Freyler H, Radax U
I. Univ.-Augenklinik Wien.
Klin Monbl Augenheilkd. 1994 Nov;205(5):275-9. doi: 10.1055/s-2008-1045528.
The pseudoexfoliation (PEX) syndrome has been described in the ophthalmic literature as a major risk factor of cataract surgery. Most of the authors have reported extracapsular cataract extraction (ECCE) complication rates of more than 10% for zonular dialysis, capsular rupture, and vitreous loss. However, Osher et al. (1993) found that these complications from in situ phacoemulsification (PE) cataract surgery were less than 1%. We compared ECCE with PE by using the same surgeons for both procedures and evaluated retrospectively the complications for each in our patients.
Of 10,450 patients who underwent cataract surgery from 1986 to 1993, 102 PEX cases (0.98%) occurred. ECCE was performed on 34 of these patients, PE on 68 of the 102 patients. The average age of the PEX patients was 78 years. Miosis of 4 mm or less occurred in 19 eyes. To dilate the pupils, sphincterectomies were performed and iris retraction hooks were applied to the iris in the last two years. Eight surgeons (four with long-term experience and the remainder in training) performed the operations.
The complication rates were 16.6% altogether for zonular dialysis, capsular rupture and vitreous loss, 26.47% for ECCE, and 11.76% for PE (p = 0.0664), in contrast to 1.3% for uncomplicated age-related cataract operations. However, these complications occurred in 14.28% of the ECCE patients and 9.09% of the PE patients with more or less normal dilation of the pupil. Still PE with miosis had fewer complications (23.07%) and was, thus, significantly safer (p = 0.0022) than ECCE (83.33%). Slight phakodonesis, observed during capsulorhexis, and an additional diagnosis of chronic open-angle glaucoma did not provide significant differences between the two surgical methods resulting in PEX.
Miosis is beside phacodonesis the primary risk factor of PEX associated with cataract surgery. Compared with ECCE, PE had significantly fewer complications from PEX with miosis, not from PEX with phacodonesis. Applying the small iris retraction hooks appeared to decrease the complication risks stemming from miosis.
眼科文献中已将假性剥脱（PEX）综合征描述为白内障手术的主要危险因素。大多数作者报告，囊袋撕裂、晶状体囊膜破裂和玻璃体脱出等并发症在囊外白内障摘除术（ECCE）中的发生率超过10%。然而，奥舍尔等人（1993年）发现，原位超声乳化白内障吸除术（PE）的这些并发症发生率低于1%。我们由相同的外科医生对两种手术方式进行操作，并对患者中每种手术方式的并发症进行回顾性评估，以此对ECCE和PE进行比较。
在1986年至1993年接受白内障手术的10450例患者中，发生了102例PEX病例（0.98%）。其中34例患者接受了ECCE，102例患者中的68例接受了PE。PEX患者的平均年龄为78岁。19只眼睛出现了4mm或更小的瞳孔缩小。在过去两年中，为了扩大瞳孔，进行了瞳孔括约肌切除术，并在虹膜上应用了虹膜拉钩。8名外科医生（4名经验丰富，其余为进修医生）实施了手术。
囊袋撕裂、晶状体囊膜破裂和玻璃体脱出的总体并发症发生率为16.6%，ECCE为26.47%，PE为11.76%（p = 0.0664），而无并发症的年龄相关性白内障手术的发生率为1.3%。然而，在瞳孔或多或少正常散大的ECCE患者中，这些并发症的发生率为14.28%，PE患者中为9.09%。瞳孔缩小的PE患者并发症较少（23.07%），因此，与ECCE（83.33%）相比明显更安全（p = 0.0022）。在撕囊过程中观察到的轻微晶状体震颤，以及慢性开角型青光眼的附加诊断，在导致PEX的两种手术方法之间未显示出显著差异。
除晶状体震颤外，瞳孔缩小是与白内障手术相关的PEX的主要危险因素。与ECCE相比，瞳孔缩小的PEX患者发生并发症的明显较少，而晶状体震颤的PEX患者并非如此。应用小型虹膜拉钩似乎降低了因瞳孔缩小引起的并发症风险。
