白内障超声乳化吸出术中晶体核脱入玻璃体的临床分析

目的：报告Ｋｅｌｍａｎ晶体乳化白内障吸出术（Ｋｅｌｍａｎ’ｓｐｈａｃｏｅｍｕｌｓｉｆｉｃａｔｉｏｎｃａｔａｒａｃｔ ｅｘｔｒａｃｔｉｏｎ,ＫＰＥ）中晶体核脱入玻璃体腔的发病率、临床表现和处理方法,方法：回顾我院１９９６年５月９９８年６月间４４００例中ＫＰＥ手术中晶体核脱入玻璃体１０例病人的临床表现及处理方法。结果：晶体核掉入玻璃体发生率为０．２３％,掉核后发生高眼压者１００％,掉核≤１／４,ＫＰＥ     

Risk factors for and management of dropped nucleus during phacoemulsification

PURPOSE: To study the risk factors and management of posteriorly dislocated crystalline lenses during phacoemulsification at a teaching institution. SETTING: L.V. Prasad Eye Institute, Hyderabad, India. METHODS: This retrospective analysis included all phacoemulsification procedures performed by experienced and inexperienced surgeons over 7 years. The incidence, risk factors for, role of surgical experience, mode of management, and the final outcome of posteriorly dislocated lens nuclei were evaluated. RESULTS: Of a total 11 343 phacoemulsification procedures performed between 1993 and 1999, the nucleus was dropped in 38 eyes (0.3%). Two patients with a dropped nucleus were referred from an outside practice. The incidence of dropped nucleus with experienced surgeons (22/8671; 0.2%) was significantly less than that with inexperienced surgeons (16/2672; 0.6%) (P =.007). Sixteen of the 22 cases of dropped nucleus (72.7%) in the experienced group and 1 of 16 (6.3%) in the inexperienced group had risk factors (P =.0005). Nucleus removal was performed using vitreoretinal procedures in 39 eyes; 1 eye with a dropped epinucleus was managed conservatively. The final best corrected visual acuity was 20/40 or better in 21 eyes (53.8%). CONCLUSIONS: The incidence of dropped nucleus was more frequent with inexperienced surgeons, even though experienced surgeons had more cases with predisposing risk factors. Modern vitreoretinal procedures reduce morbidity and improve the visual outcome.     

白内障超声乳化术中晶体核坠入玻璃体的处理

晶体核坠入玻璃体是白内障超声乳化术较为严重的并发症。多由于术者手法不当造成后囊膜破裂所致。本文报导３例白内障超声乳化术中晶体核坠入玻璃体的处理,术后反应及与视力预后相关的因素,分析和讨论白内障超声乳化术中晶体核坠入玻璃体发生的原因及其预防。３例患者均于晶体核坠入玻璃体后７２小时内行经睫状体扁平部的闭合式玻璃体切割术。切除玻璃体,游离晶体核,然后改用后节超声粉碎探头吸引晶体核远离视网膜后乳化吸除。视残留晶体囊膜情况,均经原白内障手术切口于睫状沟内植入后房型人工晶体。术后晶体位置稳定。３例患者术后均有不同程度的炎症反应和角膜水肿,１例术后发生黄斑囊样水肿,１例发生脉络膜脱离,经适当处理后消退。未见其他并发症。术后最终视力０．３～０．６。结果表明,对于坠入玻璃体的晶体核,应及时地改行玻璃体切割术。经过适当的处理,患者最终仍可保留较好的视力。     

