白内障超声乳化术中后囊膜破裂危险因素与预后分析

Risk factors and prognosis analysis of posterior capsular rupture during phacoemulsification cataract surgery

目的探讨白内障超声乳化术中后囊膜破裂的危险因素与预后情况。方法收集2014年8月至2017年4月我院眼科接受超声乳化术的白内障患者资料582例(794只眼),应用并发症筛选方法将30例术中发生后囊膜破裂的患者作为观察组,采用随机方法抽取122例无后囊膜破裂的患者作为对照组。通过两组间病例相关资料的比较,相关高危因素的调查以及Logistic回归分析,探讨白内障超声乳化术中后囊破裂危险因素与预后情况。结果观察组与对照组在性别、白内障原因、眼别、术前眼压等方面比较无统计学差异(P>0.05);但观察组平均年龄高于对照组,术前最佳矫正视力<0.1的比例高于对照组,晶状体核分级Ⅳ级及以上的比例高于对照组,差异具有统计学意义(P<0.05)。组间相关危险因素比较,观察组发生后囊膜破裂可能与术前矫正视力<0.1、冠心病、玻璃体手术史、青光眼、葡萄膜炎、烟酒史等因素相关。将年龄、晶状体核分级等相关危险因素代入Logistic模型进行回归分析,认为年龄、冠心病、晶状体核分级、术前矫正视力<0.1、玻璃体手术史与后囊膜破裂呈相关性(P<0.05)。30例术中发生后囊膜破裂者均一期植入人工晶状体。术后最佳矫正视力比较,对照组术后1 d、术后7 d视力要优于观察组(P<0.05),可见后囊膜破裂会对视力造成不良影响。结论白内障超声乳化术中,患者年龄、冠心病、晶状体核分级、术前矫正视力<0.1、玻璃体手术史与后囊膜破裂呈相关性,后囊膜破裂会对术后视力恢复造成影响,应该提高对相关危险因素的重视,通过对风险的早期干预与术中谨慎处理,最大程度降低后囊膜破裂发生率。

Objective The study was to analyze the risk factors and prognosis of posterior capsular rupture during phacoemulsification cataract surgery. Methods 794 eyes of 582 patients who had undergone phacoemulsification surgery during Aug. 2014 and April 2017 in our hospital were included in this study. Thirty eyes occurred posterior capsular rupture during surgery were selected in experimental group and 122 eyes without posterior capsular rupture were randomly extracted in the control group. Data of the two groups were compared to analyze the risk factors and prognosis of posterior capsular rupture during phacoemulsification cataract surgery. Results The gender,cause of cataract,preoperative intraocular pressure of the patients were not statistically different between the two groups（ P 0. 05）,while the age,the proportion of the preoperative best corrected visual acuity（ BCVA） 0. 1 and nuclear hardness of the experimental group were statistically higher than those of the control group（ P 0. 05）. The Logistic regression analysis revealed there were correlation between posterior capsular rupture and age,coronary heart disease,nuclear hardness level,preoperative BCVA 0. 1 and history of vitrectomy of patients（ P 0. 05）. Intraocular lens of all the 30 eyes were implanted meanwhile phacoemulsification were finished although posterior capsular rupture occurred. The BCVA of control group were better than that of experimental group 1 d and 7 d after surgery（ P 0. 05）. Conclusions There were correlation between posterior capsular rupture and age,coronary heart disease,nuclear hardness level,preoperative BCVA 0. 1 and vitrectomy history of patients in phacoemulsification surgery. Posterior capsular rupture may cause less improvement of vision. More attention should be paid to the related risk factors to reduce the incidence of posterior capsular rupture in cataract surgery.