超声乳化白内障吸除术中晶状体后囊膜破裂风险因素分析  

The risk factors of posterior capsule rupture in phacoemulsification of cataract

作　　者：章露易[1] 徐雯[2] 姚克[2] 

机构地区：[1]浙江省人民医院眼科 [2]浙江大学第二附属医院眼科中心浙江省眼科重点实验室,杭州310009

出　　处：《中华眼科杂志》2015年第4期282-287,共6页Chinese Journal of Ophthalmology

基　　金：国家临床重点专科基金;浙江省“十二五”适宜技术推广项目

摘　　要：目的 探讨超声乳化白内障吸除术中发生晶状体后囊膜破裂的风险因素及相关预后情况.方法 本研究为回顾性病例对照研究.选取2009年1月1日至12月31日在浙江大学医学院附属第二医院眼科中心行超声乳化白内障吸除术的连续病例3 004例（3 186只眼）,统计晶状体后囊膜破裂的例数（即后囊膜破裂组）,余下部分患者为非后囊破裂组,利用随机数列生成,以1：4的比例在所有病例中选取272例（275只眼）患者作为对照组,若选中的患者为后囊膜破裂,则舍弃继续选择.统计术前眼压、术前术后视力、白内障类型、分级、合并疾病、操作者、IOL安装位置等,利用卡方检验、t检验、Mann-Whitney秩和检验等分析后囊膜破裂的相关风险因素及预后情况.结果 男性晶状体后囊膜破裂发生率高于女性（x2=7.82,P＜0.01）、术前视力小于20/200（风险比2.3,P=0.01）是后囊膜破裂风险因素,白内障Ⅳ度核及以上的后囊膜破裂发生率与其他组相比差异有统计学意义（x2=18.01,P＜0.01）,术者熟练程度对后囊膜破裂发生率的差异也有统计学意义（x2=14.13,P＜0.01）且后囊膜破裂组术前平均视力为（2.1±1.0） LogMAR,术后平均视力提高至（1.2±0.8）LogMAR（t=7.71×10-11,P＜0.01）而对照组术前平均视力（1.5±0.8）LogMAR,术后平均视力（0.7 ±0.7） LogMAR（t=1.27×10-42,p＜0.01）,而患者年龄、眼别、术前眼压、青光眼病史、全身疾病史等差异对于发生后囊膜破裂并无统计学意义.结论 性别、术前视力,白内障核分级及术者熟练程度均影响超声乳化白内障吸除手术中后囊膜破裂的发生,后囊膜破裂会显著影响患者术后的视力恢复。Objective To demonstrate the incidence of posterior capsule rupture during the phacoemulsification of cataract and the risk factors of the complication and to find ways to reduce the rate of the complication.Methods This retrospective chart review comprised cataract phacoemulsification performed from January 1,2009 to December 31,2009 with a total of 3 004 cases （3 186 eyes）.The incidence of posterior capsule rupture and the risk factors were the main outcomes.The variables of patient age and gender;laterality of surgical eye;pre-operative visual acuity and intraocular pressure;post-operative visual acuity;the nuclear stages,presence of diabetes mellitus,glaucoma,hypertension and other diseases;history of vitrectomy the surgeons were collected and analyzed.Results Male（x2 =7.82,P〈0.01）,pre-operative visual acuity less than 20/200 （HR=2.3,P=0.01）,and the nuclear stage higher than Ⅳ （x2 =18.01,P〈0.01）all statistically significantly increased in the posterior capsule rupture group （x2 =14.13,P〈 0.01）.The post-operative visual acuity increased in both groups （（2.1 ± 1.0）LogMAR to （1.2±0.8）LogMAR,t=7.71 × 10-11,P〈0.01 vs （1.5 ±0.8） LogMAR to （0.7±0.7） LogMAR,t=1.27 × 10-42,P〈0.01）.Conclusions Gender,pre-operative visual acuity,the nuclear stages are all significantly affect the incidence of the posterior capsule rupture.Improving training of surgeons should further reduce the frequency.

关 键 词：超声乳化白内障吸除术 手术中并发症 晶体后囊 后囊破裂 眼 危险因素 

分 类 号：R779.66[医药卫生—眼科]