同轴微切口超声乳化术后玻璃体后脱离的临床观察

Clinical research on the development of posterior vitreous detachments after coaxial microincision phacoemulsification

目的:探讨同轴微切口超声乳化术后玻璃体后脱离(posterior vitreous detachment,PVD)的发展进程。方法:收集我院行同轴微切口超声乳化手术的917例患者临床资料,917眼手术眼组成观察组,917眼对侧眼组成对照组。所有患者术前均行全面的眼科检查,术后1wk;1,3,6,12mo随访,采用B超和裂隙灯联合+90D前置镜检查,记录有无PVD、视网膜变性、视网膜裂孔、视网膜脱离等情况。结果:观察组术后1wk;1,3,6,12mo累计PVD者分别是8眼(0.9%),31眼(3.4%),53眼(5.8%),78眼(8.5%),129眼(14.1%);129例PVD患者中,1a视网膜裂孔的发生率是7.8%(10/129);而未发生PVD的788眼中,只有1例(0.1%)存在视网膜裂孔,两者之间比较差异有统计学意义(P=0.009)。129例PVD中,有54例存在格子样变性,14.8%(8/54)的格子样变性眼1a内进展为视网膜裂孔,2.7%(2/75)的无格子样变性眼进展为视网膜裂孔,两者之间差异有统计学意义(P=0.004)。结论:同轴微切口超声乳化手术加快了PVD的进程。大约7.8%的PVD患者出现视网膜裂孔。存在格子样变性的患者发生视网膜裂孔的风险较不存在者高5.5倍。所以对同轴微切口白内障超声乳化术后患者进行长期随访十分必要。

AIM： To explore the development process of when posterior vitreous detachments （PVDs） after coaxial micro-incision phacoemulsification and aspiration combined with foldable intraocular lens implantation. METHODS： Clinical data of 917 patients with cataract were collected after coaxial microincision phacoemulsification and aspiration combined with foldable intraocular lens implantation. The 917 operating eyes forms observation group and the 917 corresponding normal eyes serve as control group. All patients underwent a comprehensive ocular examination before surgery. The vitreous and retinal condition was tested by B-scan ultrasonography and biomicroscope with a 90-diopter （D） preset lens after 1 week and 1, 3, 6, and 12 months postoperatively. RESULTS： The incident rate of eyes in the observation group that developed PVD after operation were 8 （0.9%）, 31 （3.4%）, 53 （5.8%）, 78 （8.5%）, 129 （14.1%） within 1 week and 1, 3, 6, 12 months, respectively. Ten （7.8%） of the 129 eyes in which PVD developed during the one year follow-up period had new retinal breaks with or without a retinal detachment; One （0.1%） of the 788 eyes in which a PVD did not developed during the follow-up period had new retinal tear with or without a retinal detachment; these percentages were statistically significant （P=0009）. Eight （14.8%） of 54 eyes with lattice degeneration and 2 （2.7%） of 75 eyes without lattice degeneration had retinal tears associated with a PVD; the difference was statistically significant （P=0.004）. CONCLUSION： Development of PVDs seems to accelerate after coaxial microincision phacoemulsification and linearly accumulated for 1 year postoperatively. Approximately 7.8% of eyes with a PVD had retinal tears. Compared with patients having no lattice degeneration, Patients eyes with lattice degeneration had a 5.5-fold higher risk of developing retinal breaks associated with a PVD. This indicates long-term follow-up is necessary after phacoemulsification is performed.