玻璃体切除术后白内障发生或进展的机制及其影响因素

Mechanisms and influencing factors of cataract occurrence or progression after vitrectomy

玻璃体切除术(pars plana vitrectomy,PPV)自1972年由O'Malley提出后已成为眼科治疗史的一大革命,打破了既往的手术禁区,为无数玻璃体视网膜疾病的患者带去了希望。随着玻璃体切除术的不断发展,其安全性及有效性增加,手术适应证扩大,目前玻璃体切除术已成为治疗眼后段疾病最常用的手术方式。虽然玻璃体切除术后并发症越来越少,但白内障的发生或进展仍为PPV术后最常见的高发并发症,严重影响患者术后视力及眼底的观察,且目前尚无有效办法预防,白内障摘除手术为其主要治疗方法,严重增加了患者的负担。PPV术后白内障进展的影响因素众多,对其发病机制有多种假说,包括晶状体周围氧分压增高、玻璃体正常结构的破坏、光毒性等,但尚无定论。本文将从PPV术后白内障发生或进展的发生率、发生机制、影响因素几方面对玻璃体切除术后白内障发生或进展进行综述,以期为其后续的研究及临床预防和治疗提供参考。

Since first proposed by O’Malley in 1972,the revolutionary vitrectomy has brought ophthalmic surgery into a new era,bringing hope to countless patients with vitreoretinal diseases.With the development of surgical techniques,increased safety and effectiveness,and expanded surgical indications,vitrectomy has become the most common surgical treatment for various posterior segment diseases.Though there is a trend of decreasing in postoperative complications,the occurrence and progression of cataract remains the most common complication after vitrectomy.As cataract would compromise the postoperative vision and fundus observation,cataract extraction surgery is always inevitable,which seriously increases the burden of patients.The pathogenesis of cataract is till inconclusive.There are currently many hypotheses including increased oxygen partial pressure around the lens,destruction of the vitreous structure,and phototoxicity.This article reviews the incidence,mechanism and influencing factors of cataract occurrence or progression after vitrectomy,aiming to provide more evidence for further investigation of pathogenesis,prevention and treatment for post-vitrectomy cataract.