白内障超声乳化术后前房膜形成的危险因素(英文)

Risk factors for anterior chamber membrane formation after phacoemulsification

目的:探讨白内障超声乳化术后前房膜形成的危险因素。方法:对1356例行白内障超声乳化+单片式PMMA人工晶体植入术患者进行前瞻性研究。假性囊膜剥脱综合症,核硬度,瞳孔大小,超声时间,实际超声时间,系统性疾病,术中并发症(囊膜撕裂,悬韧带断裂,后囊破裂伴玻璃体丢失),IOL植入位置和术后并发症(眼内压变化,粘连形成)作为膜形成的危险因素分析。结果:观察到111例患者(8.1%)术后出现伴有膜形成的纤维素性前葡萄膜炎。膜形成平均时间是术后第2d(术后第1～7d),膜存在持续时间平均为5.2d(1～48d)。在膜形成病例中,+4级核病例占45%,而在无膜形成病例中仅为13.5%,差异具有显著统计学意义(P<0.05)。在膜形成组,平均超声时间为2.4min,平均实际超声时间为32.8s,而无膜形成组分别为1.8min和22.1s。这两项参数在膜形成组均明显较长(P<0.05)。在膜形成组中,出现后囊破裂伴玻璃体丢失和IOL睫状沟植入者占33%,而无膜形成组为11%(P<0.05)。其他危险因素在膜形成组和无膜形成组中的比较无统计学意义。在术后第1d和第7d,平均最佳矫正视力(Snellen视力表)在膜形成组分别为0.2和0.4,无膜形成组为0.4和0.6(P<0.05)。但术后3mo,平均最佳矫正视力在膜形成组和无膜形成组中结果相似(分别为0.8和0.9)。结论:晶状体核硬度较高,较长超声时间和实际超声时间,术中后囊破裂是术后前房纤维膜形成的明显相关性危险因素。

AIM： To investigate risk factors for the development of membrane formation in the anterior chamber alter phacoemulsifTcation.METHODS： A total of 1356 patients who underwent phacoemulsification with implantation of single piece polymethyl methacrylate （PMMA） IOL were prospectively evaluated. Pres- ence of pseudoexfoliation syndrome, nuclear hardness, pupil size, phaco time, effective phaco time, systemic diseases, pe- rioperative complications （capsulorhexis rupture, zonular dial- ysis, posterior capsule rupture with vitreous loss）, location of IOL placement and postoperative complications （intraocular pressure changes, synechia formation） were analyzed as risk factors for development of membrane formation.RESULTS： In 111 （8.1%） patients postoperative fibrinous anterior uveitis with membrane formation was observed. The mean time for membrane formation was postoperative second day （range postoperative 1^st and 7^th day）. Mean duration of the presence of membrane was 5.2 days （range 1 to 48 days）. Among the patients who had membrane formation, ＋4 hardness of the nucleus was present in 45%, while it was present in only 13.5% of patients who did not have membrane formation. The difference was statistically significant （P〈0.05）. In the membrane-forming group, mean phaco time was 2.4 minute and mean effective phaco time was 32.8 seconds, compared to 1.8 minute and 22.1 seconds in the membrane-free group. Both parameters were significantly longer in the membrane-forming group （P〈0.05）. Posterior capsule rupture with vitreous loss and sulcus implantation of IOL was seen in 33% of membrane-forming patients and in 11% of membrane-free patients （P〈0.05）. Other risk factors were not statistically different between membrane-forming and membrane-free patients. On postoperative first and 7^th day, the mean best corrected visual acuity in the membrane-forming group was 0.2 and 0.4 respectively, versus 0.4 and 0.6 in the membrane-free group on Snellen chard （P〈0.05）. But three months after surgery, the best corrected visual acuity was similar between the membrane-forming and membranefree patients （0.8 and 0.9 respectively）. CONCLUSION： Higher nucleus hardness, longer phaco time and effective phaco time, and posterior capsule rupture during surgery were risk factors which significantly assocaiated with postoperative fibrinous membrane formation in the anterior chamber.