白内障术后并发症:现状与对策
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摘要
近年来,由于手术方式、仪器设备和人工晶状体的改进,白内障术后并发症的发生率已明显下降。晶状体上皮细胞间质转化机制学说和人工晶状体材料及设计研究有了新的突破,为后发性白内障的防治提供了新途径。大量临床研究证实,术毕前房注射抗生素(头孢呋辛或莫西沙星)可显著降低术后眼内炎的发生率,包括术中合并晶状体后囊膜破裂的患者,未来有望在临床广泛推广。体外培养人角膜内皮细胞和促角膜内皮细胞增生药物的研发为白内障术后角膜内皮损伤的治疗带来了曙光。利用光学相干断层扫描、光学相干断层扫描血管成像能在早期准确诊断白内障术后黄斑囊样水肿,且非甾体抗炎药或抗血管内皮生长因子药物玻璃体内注射对此疗效明确。随着研究的深入,进一步认识到先天性白内障手术时机、人工晶状体植入否与术后继发性青光眼的相关性。高度近视眼患者晶状体屈光性手术的提前,增加了这类患者晚期人工晶状体-囊袋复合体脱位的发生率,并让相应治疗面临新的挑战。飞秒激光辅助的白内障手术因其精准性和安全性已在临床逐渐应用,但仍需关注其可能带来的干眼、瞳孔缩小、视网膜光损伤等并发症。另外,由于糖尿病的高发病率,对糖尿病患者的白内障手术应全面、综合、系统地治疗,以防止术后各种眼表、眼底并发症的发生。本文就上述各方面的研究现状和相应对策进行综述,以期帮助眼科医生进行临床诊疗。
In recent years,the postoperative complications of cataract surgery has been significantly reduced with the improvement of surgical methods,instruments and design of intraocular lens. The theory of lens epithelial cell mesenchymal transition mechanism and the research of intraocular lens materials have made new breakthroughs,providing a new way for the prevention and treatment of posterior capsular cataract. A large number of clinical studies have supported that the incidence of postoperative endophthalmitis can be significantly reduced by intracameral injection of antibiotics( cefuroxime or moxifloxacin),even in patients combined with capsule rupture during cataract surgery,which may be widely promoted in the clinic. Cultured human corneal endothelial cells in vitro and drugs that promote corneal endothelial proliferation will provide a new approach to the treatment of corneal endothelial injury after cataract surgery. Postoperative cystoid macular edema can be accurately diagnosed by OCT and OCTA at the early stage,and the non-steroidal anti-inflammatory drugs or anti-VEGF intravitreal injection present an effective effect. W ith the deepening of understanding,the correlation among the timing of surgery,IOL implantation and secondary glaucoma has been extensively studied and even more clarified in congenital cataract. In addition,with earlier refractive lens surgery in high myopia patients with or without cataract,the risk of late dislocation of the IOL-capsular bag complex is higher and the treatment is tricky. Femtosecond laser-assisted cataract surgery has been used in clinic due to its accuracy and safety,but the potential complications such as dry eyes,pupil narrowing and retinal light damage have to be concerned. As the incidence of diabetes increases year by year,diabetic patients with cataract should be treated comprehensively and systematically to prevent various ocular complications. The current status and corresponding countermeasures will be summarized to help the clinical diagnosis and treatment in this paper.
In recent years,the postoperative complications of cataract surgery has been significantly reduced with the improvement of surgical methods,instruments and design of intraocular lens. The theory of lens epithelial cell mesenchymal transition mechanism and the research of intraocular lens materials have made new breakthroughs,providing a new way for the prevention and treatment of posterior capsular cataract. A large number of clinical studies have supported that the incidence of postoperative endophthalmitis can be significantly reduced by intracameral injection of antibiotics( cefuroxime or moxifloxacin),even in patients combined with capsule rupture during cataract surgery,which may be widely promoted in the clinic. Cultured human corneal endothelial cells in vitro and drugs that promote corneal endothelial proliferation will provide a new approach to the treatment of corneal endothelial injury after cataract surgery. Postoperative cystoid macular edema can be accurately diagnosed by OCT and OCTA at the early stage,and the non-steroidal anti-inflammatory drugs or anti-VEGF intravitreal injection present an effective effect. W ith the deepening of understanding,the correlation among the timing of surgery,IOL implantation and secondary glaucoma has been extensively studied and even more clarified in congenital cataract. In addition,with earlier refractive lens surgery in high myopia patients with or without cataract,the risk of late dislocation of the IOL-capsular bag complex is higher and the treatment is tricky. Femtosecond laser-assisted cataract surgery has been used in clinic due to its accuracy and safety,but the potential complications such as dry eyes,pupil narrowing and retinal light damage have to be concerned. As the incidence of diabetes increases year by year,diabetic patients with cataract should be treated comprehensively and systematically to prevent various ocular complications. The current status and corresponding countermeasures will be summarized to help the clinical diagnosis and treatment in this paper.
引文
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