抗青光眼预处理对先天性小眼球合并白内障晶状体摘除术后并发症的影响

Effect of pretreatment of anti-glaucoma on incidence of complications after cataract surgery in patients with nanophthalmos

目的研究抗青光眼预处理对先天性小眼球合并白内障晶状体摘除术后并发症的影响。方法本研究为前瞻性队列研究。收集解放军总医院眼科2012年12月-2016年3月因先天性小眼球合并白内障行白内障超声乳化、人工晶状体植入术患者110例,按患者既往是否接受过抗青光眼手术分为抗青光眼手术史组（n=60）和无手术史组（n=50）。记录术后早期（〈1个月）和晚期（术后1~3个月）并发症的发生情况。结果术前两组年龄、性别、白内障核硬度、眼压差异均无统计学意义（P〉0.05）。既往有手术史组术后早期并发症（前房炎症反应、黄斑水肿和脉络膜脱离）发生率均较无手术组高（73.3%vs38.0%,P〈0.05）,但前者术后眼压控制更好（12.45 mm Hg vs 15.45 mm Hg,P〈0.05）（1 mm Hg=0.133 k Pa）。结论先天性小眼球合并白内障患者术前进行降眼压干预能有效降低患者术后眼压,但黄斑水肿等难治性并发症发生率升高。

Objective To investigate the effect of pretreatment of anti-glaucoma on incidence of complications after cataract surgery in nanophthalmos. Methods It was a prospective cohort study. One hundred and ten cases with nanophthalmos who underwent phacoemulsification surgery from December 2012 to March 2016 in department of ophthalmology, Chinese PLA General Hospital were enrolled in this study. The patients were divided into with a history of anti-glaucomatous surgery group（group A, n=60） and without history of anti-glaucomatous surgery group（group B, n=50）. Early（1 month after surgery） and late（1-3 months after surgery） complications were recorded. Results There was no significant difference in age, sex, cataract nucleus hardness and intraocular pressure between two groups before operation. The incidence of early complications including anterior inflammatory response, cystoid macular edema and uveal effusion in group A were higher than those in group B（44% vs 19%, P〈0.05）, while, the intraocular pressure in group A was lower（12.45 mm Hg vs 15.45 mm Hg, P〈0.05）. Conclusion Preoperative surgical intervention can effectively reduce the postoperative intraocular pressure in patients with nanophthalmos, however, the incidence of complications increase, such as macular edema in congenital microphthalmos with cataract.