超声乳化白内障吸除术中晶状体后囊膜破裂风险因素及预后分析

摘要

Objective To explore the risk factors and prognosis of posterior capsule rupture in phacoemulsification of cataract. Methods A total of 2,409 cases (2,576 eyes) scheduled for cataract phacoemulsification in our hospital between January 2014 and October 2015 were included in the retrospective study. Among the patients 24 cases (26 eyes) of posterior capsular rupture patients were seleted as the observation group, and 120 patients (135 eyes) were selected from the remaining patients as control group, with a ratio of 1 to 5. If the selected patients had posterior capsule rupture, they were removed and other patients were selected. Clinical data such as age, gender, preoperative intraocular pressure (IOP), cataract type and grade, preoperative and postoperative vision, a history of glaucoma and concomitant diseases were compared between the two groups. The risk factors and prognosis of posterior capsular rupture were analyzed. Results The incidence of posterior capsular rupture in the male was higher than that in the female ( < 0.05). Preoperative visual acuity less than 20/200 was one of the risk factors of posterior capsular rupture ( < 0.05). The incidence of posterior capsular rupture was significantly increased in the patients of degree IV and above nuclear cataract, the difference was statistically significant ( < 0.05). In the observation group the average visual acuity was (2.3 ± 0.8) LogMAR before treatment and (1.1 ± 0.6) LogMAR after treatment, the difference was statistically significant ( < 0.05). In the control group, the average visual acuity was (1.7 ± 0.4)LogMAR before treatment and (0.8 ± 0.5) LogMAR after treatment, the difference was statistically significant ( <0.05). Age, preoperative IOP, glaucoma history or concomitant diseases had no obvious correlation with posterior capsule rupture ( >0.05). Conclusions Gender, preoperative visual acuity and cataract grading are associated with posterior capsular rupture in contact phacoemulsification. Analysis of these factors should be emphasized in the process of clinical diagnosis and treatment to avoid the rupture of posterior capsule after surgery and promote the recovery of visual acuity.%目的：探讨超声乳化白内障吸除术中晶状体后囊膜破裂的相关风险因素及预后。方法选取2014年1月-2015月10日于河北省眼科医院行超声乳化白内障吸除术的患者2409例（2576只眼）为研究对象进行回顾性资料分析，发生后囊膜破裂的24例（26只眼）患者作为观察组，以1∶5的比例，从剩余患者中采用随机数列选取120例（135只眼）患者作为对照组，若选中的患者发生后囊膜破裂，则剔除继续选择。比较两组患者年龄、性别、术前眼压、白内障类型及分级、术前术后视力、青光眼病史、合并疾病等临床资料，分析后囊膜破裂的相关风险因素及预后。结果男性晶状体后囊膜破裂发生率明显高于女性（<0.05）；术前视力<20/200是后囊膜破裂的相关风险因素（<0.05）；白内障Ⅳ级核及以上的后囊膜破裂发生率明显增高，差异有统计学意义（<0.05）；观察组术前平均视力（2.3±0.8）LogMAR，术后平均视力（1.1±0.6）LogMAR，差异有统计学意义（<0.05），对照组术前平均视力（1.7±0.4）LogMAR，术后平均视力（0.8±0.5）LogMAR，差异有统计学意义（<0.05）；患者年龄、眼别、术前眼压、青光眼病史、合并疾病等与后囊膜破裂无明显相关性（>0.05）。结论性别、术前视力、白内障核分级均影响超声乳化白内障吸除术患者后囊膜破裂的发生，临床诊疗过程中应避免术后晶状体后囊膜破裂，以促进患者视力恢复。