伴有系统性疾病的白内障患者手术疗效及围手术期处理原则

目的　评价伴有系统性疾病的白内障患者行超声乳化白内障吸除联合人工晶状体植入术的安全性、疗效和围手术期处理原则。方法　选取2018年5月至2020年5月于天津医科大学总医院眼科诊断为白内障并伴有系统性疾病且接受超声乳化白内障吸除联合人工晶状体植入术的患者401例(499眼)为研究对象，加强术前围手术期管理，术后随访至少3个月，对比观察术前及术后患者最佳矫正视力(BCVA)、眼压、角膜内皮细胞数，并分析眼部并发症与系统性疾病的关系。结果　术后3个月，BCVA较术前提高者481眼(96.39％)，不变者12眼(2.40％)，下降者6眼(1.20%)。术前眼压为（16.64±4.76）mmHg（1 kPa=7.5 mmHg)，术后3个月为（15.79±5.98）mmHg，差异具有统计学意义(t=2.710，P<0.05)。术前角膜内皮细胞数为（2523.80±469.52)个·mm^-2，术后3个月为（2245.56±469.94)个·mm^-2，差异具有统计学意义(Z=-17.307，P<0.05)。术后并发症主要包括:一过性角膜水肿168眼(33.67%)、一过性高眼压63眼(12.63%)、一过性低眼压7眼(1.40%)、前房渗出14眼(2.81%)。通过分类变量分析，2型糖尿病、尿毒症与术后一过性高眼压均相关(均为P<0.05)；冠心病与术后一过性低眼压相关(P<0.05)；2型糖尿病、高血压、冠心病、尿毒症、系统性红斑狼疮与术后一过性角膜水肿均相关(均为P<0.05)；系统性红斑狼疮与术后前房渗出相关(P<0.05)。术后随访期内患者系统性疾病均稳定。结论　超声乳化白内障吸除联合人工晶状体植入术是治疗伴有系统性疾病的白内障患者安全有效的方法。术前完善全身相关检查并控制系统性疾病是安全完成手术的基础。

Surgical effect for cataract patients with systemic diseases and principles of perioperative management

Objective To evaluate the safety,efficacy and perioperative management principles of phacoemulsification combined with intraocular lens implantation in cataract patients with systemic diseases.Methods A total of 401 cataract patients(499 eyes)with systemic diseases that underwent phacoemulsification combined with intraocular lens implantation in Tianjin Medical University General Hospital from May 2018 to May 2020 were selected in this study.All eyes received preoperative and postoperative examinations,including best corrected visual acuity(BCVA),intraocular pressure(IOP),and corneal endothelial cell counts.All patients were followed up for at least 3 months.The relationship between ocular complications and systemic diseases was analyzed.Results Postoperatively,481 eyes’(96.39%)BCVA improved,12 eyes’(2.40%)BCVA remained unchanged,and 6 eyes’(1.20%)BCVA decreased at 3 months after surgery.The mean IOP at 3 months postoperative was significantly reduced compared with the preoperative measurement(15.79±5.98)mmHg versus(16.64±4.76)mmHg,1 kPa=7.5 mmHg,and the difference was statistically significant(t=2.710,P<0.05).The density of corneal endothelial cells at 3 months postoperative was also decreased compared with the preoperative measurement(2245.56±469.94)mm^-2 versus(2523.80±469.52)mm^-2,and the difference was statistically significant(Z=-17.307,P<0.05).Postoperative complications mainly included transient corneal edema(168 eyes,33.67%),transient high IOP(63 eyes,12.63%),transient low IOP(7 eyes,1.40%),and anterior chamber exudation(14 eyes,2.81%).Through analysis of categorical variables,type 2 diabetes and uremia were found to be associated with transient high IOP postoperatively(both P<0.05),and coronary heart disease(CHD)was associated with transient low IOP postoperatively(P<0.05).Type 2 diabetes,hypertension,CHD,uremia,and systemic lupus erythematosus were associated with transient corneal edema postoperatively(all P<0.05),and systemic lupus erythematosus was also associated with anterior chamber exudation postoperatively(P<0.05).Patients’systemic diseases were stable during the postoperative follow-up period.Conclusion Phacoemulsification combined with intraocular lens implantation is a safe and effective method for the treatment of cataract patients with systemic diseases.Preoperative systemic examinations and control of systemic diseases are important for the success of cataract surgery.