白内障超声乳化联合玻璃体切割术后长期并发症分析

目的:评价白内障超声乳化联合玻璃体切割治疗白内障合并玻璃体视网膜病变的主要术后并发症。方法:回顾性分析117例(138眼)行白内障超声乳化联合玻璃体切割的白内障合并玻璃体视网膜病变患者的临床数据,观察其视力恢复情况并从不同疾病类型,不同晶状体类型,不同术中玻璃体填充物,不同手术方式等方面观察分析患者联合术后并发症情况。结果:术后随访4~23(平均6.7)mo。113眼(81.9%)术后视力改善,视力提高2行以上占67眼(48.6%)。术后常见的并发症有角膜水肿、前房反应和一过性高眼压。角膜水肿的发生率是22.5%,前房反应的发生率是34.8%,术后一过性高眼压(术后1mo内眼压高于25mmHg)的发生率是25.4%,6例(4.4%)出现继发性青光眼,其余均在术后2wk内恢复正常,8例(5.8%)出现视网膜脱离,其中4例(2.9%)为复发性视网膜脱离。较少见的并发症是葡萄膜炎、黄斑水肿等。从分组方面分析,糖尿病视网膜病变、术中予硅油和膨胀气体填充、术中手术方式为联合手术并巩膜外冷凝扣带术组及联合手术并视网膜光凝并巩膜外冷凝术组术后并发症高于相对应组。术中植入疏水性丙烯酸酯折叠人工晶状体组术后发生前房反应几率高于相对应组。结论:白内障超声乳化联合玻璃体切割治疗白内障合并玻璃体视网膜病变安全有效。合理选择手术适应证,不断改进手术技巧均可以减少并发症的发生。

Long-term complications of combined surery of phacoemulsification and vitrectomy

AIM:To evaluate the long-term complications of combined surgery of phacoemulsification and vitrectomy.METHODS: We retrospectively reviewed records of 137 patients with coexisting cataract and vitreoretinal disease who underwent combined surgery of phacoemulsification and vitrectomy.RESULTS: The major postoperative complications were corneal edema (22.5%), fibrinous exudation in the anterior chamber (34.8%) and transient intraocular pressure rise (25.4%). The minor postoperative complications were secondary glaucoma (4.4%), rentinal detachment (5.8%), uveitis and macular edema. Subgroup analysis revealed that the postoperative complications more frequently occurred in those treated with proliferative diabetic retinopathy (PDR), endotamponade of silicone oil or C3F8 gas or C2F6 gas, usage of scleral buckling and intraoperative laser and cryocoagulation. Fibrinous exudation in the anterior chamber was more significantly frequent after the implantation of hydrophobic acrylate folder lens.CONCLUSION: Combined surgery of phacoemulsification and vitrectomy is safe and effective. The operative indications should be selected reasonably to reduce the incidence of complications.