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飞秒激光辅助白内障手术治疗玻璃体切割术后白内障的效果:一项前瞻性随机对照研究。

Effect of femtosecond laser-assisted cataract surgery for cataracts after pars plana vitrectomy: a prospective randomized controlled study.

作者信息

Wen Lin, Lian Hao, Liu Yi, Wei Bin, Deng Yan, Hu Jianqi, Wu Ying, Zhang Min, Fan Yaoqin, Xu Li

机构信息

Chengdu Aidi Eye Hospital, No. 45, West Section 2, Ring 2 Road, Qingyang District, Chengdu, Sichuan, China.

Ophthalmology department, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

出版信息

BMC Ophthalmol. 2025 Feb 17;25(1):79. doi: 10.1186/s12886-025-03871-w.

Abstract

OBJECTIVE

To compare the efficacy of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS) in treating postvitrectomy cataracts.

METHODS

Prospective randomized controlled study. Patients who underwent cataract surgery after pars plana vitrectomy (PPV) were randomly divided into the FLACS group and the CPS group. Preoperative data of all patients were collected to compare intraoperative complications, average phacoemulsification energy (AVE), effective phacoemulsification time (EPT), postoperative intraocular pressure, corneal endothelial cell density (ECD), and best corrected visual acuity (BCVA).

RESULTS

A total of 92 eyes were included in the analysis, with 47 eyes in the FLACS group and 45 eyes in the CPS group. The intraoperative AVEs and EPTs in the FLACS group were both lower than those in the CPS group (P < 0.05). In the FLACS group, incomplete prechopping and incomplete capsulorhexis occurred in 3 eyes (3/47, 6.38%), and incomplete lens dislocation occurred in 1 eye (1/47, 2.13%). In the CPS group, incomplete lens dislocation occurred in 2 eyes (2/45, 4.44%), and anterior capsule tears occurred in 1 eye (1/45, 2.22%). There was no statistically significant difference in intraoperative complications between the two groups (P > 0.05). Postoperatively, intraocular pressure (IOP) was lower in both groups than preoperatively, and there was no statistically significant difference in intraocular pressure between the two groups at three months postsurgery (P > 0.05). Three months postoperatively, the ECD in the FLACS group was greater than that in the CPS group, with less average endothelial cell loss (ECL) than that in the CPS group (P < 0.01). The BCVA in both groups improved to varying degrees compared with the preoperative values, with the FLACS group performing better than the CPS group on the first postoperative day (P < 0.05). There was no statistically significant difference between the two groups at one week, one month, or three months postoperatively (all P > 0.05).

CONCLUSION

FLACS is safe and effective for treating post-PPV cataracts and, compared with CPS, facilitates early postoperative recovery with no difference in final visual acuity. Residual silicone oil in the anterior chamber post-PPV may lead to certain specific outcomes for FLACS. Although it may not affect surgical results, it is still noteworthy.

摘要

目的

比较飞秒激光辅助白内障手术(FLACS)与传统超声乳化白内障手术(CPS)治疗玻璃体切除术后白内障的疗效。

方法

前瞻性随机对照研究。将接受平坦部玻璃体切除术(PPV)后行白内障手术的患者随机分为FLACS组和CPS组。收集所有患者的术前数据,以比较术中并发症、平均超声乳化能量(AVE)、有效超声乳化时间(EPT)、术后眼压、角膜内皮细胞密度(ECD)和最佳矫正视力(BCVA)。

结果

共92只眼纳入分析,FLACS组47只眼,CPS组45只眼。FLACS组术中AVE和EPT均低于CPS组(P < 0.05)。FLACS组中,3只眼(3/47,6.38%)发生不完全预劈核和不完全撕囊,1只眼(1/47,2.13%)发生晶状体不完全脱位。CPS组中,2只眼(2/45,4.44%)发生晶状体不完全脱位,1只眼(1/45,2.22%)发生前囊膜撕裂。两组术中并发症差异无统计学意义(P > 0.05)。术后,两组眼压均低于术前,术后3个月两组眼压差异无统计学意义(P > 0.05)。术后3个月,FLACS组ECD大于CPS组,平均内皮细胞损失(ECL)少于CPS组(P < 0.01)。两组BCVA均较术前有不同程度提高,术后第1天FLACS组优于CPS组(P < 0.05)。术后1周、1个月和3个月两组差异无统计学意义(均P > 0.05)。

结论

FLACS治疗PPV后白内障安全有效,与CPS相比,有助于术后早期恢复,最终视力无差异。PPV后前房残留硅油可能导致FLACS出现某些特定结果。虽然可能不影响手术效果,但仍值得注意。

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