Cumulative sum analysis score and phacoemulsification competency learning curve

AIM: To use the cumulative sum analysis score (CUSUM) to construct objectively the learning curve of phacoemulsification competency. METHODS: Three second-year residents and an experienced consultant were monitored for a series of 70 phacoemulsification cases each and had their series analysed by CUSUM regarding posterior capsule rupture (PCR) and best-corrected visual acuity. The acceptable rate for PCR was <5% (lower limit h) and the unacceptable rate was >10% (upper limit h). The acceptable rate for best-corrected visual acuity worse than 20/40 was <10% (lower limit h) and the unacceptable rate was >20% (upper limit h). The area between lower limit h and upper limit h is called the decision interval. RESULTS: There was no statistically significant difference in the mean age, sex or cataract grades between groups. The first trainee achieved PCR CUSUM competency at his 22nd case. His best-corrected visual acuity CUSUM was in the decision interval from his third case and stayed there until the end, never reaching competency. The second trainee achieved PCR CUSUM competency at his 39th case. He could reach best-corrected visual acuity CUSUM competency at his 22nd case. The third trainee achieved PCR CUSUM competency at his 41st case. He reached best-corrected visual acuity CUSUM competency at his 14th case. CONCLUSION: The learning curve of competency in phacoemulsification is constructed by CUSUM and in average took 38 cases for each trainee to achieve it.     

白内障超声乳化吸出术的学习曲线

目的 探讨白内障超声乳化吸出术的学习方法，研究早期手术并发症。方法 经过理论学习，动物实验和充当助手，选择病例，完成最初连续96例100眼白内障超声乳化吸出术，应用球周麻醉，角巩膜缘隧道切口，连续环形撕囊或截囊，水分离或水分层，单或双手法乳化晶状体核，植入人工晶状体。结果 在手术的前后两阶段，连续环形撕囊成功率分别为38％和74％，主要并发症后囊破裂发生率分别为30％和12％。53眼（53％）术后矫正视力达0．5以上。结论 遵守循序渐进的学习规律，正规训练，严格掌握适应证，正确处理并发症等有利于早期超声乳化术达到囊外摘出术效果，安全地完成成功的转化。     

白内障超声乳化吸除术和囊外摘除术初学者玻璃体脱出危险因素分析

Objective To investigate the risk factors related to vitreous loss of phacoemulsification and extracapsular cataract extraction. Methods The clinical data of the initial continuous 350 cases of pha-coemulsification and 350 cases of extracapsular cataract extraction were reviewed. Vitreous loss rate related to each risk factors (gender, age, laterality of the eye,type of cataract, IOL power,success of capsulorhexis,coordinafion of the patients, etc) were measured. Chi-square and Logistic analysis were used to identify the differ-ence of each rate. Results In the ECCE group, there is no significance among each risk factor. In the Phaco group,type of cataract,IOL power and capsulorhexis successful or not affected the vitreous loss rate. Grade IV nuclear,unsuccessful capsulorhexis, IOL power ≥ 24.5D, IOL power ≤ 15.0D and grade Ⅰ nuclear are the risk factors related to the vitreous loss rate,while grade Ⅱ nuclear is a significant protect factor (p <0.05). Conclu-sion The trainees are suggested to choose patients with emmetropia,cataract with grade n nuclear and relative young age and to perform phacoemulsification with successful capsulorhexis.     

白内障超声乳化吸除术和囊外摘除术初学者玻璃体脱出危险因素分析

目的 探讨白内障手术初学者超声乳化吸除术和囊外摘除术,学习曲线特点及学习过程中同玻璃体脱出相关的危险因素.方法 回顾分析作者最初的连续350例超声乳化手术和350例囊外摘除手术经过,并分析手术患者性别、年龄、眼别、白内障类型、人工晶状体度数、撕囊是否成功、患者是否配合等因素对玻璃体脱出的影响.结果 各因素对囊外摘除手术玻璃体脱出发生率均无影响,白内障类型、人工晶状体度数、撕囊是否成功对超声乳化手术玻璃体脱出率有影响,其中IV级核、撕囊不成功、IOL度数≥24.5、Ⅰ级核及IOL度数≤15.0等5个因素是玻璃体脱出的危险因素,Ⅱ级核是保护因素(P<0.05).结论 超声乳化手术较囊外摘除手术受患者条件影响更大,初学者宜选取正视眼、Ⅱ级核、相对年轻的患者并在撕囊成功的前提下进行超声乳化手术的学习.     

