基层医院白内障培训项目术后视力预后  

Visual Outcomes of Extracapsular Cataract Extraction in a Hands-on Training Project in Rural Southern China

作　　者：黄文勇[1] 康丹[1] 黄国富[1] 陈倩韵[1] Nathan Congdon 何明光[1] 

机构地区：[1]眼科学国家重点实验室//中山大学中山眼科中心预防眼科,广东广州510060

出　　处：《中山大学学报（医学科学版）》2010年第6期744-747,共4页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：海伦凯勒国际防盲组织的Starr项目

摘　　要：【目的】了解基层医院眼科医生在接受中山眼科中心手把手培训期间所施行的白内障手术的患者术后视力以及影响视力的常见手术并发症。【方法】选取韶关市曲江区中医院和郁南县中医院两家县级医院作为目标医院,两名从无任何手术经验的术者,在接受培训期间对患者施行了手法小切口白内障摘除联合人工晶状体植入手术。对所有手术后超过3个月的患者并进行眼部临床检查。【结果】在518名符合入选条件的白内障术后患者中,共342名患者(66.02%,共385例术眼)来诊。其中26眼因存在与手术无关的视神经视网膜病变或晚期青光眼改变而不加入进一步数据分析。342名患者平均年龄为73.2(S8.8)岁,女性占62.28%。单眼手术301(77.19%)人,双眼手术41(12.2%)人。术后非矫正视力(UCVA)范围为0.1≤UCVA<0.3和UCVA<0.1者分别占9.74%和9.0%。术后针孔视力(做为最佳矫正视力,BCVA)范围为0.1≤BCVA<0.3和BCVA<0.1者分别占3.15%和4.3%。影响术后UCVA的原因主要包括屈光不正(56.34%)、无人工晶状体眼(18.31%)、散光(9.86%)、后囊膜混浊(8.45%),黄斑水肿(5.63%)及角膜混浊(1.41%)。【结论】基层医院医生接受手把手培训期间所施行的白内障手术的治疗效果良好。屈光不正是术后视力不良的主要原因。术前重视眼底疾病的诊断以及人工晶状体度数的准确测定有助于提高白内障手术的治疗质量和效果。【Objective】 To assess the visual acuity and surgical-related causes of low vision after manual small incision cataract surgery （MSICS） in a hands-on training project in rural southern China. 【Methods】 MSICS was offered by local surgeons in Yuanan and Qujiang countries,who completed the hands-on training project provided by Zhongshan Ophthalmic Center. Visual acuity and causes of low vision were assessed 3 months postoperatively. 【Results】 A total of 518 patients underwent MSICS during November 2009. Of these,342 （66.02%,385 eyes）were available for analysis. 26 cases with poor vision due to late stage glaucoma or retinal abnormalities were excluded from further analysis. The mean （standard deviation SD） age was 73.2±8.2 years and female accounted for 62.28%. Based on uncorrected visual acuity UCVA,the prevalence of post-operative visual impairment （0.1 ≤ UCVA 0.3） and blindness （UCVA 0.1） was 9.74% and 9.0%,respectively. Based on pin-hole visual acuity,the prevalence of visual impairment and blindness was 3.15% and 4.3%,respectively. The leading cause of uncorrected visual impairment was refractive error （56.34%）,followed by uncorrected aphakia （18.31% ）,astigmatism （9.86% ）,posterior capsular opacity （8.45%）,macular edema （5.63%）,and corneal scar / opacity （1.41%）. 【Conclusion】 The visual outcomes after MSICS are satisfactory in the hands-on training project. The leading cause of uncorrected visual impairment was refractive error. These findings highlight the importance of accurate intraocular lens power measurement before operation.

关 键 词：培训 白内障手术 术后低视力原因 

分 类 号：R776.1[医药卫生—眼科]