50%，而对照组为62%（P<0.001）。在ZD组中，最常见的术中并发症是玻璃体脱出（34.3%），其次是后囊膜破裂（PCR）（11.1%）。术后CME发生率为2.3%，而对照组为1.4%（P = 0.01），9.3%的眼睛需要手术矫正无晶状体、人工晶状体偏位或取出脱落的晶状体碎片。
ZD的发生与术后视力较差、玻璃体脱出和PCR发生率增加以及CME风险较高有关。
