少量中心玻璃体切除后再行白内障超声乳化手术治疗伴玻璃体积血白内障患者的效果

Effect of Phacoemulsification After A Small Number of Central Vitrectomy in Patients with Vitreous Accumulation Cataract

目的研究因玻璃体积血而无红光反射的眼睛中,白内障手术前先行少量中心玻璃体切除术的有效性和安全性。方法回顾性分析。2022年1—4月郑州大学第一附属医院东院区眼一科收治的40例(40眼)伴玻璃体积血的白内障患者,眼底红光反射不清,分为A(20眼)和B(20眼)两组,A组患者先接受白内障超声乳化联合人工晶体植入手术,然后在进行全玻璃体切除术。B组患者先接受少量中心玻璃体切除术(0.5~1 mL),然后进行白内障超声乳化联合人工晶体植入手术,最后进行全玻璃体切除术。术后随访时间不少于6个月。所有患者均行23G超声乳化联合玻璃体切除术。观察手术时间(连续环形撕囊总时间、白内障手术总时间)及手术相关并发症的发生率。结果B组的连续环形撕囊总时间和白内障手术总时间均短于A组(P<0.05)。在并发症中,A组的前囊撕裂发生率高于B组(P=0.072);白内障手术期间,B组瞳孔缩小发生率大于A组(P=0.152);两组均未出现后囊膜破裂的情况。A组和B组的术后最佳矫正视力(BCVA)同术前比,均有提高,差异有统计学意义(P<0.05)。结论对伴有玻璃体积血的白内障患者行超声乳化白内障手术前先行少量中心玻璃体切除术(0.5~1 mL),有助于获得良好的红光反射,可减少白内障手术时间和白内障手术相关并发症。

Objective To investigate the efficacy and safety of a small central vitrectomy prior to cataract surgery in eyes without red light reflection due to vitreous hemorrhage.Methods Retrospectively analysis.From January 2022 to April 2024,40 patients(40 eyes)with vitreous cataract admitted to the First Eye Department of the First Affiliated Hospital of Zhengzhou University had unclear red light reflex in the fundus.They were divided into two groups:group A(20 eyes)and group B(20 eyes).Patients in group A underwent phacoemulsification combined with intraocular lens implantation first,and then underwent total vitrectomy.Group B underwent a small amount of central vitrectomy(0.5-1 mL),followed by cataract phacoemulsification combined with intraocular lens implantation,and finally complete vitrectomy.Postoperative follow-up was not less than 6 months.All patients underwent 23G phacoemulsification combined with vitrectomy.The operative time(total time of continuous annular capsulorhexis,total time of cataract operation)and the incidence of surgery-related complications were observed.Results The total time of continuous curvilinear capsulorhexis and cataract operation in group B were shorter than those in group A(P<0.05).In the complications,the incidence of anterior capsule tear in group A was higher than that in group B(P=0.072).During cataract surgery,Pupil size reduction during cataract surgery in group B was greater than that in group A(P=0.152).No posterior capsule rupture occurred in both groups.The best corrected visual acuity of group A and group B after surgery was significantly higher than that before surgery,and the difference was statistically significant(P<0.05).Conclusion A small amount of central vitrectomy(0.5-1.0 mL)is performed before phacoemulsification cataract surgery in patients with vitreous hemorrhage,which helps to obtain a good red light reflex and reduces cataract surgery time and complications associated with cataract surgery.