白内障超声乳化术中虹膜松弛综合征发生的新危险因素和预测指标

摘要

目的:观察中国患者虹膜松弛综合征(IFIS)在白内障超声乳化术中的发生率,并探究IFIS的新危险因素及其可能的预测指标.方法:前瞻性、观察性研究.我们收集了1a内进行白内障手术的患者.记录他们的服药史、散瞳前后的瞳孔直径、IFIS发生的情况.结果:有中国汉族的白内障手术患者807例1 068眼,共计1 068例手术纳入研究,其中34眼发生了IFIS.进行回归分析发现,以下危险因素与IFIS的发生有关:非那西丁(6.4％,OR=5.885),坦洛新(25％,OR=21.578),利血平(16.7％,OR=12.947),氯氮平(66.7％,OR=139.467)及全视网膜光凝术后(14.3％,OR=10.789).散瞳后瞳孔直径小,尤其是小于7.25mm的患者更易于发生IFIS(P＜0.001).结论:中国人群中IFIS的发生率是3.18％.我们发现了3个新的IFIS危险因素:利血平、氯氮平用药史和视网膜光凝术后.术前散瞳困难可能预示着IFIS的发生几率增大.%AIM:To determine the incidence of intraoperative floppy iris syndrome (IFIS) in patients undergoing phacoemulsification in a Chinese hospital,and to assess new risk factors and predictive factors for IFIS.METHODS:A prospective,observational case series.In the consecutive cataract surgeries performed in one year,the medicine administration,pupil size (PS)before and after mydriasis,and signs of IFIS were recorded.RESULTS:Totally 807 patients (1068 eyes) underwent cataract surgeries.Among the 1068 eyes,signs of IFIS were noted in 34 eyes.Strong positive correlations were showed between finasteride (6.4％,OR =5.885),tamsulosin (25％,OR=21.578),reserpine (16.7％,OR=12.947),clozapine (66.7％,OR=139.467),post-panretinal photocoagulation (14.3％,OR =10.789) and IFIS.Pupil size was inversely related to IFIS incidence (P＜0.001).A dilated pupil smaller than 7.25mm could predict iFiS (P＜0.001).CONCLUSION:The incidence rate of IFIS was 3.18％.Reserpine,clozapine and post-panretinal photocoagulation emerged as new risk factors for IFIS.A small dilated pupil may imply IFIS occurrence.