白内障超声乳化吸除术和囊外摘除术初学者玻璃体脱出危险因素分析

Objective To investigate the risk factors related to vitreous loss of phacoemulsification and extracapsular cataract extraction. Methods The clinical data of the initial continuous 350 cases of pha-coemulsification and 350 cases of extracapsular cataract extraction were reviewed. Vitreous loss rate related to each risk factors (gender, age, laterality of the eye,type of cataract, IOL power,success of capsulorhexis,coordinafion of the patients, etc) were measured. Chi-square and Logistic analysis were used to identify the differ-ence of each rate. Results In the ECCE group, there is no significance among each risk factor. In the Phaco group,type of cataract,IOL power and capsulorhexis successful or not affected the vitreous loss rate. Grade IV nuclear,unsuccessful capsulorhexis, IOL power ≥ 24.5D, IOL power ≤ 15.0D and grade Ⅰ nuclear are the risk factors related to the vitreous loss rate,while grade Ⅱ nuclear is a significant protect factor (p <0.05). Conclu-sion The trainees are suggested to choose patients with emmetropia,cataract with grade n nuclear and relative young age and to perform phacoemulsification with successful capsulorhexis.     

白内障超声乳化吸除术和囊外摘除术初学者玻璃体脱出危险因素分析

Objective To investigate the risk factors related to vitreous loss of phacoemulsification and extracapsular cataract extraction. Methods The clinical data of the initial continuous 350 cases of pha-coemulsification and 350 cases of extracapsular cataract extraction were reviewed. Vitreous loss rate related to each risk factors (gender, age, laterality of the eye,type of cataract, IOL power,success of capsulorhexis,coordinafion of the patients, etc) were measured. Chi-square and Logistic analysis were used to identify the differ-ence of each rate. Results In the ECCE group, there is no significance among each risk factor. In the Phaco group,type of cataract,IOL power and capsulorhexis successful or not affected the vitreous loss rate. Grade IV nuclear,unsuccessful capsulorhexis, IOL power ≥ 24.5D, IOL power ≤ 15.0D and grade Ⅰ nuclear are the risk factors related to the vitreous loss rate,while grade Ⅱ nuclear is a significant protect factor (p <0.05). Conclu-sion The trainees are suggested to choose patients with emmetropia,cataract with grade n nuclear and relative young age and to perform phacoemulsification with successful capsulorhexis.     

白内障超声乳化吸除术和囊外摘除术初学者玻璃体脱出危险因素分析

Objective To investigate the risk factors related to vitreous loss of phacoemulsification and extracapsular cataract extraction. Methods The clinical data of the initial continuous 350 cases of pha-coemulsification and 350 cases of extracapsular cataract extraction were reviewed. Vitreous loss rate related to each risk factors (gender, age, laterality of the eye,type of cataract, IOL power,success of capsulorhexis,coordinafion of the patients, etc) were measured. Chi-square and Logistic analysis were used to identify the differ-ence of each rate. Results In the ECCE group, there is no significance among each risk factor. In the Phaco group,type of cataract,IOL power and capsulorhexis successful or not affected the vitreous loss rate. Grade IV nuclear,unsuccessful capsulorhexis, IOL power ≥ 24.5D, IOL power ≤ 15.0D and grade Ⅰ nuclear are the risk factors related to the vitreous loss rate,while grade Ⅱ nuclear is a significant protect factor (p <0.05). Conclu-sion The trainees are suggested to choose patients with emmetropia,cataract with grade n nuclear and relative young age and to perform phacoemulsification with successful capsulorhexis.     

白内障超声乳化吸除术和囊外摘除术初学者玻璃体脱出危险因素分析

Objective To investigate the risk factors related to vitreous loss of phacoemulsification and extracapsular cataract extraction. Methods The clinical data of the initial continuous 350 cases of pha-coemulsification and 350 cases of extracapsular cataract extraction were reviewed. Vitreous loss rate related to each risk factors (gender, age, laterality of the eye,type of cataract, IOL power,success of capsulorhexis,coordinafion of the patients, etc) were measured. Chi-square and Logistic analysis were used to identify the differ-ence of each rate. Results In the ECCE group, there is no significance among each risk factor. In the Phaco group,type of cataract,IOL power and capsulorhexis successful or not affected the vitreous loss rate. Grade IV nuclear,unsuccessful capsulorhexis, IOL power ≥ 24.5D, IOL power ≤ 15.0D and grade Ⅰ nuclear are the risk factors related to the vitreous loss rate,while grade Ⅱ nuclear is a significant protect factor (p <0.05). Conclu-sion The trainees are suggested to choose patients with emmetropia,cataract with grade n nuclear and relative young age and to perform phacoemulsification with successful capsulorhexis.     

