267例硬核白内障复明手术质量分析

目的分析硬核白内障在接受复明手术人群中的分布特点、术中主要并发症的发生率和视力预后。设计回顾性病例系列。研究对象上海爱尔眼科医院完成的市级白内障防盲复明项目中接受白内障手术的1061例白内障患者中,四级以上硬核白内障267例(267眼),其余794例非硬核白内障患者作为对照。方法对研究对象的术前眼部特点、术中、术后并发症发生率和术后视力进行回顾性分析,计算其脱盲率和脱残率,并与本复明项目的非硬核白内障者进行比较,脱盲的标准为矫正视力>0.05;脱残的标准为矫正视力>0.3。主要指标临床特征、并发症、术后视力。结果 267例硬核白内障患者中,术前矫正视力低于眼前指数者124例(46.3%),≤0.1者89例(33.3%),0.1以上者54例(20.4%)。白内障伴晶状体不全脱位2例,既往青光眼滤过手术史6例(1.2%)。接受超声乳化手术254例(95.1%),13例综合考虑术前检查结果、术中具体情况改行白内障囊外摘除术。主要手术并发症:后囊膜破裂14例(5.24%),发生率明显高于同批非硬核白内障患者(13/794例,1.64%)(χ2=10.33,P<0.01);术后1天角膜水肿35例(13.1%),显著高于同批非硬核白内障患者(19/794例,2.4%)(χ2=46.98,P<0.01)。术后1个月矫正视力>0.05者261例,脱盲率97.4%;矫正视力>0.3者234例,脱残率87.6%。其中72例(27.0%)矫正视力高于0.6,视力状态与术前相比存在显著差异(χ2=367.51,P<0.01)。结论本防盲复明项目中,硬核白内障的手术比例高,手术难度高于常规白内障手术。对术眼复杂状态的充分预测和估计、术中及时转换术式能提高大批量复明手术中硬核白内障的手术成功率,改善患者的生活质量。

Quality analysis of surgery for 267 cataract cases with hard nuclear lens in government organized cataract rehabilitation project

Objective To analyze the clinical charactaristics,operation complications and visual outcomes of the sugery for the cataract patients with hard nuclear lens in government organized cataract rehabilitation project.Design Retrospective case series.Participants Among 1061 cataract cases who accepted the surgery in government organized cataract rehabilitation project in Shanghai Aier eye hospital,267 cases with hard nucleus（25.2%） were observed.The other 794 cases were considered as the control group.Method The clinical charactaristics,main intraoperative and postoperative complications and visual acuities were analyzed and compared with control group.Main Outcome Measures Clinical charactaristics,operation complications,visual acuity,and rehabilitation rate.Results Before the surgery,best corrected vision acuity（BCVA） of 124 cases（46.3%） were less than finger count;BCVA of 89 cases（33.3%） were less than or equal to 0.1;and BCVA of 54 cases（20.4%） were better than 0.1.Two cases were accompanied with lens dislocation,6 cases were accepted filtration surgery before.Phacoemulsification were performed on 254 cases and extracapsular cataract extraction（ECCE） were performed on 13 cases.Posterior capsular ruptures were observed in 14 cases（5.24%） during the operations,the frequency of which was significantly higher than the control group（13 cases,1.64%）（χ2=10.33,P0.01）.Cornea edema rate was 13.1% at the first day after operation,which was significantly higher than the control group（19 cases,2.4%）（χ2=46.98,P0.01）.One month after the surgery,the BCVA of 261 cases（97.4%） were better than 0.05,BCVA of 234 cases（87.6%） were better than 0.3,and the BCVA of 72 cases（27.0%） were better than 0.6.Visual acuities after surgery were significantly better than before operation（χ2=367.51,P0.01）.Conclusion There is a high rate of hard nuclear cataracts in government organized cataract rehabilitation project.Fully estimating the complicated conditions,switching to ECCE in specific cases were wisdom strategies to deal with the possible intraoperative complications of hard nuclear cataracts and to acquire the best visual outcomes for those patients.