白内障超声乳化吸除联合人工晶体植入术后视网膜脱离的相关因素

目的 探讨未经选择患者白内障超声乳化吸除联合人工晶体(IOL)植入术后视网膜脱离(RD)的发生率及发生的相关因素.方法 回顾性分析温州医学院附属眼视光医院1998年12月1日至2008年9月30日行白内障超声乳化吸除联合IOL植入术患者10 076例(13 625只眼),术后发生RD及其相关危险因素.结果 10076例白内障患者的平均年龄(67±15)岁,男4439例和女5637例的数量差异有统计学意义(χ2=142.44,P<0.01),左眼6701例和右眼6924例的数量差异无统计学意义(χ2=3.65,P0.05),其中年龄相关性白内障6641例所占比例为65.91%.白内障超声乳化吸除联合IOL植入术后共计32例32只眼发生RD,发生率为0.32%,发生的时间间隔为术后10天至74个月,风险度估计(Kaplan-Meier法)为0.47%.高度近视和眼轴延长(χ2=14.55,P<0.01)与RD的发生紧密相关.相关危险因素有高度近视、术中晶状体后囊膜破裂、术后后发性白内障行Nd:YAG激光后囊膜切开.32只眼中31只眼1次手术复位成功,2只眼手术后复发放弃手术.结论 白内障超声乳化吸除联合IOL.植入术后增加了RD的发生率;术前合并眼病、高度近视及眼轴延长,术中晶状体后囊膜破裂及术后后发性白内障行Nd:YAG激光后囊膜切开是术后RD发生的危险因素.

Relative factors of retinal detachment after phacoemulsification cataract extraction and intraocular lens implantation

Objective To investigate the incidence and related factors of retinal detachment(RD) after phacoumulsification cataract extraction and intraocular lens(IOL) implantation in an unselected patient group. Methods This retrospective review was comprised of 10 076 cataract patients(13 625 eyes)who had phacoemulsification cataract extraction and IOL implantation from December 1, 1998 to September 30, 2008. The patients were of different ages, gender, left or right eye and different type of cataracts. The incidence of postoperative RD was assessed and the relative risk factors were estimated using the Kaplan-Meier method. Results The average age was 67.22±15.10 years old with 4439 males and 5637 females. The difference between the numbers of men and women was statistically significant (χ2 = 142.44, P <0.01). A total of 6701 left eyes and 6924 right eyes showed no significant difference (χ2 =3.65, P =0.056). And 65.91% of these eyes were age-related cataract. During the post-operation observation period, 32 eyes of RD in 32 patients were observed from 10 days to 74 months post-operation. The ratio was 0.32% with an estimated risk (Kaplan-Meier) of 0.47% at 74 months. These results confirmed that myopia and increased axial length were significantly associated with RD (χ2= 14.55, P < 0.001) and recognized risk factors for RD such as high myopia, posterior capsular bag rupture and Nd : YAG capsulotomy. Among these 32 eyes, 31 eyes had one successful retina re-attaching operation(90.32%) and two eyes were given up because of post-operative relapse. Conclusion The incidence of RD increases after phacoumulsification cataract extraction and IOL implantation in an unselected patient group. Hypermyopia, posterior capsular bag rupture and Nd: YAG capsulotomy are possible risk factors of the RD.