白内障超声乳化吸除术和囊外摘除术初学者玻璃体脱出危险因素分析

Objective To investigate the risk factors related to vitreous loss of phacoemulsification and extracapsular cataract extraction. Methods The clinical data of the initial continuous 350 cases of pha-coemulsification and 350 cases of extracapsular cataract extraction were reviewed. Vitreous loss rate related to each risk factors (gender, age, laterality of the eye,type of cataract, IOL power,success of capsulorhexis,coordinafion of the patients, etc) were measured. Chi-square and Logistic analysis were used to identify the differ-ence of each rate. Results In the ECCE group, there is no significance among each risk factor. In the Phaco group,type of cataract,IOL power and capsulorhexis successful or not affected the vitreous loss rate. Grade IV nuclear,unsuccessful capsulorhexis, IOL power ≥ 24.5D, IOL power ≤ 15.0D and grade Ⅰ nuclear are the risk factors related to the vitreous loss rate,while grade Ⅱ nuclear is a significant protect factor (p <0.05). Conclu-sion The trainees are suggested to choose patients with emmetropia,cataract with grade n nuclear and relative young age and to perform phacoemulsification with successful capsulorhexis.     

白内障超声乳化吸除术和囊外摘除术初学者玻璃体脱出危险因素分析

Objective To investigate the risk factors related to vitreous loss of phacoemulsification and extracapsular cataract extraction. Methods The clinical data of the initial continuous 350 cases of pha-coemulsification and 350 cases of extracapsular cataract extraction were reviewed. Vitreous loss rate related to each risk factors (gender, age, laterality of the eye,type of cataract, IOL power,success of capsulorhexis,coordinafion of the patients, etc) were measured. Chi-square and Logistic analysis were used to identify the differ-ence of each rate. Results In the ECCE group, there is no significance among each risk factor. In the Phaco group,type of cataract,IOL power and capsulorhexis successful or not affected the vitreous loss rate. Grade IV nuclear,unsuccessful capsulorhexis, IOL power ≥ 24.5D, IOL power ≤ 15.0D and grade Ⅰ nuclear are the risk factors related to the vitreous loss rate,while grade Ⅱ nuclear is a significant protect factor (p <0.05). Conclu-sion The trainees are suggested to choose patients with emmetropia,cataract with grade n nuclear and relative young age and to perform phacoemulsification with successful capsulorhexis.     

白内障超声乳化吸除术和囊外摘除术初学者玻璃体脱出危险因素分析

Objective To investigate the risk factors related to vitreous loss of phacoemulsification and extracapsular cataract extraction. Methods The clinical data of the initial continuous 350 cases of pha-coemulsification and 350 cases of extracapsular cataract extraction were reviewed. Vitreous loss rate related to each risk factors (gender, age, laterality of the eye,type of cataract, IOL power,success of capsulorhexis,coordinafion of the patients, etc) were measured. Chi-square and Logistic analysis were used to identify the differ-ence of each rate. Results In the ECCE group, there is no significance among each risk factor. In the Phaco group,type of cataract,IOL power and capsulorhexis successful or not affected the vitreous loss rate. Grade IV nuclear,unsuccessful capsulorhexis, IOL power ≥ 24.5D, IOL power ≤ 15.0D and grade Ⅰ nuclear are the risk factors related to the vitreous loss rate,while grade Ⅱ nuclear is a significant protect factor (p <0.05). Conclu-sion The trainees are suggested to choose patients with emmetropia,cataract with grade n nuclear and relative young age and to perform phacoemulsification with successful capsulorhexis.