伴有严重全身病的白内障术前处理及手术效果

目的 评价伴有严重全身疾病的白内障患者术前处理及手术效果.方法 分析我院手术的伴有严重全身疾病的白内障246例（393只眼）.年龄46 ～ 95岁,平均（73.00±9.26）岁.术前视力光感～0.6.全身疾病包括：循环系统疾病175例（慢性心力衰竭1例,心律失常40例,心绞痛81例,心肌梗死47例,心脏瓣膜病4例,心肌疾病2例）,呼吸系统疾病26例,脑血管疾病62例,慢性肾衰竭17例（其中7例尿毒症期）,特发性血小板减少性紫癜3例,免疫系统疾病20例,合并恶性肿瘤者29例.术前处理方法：心脏支架或搭桥患者术前7d停用抗凝药物,改用低分子肝素.肾透析患者术前1d肾透析时使用0.4 ml低分子肝素,术后使用鱼精蛋白中和肝素.手术方式：行晶状体超声乳化吸出术230例（372只眼）,小切口白内障囊外摘出术16例（21只眼）.所有术眼囊袋内植入后房型人工晶状体.术后随访1 ～12个月.结果 所有患者术中均在心电监护和持续低流量吸氧实施下顺利完成白内障手术.术后视力提高385只眼（97.96％）,视力不变8只眼（2.04％）.术后最佳矫正视力0.25及以下者20只眼（5.09％）,0.3至0.5者59只眼（15.01％）,0.6至0.8者141只眼（35.88％）,1.O及以上者173只眼（44.02％）.术中血压升高13例（5.28％）,立即静脉注射药物将血压降到正常范围.术后并发症包括角膜水肿52只眼（13.23％）,前房渗出4只眼（1.02％）,前房少量积血1只眼（0.25％）,暂时性高眼压5只眼（1.27％）.术后随访全身疾病无明显进展.结论 对于伴有严重全身疾病的白内障患者术前积极控制全身疾病,可使手术顺利进行.手术安全可靠,效果良好.

Preoperative management and efficacy of surgery for cataract patients with severe systemic diseases

Objective To evaluate the efficacy of cataract surgery and preoperative treatment for cataract patients with severe systemic diseases.Methods Data of 393 eyes of 246 cataract patients with severe systemic disease who underwent cataract surgery in our hospital were retrospectively analyzed.The age was from 46 to 95 years old with average （73.00 ± 9.26） years.The preoperative visual acuity ranged from light perception to 0.6.There were 175 patients with circulatory systemic diseases：1 patient with chronic heart failure,40 patients with arrhythmia,81 patients with angina,47 patients with myocardial infarction,4 patients with valvular disease and 2 patients with myocardiopathy.Other systemic diseases included respiratory systemic diseases in 26 patients,cerebrovascular diseases in 62 patients,chronic renal failure in 17 patients （uraemia in 7）,idiopathic thrombocytopenic purpura in 3 patients,and diseases of immune system in 20 patients,cancers in 29 patients.The preoperative managements included：low molecular Heparin instead of anticoagulant used in patients with cardiac bypass surgery or coronary stent implantation 7 days preoperatively,low molecular Heparin 0.4 ml used during renal dialysis in patients with renal insufficiency 1 day before surgery and Protamine used postoperatively to neutralize Heparin.The surgical options included：phacoemulsification in 230 patients （372 eyes） and extracapsular cataract extraction in 16 patients （21 eyes）.Posterior chamber intraocular lens were implanted in the bag in all patients.The follow-up time was from 1 to 12 months.Results All the surgeries were performed successfully under electrocardiograph monitoring and continuous low flow oxygen inhalation.The postoperative best corrected visual acuity increased in 385 eyes （97.96%）,and remained unchanged in 8 eyes （2.04%）.The best corrected visual acuity was 0.25 or below in 20 （5.09%） eyes,between 0.3 and 0.5 in 59 （15.01%） eyes,between 0.6 and 0.8 in 141 （35.88%） eyes,and 1.0 or better i