Margherio R R, Margherio A R, Pendergast S D, Williams G A, Garretson B R, Strong L E, Trese M T, Cox M S, Hassan T S
Associated Retinal Consultants, P.C., Royal Oak, Michigan, USA.
Ophthalmology. 1997 Sep;104(9):1426-32. doi: 10.1016/s0161-6420(97)30120-1.
Posterior lens fragments after phacoemulsification can be a serious complication of cataract surgery. This study is designed to evaluate the clinical features of eyes after pars plana vitrectomy has been performed to remove posteriorly dislocated lens fragments after phacoemulsification.
The authors performed a retrospective chart review of 126 consecutive eyes of 126 patients with dislocated lens fragments after phacoemulsification, managed with pars plana vitrectomy at Associated Retinal Consultants of Michigan. These eyes were operated on from January 1986 through January 1996.
The relation of the intervals between cataract surgery and vitrectomy to various postoperative clinical parameters was studied. Clinical features at presentation included elevated intraocular pressure (IOP over 25 mmHg) in 52.4% of the eyes, uveitis in 69.6%, and corneal edema in 50.8%. Initial visual acuity was 20/400 or worse in 73.8% of the eyes. The mean preoperative visual acuity was 20/278 (median, 20/400), whereas the mean final visual acuity was 20/40 (median, 20/50) after a mean follow-up of 18.9 months. Retinal detachments were found in 20 eyes: 7 before vitrectomy and 13 during or after it. After surgery, 44% of eyes achieved a final visual acuity of 20/40 or better and 90% were 20/400 or better. The distribution of best-corrected final visual acuities among the eyes showed statistically significant differences based on the type of intraocular lens (IOL) used, with posterior chamber IOL greater than anterior chamber IOL, and anterior chamber IOL greater than aphakia. Reasons for a poor visual outcome included persistent corneal edema (four eyes), retinal detachment (two eyes), central retinal vein occlusion (two eyes), age-related macular degeneration (two eyes) glaucoma (one year), and endophthalmitis (one eye).
There were no statistically significant differences between early (< 7 days) and delayed (8 days or more) vitrectomy when increased IOP, corneal edema, choroidal effusions, cystoid macular edema, and visual acuity were analyzed. The use of vitrectomy to remove posteriorly dislocated lens fragments has been shown to be an effective treatment method that significantly reduces the inflammatory response and hastens visual recovery.
超声乳化白内障吸除术后晶状体后囊膜碎片是白内障手术的一种严重并发症。本研究旨在评估经睫状体平坦部玻璃体切除术治疗超声乳化白内障吸除术后晶状体后囊膜碎片后脱位眼的临床特征。
作者对密歇根联合视网膜咨询中心126例超声乳化白内障吸除术后晶状体后囊膜碎片脱位患者的126只连续眼进行了回顾性病历分析。这些眼于1986年1月至1996年1月接受手术。
研究了白内障手术与玻璃体切除术间隔时间与各种术后临床参数之间的关系。就诊时的临床特征包括52.4%的眼眼压升高（眼压超过25 mmHg）、69.6%的眼葡萄膜炎和50.8%的眼角膜水肿。73.8%的眼初始视力为20/400或更差。术前平均视力为20/278（中位数，20/400），而平均随访18.9个月后最终平均视力为20/40（中位数，20/50）。发现20只眼发生视网膜脱离：7只在玻璃体切除术之前，13只在玻璃体切除术期间或之后。手术后，44%的眼最终视力达到20/40或更好，90%的眼达到20/400或更好。根据所使用的人工晶状体（IOL）类型，最佳矫正最终视力在各眼中的分布显示出统计学显著差异，后房型IOL优于前房型IOL，前房型IOL优于无晶状体眼。视力预后不良的原因包括持续性角膜水肿（4只眼）、视网膜脱离（2只眼）、视网膜中央静脉阻塞（2只眼）、年龄相关性黄斑变性（2只眼）、青光眼（1只眼）和眼内炎（1只眼）。
分析眼压升高、角膜水肿、脉络膜渗漏、黄斑囊样水肿和视力时，早期（<7天）和延迟（8天或更长时间）玻璃体切除术之间无统计学显著差异。已证明使用玻璃体切除术清除晶状体后囊膜碎片后脱位是一种有效的治疗方法，可显著减轻炎症反应并加速视力恢复。
