超声乳化吸除联合人工晶体植入术治疗白内障患者前房渗出发生率的影响因素分析

Analysis of influence factors of phacoemulsification combined with IOL implantation on the incidence of exudation in anterior chamber in cataract patients

目的探讨分析超声乳化白内障吸除术(PE)联合人工晶体(IOL)植入术后前房(AC)渗出发生率的相关影响因素。方法回顾性分析2015年3月～2017年10月于柳州市柳铁中心医院施行植入术的白内障患者389例(405眼)的临床资料,按手术后是否出现AC渗出分为两组,出现渗出的23例(24眼)为研究组,未出现的366例(381眼)为对照组,并统计分析出现比例,通过Logistic回归模型进行分析。结果患者有高度近视、青光眼、术前眼内压(IOP)>21 mmHg(1 mmHg=0.133 kPa)、术前视力<1、术中发生晶状体后囊膜破裂(PCR)、超声累积能量复合参数(AECP)>7.25(%×min)、术中瞳孔直径<3 mm、葡萄膜炎、晶状体核分级≥Ⅳ级9项指标的组间差异有统计学意义(P <0.05),是手术后出现AC渗出的危险因素。而其中患者青光眼、葡萄膜炎、高度近视、术中发生PCR、超声AECP>7.25(%×min)、术前IOP>21 mmHg、晶状体核分级≥Ⅳ级7项指标为独立危险因素(P <0.05)。结论术前IOP>21 mmHg、患者晶状体核分级≥Ⅳ级,患者本身患有高度近视、葡萄膜炎、青光眼,以及超声AECP>7.25(%×min)等均为PE联合IOL植入术后引发AC渗出的主要因素,临床上应该通过及早发现诊断,采取防治措施。

Objective To investigate the related influence factors of phacoemulsification (PE) combined with intraocular lens implantation (IOL) on the incidence of exudation in anterior chamber (AC). Methods The clinical data of 389 cataract patients (405 eyes) treated with PE combined with IOL implantation in Liuzhou Liutie Central Hospital from March 2015 to October 2017 were analyzed retrospectively. There were 23 cases (24 eyes) occuring exudation in AC as study group, and 366 cases (381 eyes) without exudation in AC as control group. Statistical analysis of the incidence of AC exudation after surgery were performed. Multivariate Logistic regression analysis was carried out. Results High myopia, glaucoma, preoperative intraocular pressure(IOP)>21 mmHg(1 mmHg=0.133 kPa), preoperative vision<1, posterior capsular rupture (PCR), in ultrasonic accumulated energy complex parameter (AECP)>7.25(%×min), intraoperative pupil diameter<3 mm, uveitis, lenticular nucleus classification≥Ⅳ levels, all the 9 indices had significant difference between the two groups (P < 0.05), and they were risk factors of exudation in AC. Among the 9 factors, 7 factors, glaucoma, uveitis, high myopia, PCR, ultrasonic in AECP>7.25(%×min), preoperative IOP>21 mmHg, lenticular nucleus classification≥Ⅳ levels were independent risk factors (P < 0.05). Conclusion The preoperative IOP>21 mmHg and patients' nucleus classification of lens≥Ⅳ degree, patients with high myopia, uveitis, glaucoma, and ultrasound AECP>7.25 (%×min) are main risk factors for AC exudation after PE combined with IOL implantation in cataract patients. Early prevention and treatment should be taken in clinical practice.