超声乳化吸除联合人工晶体植入术治疗白内障患者前房渗出发生率的影响因素分析
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摘要
目的探讨分析超声乳化白内障吸除术(PE)联合人工晶体(IOL)植入术后前房(AC)渗出发生率的相关影响因素。方法回顾性分析2015年3月～2017年10月于柳州市柳铁中心医院施行植入术的白内障患者389例(405眼)的临床资料,按手术后是否出现AC渗出分为两组,出现渗出的23例(24眼)为研究组,未出现的366例(381眼)为对照组,并统计分析出现比例,通过Logistic回归模型进行分析。结果患者有高度近视、青光眼、术前眼内压(IOP)>21 mmHg(1 mmHg=0.133 kPa)、术前视力<1、术中发生晶状体后囊膜破裂(PCR)、超声累积能量复合参数(AECP)>7.25(%×min)、术中瞳孔直径<3 mm、葡萄膜炎、晶状体核分级≥Ⅳ级9项指标的组间差异有统计学意义(P <0.05),是手术后出现AC渗出的危险因素。而其中患者青光眼、葡萄膜炎、高度近视、术中发生PCR、超声AECP>7.25(%×min)、术前IOP>21 mmHg、晶状体核分级≥Ⅳ级7项指标为独立危险因素(P <0.05)。结论术前IOP>21 mmHg、患者晶状体核分级≥Ⅳ级,患者本身患有高度近视、葡萄膜炎、青光眼,以及超声AECP>7.25(%×min)等均为PE联合IOL植入术后引发AC渗出的主要因素,临床上应该通过及早发现诊断,采取防治措施。
Objective To investigate the related influence factors of phacoemulsification(PE) combined with intraocular lens implantation(IOL) on the incidence of exudation in anterior chamber(AC). Methods The clinical data of 389 cataract patients(405 eyes) treated with PE combined with IOL implantation in Liuzhou Liutie Central Hospital from March 2015 to October 2017 were analyzed retrospectively. There were 23 cases(24 eyes) occuring exudation in AC as study group, and 366 cases(381 eyes) without exudation in AC as control group. Statistical analysis of the incidence of AC exudation after surgery were performed. Multivariate Logistic regression analysis was carried out. Results High myopia, glaucoma, preoperative intraocular pressure(IOP)>21 mmHg(1 mmHg=0.133 kPa), preoperative vision<1, posterior capsular rupture(PCR), in ultrasonic accumulated energy complex parameter(AECP)>7.25(%×min), intraoperative pupil diameter <3 mm, uveitis, lenticular nucleus classification ≥ Ⅳ levels, all the 9 indices had significant difference between the two groups(P < 0.05), and they were risk factors of exudation in AC. Among the 9 factors, 7 factors, glaucoma, uveitis, high myopia, PCR, ultrasonic in AECP>7.25(%×min), preoperative IOP>21 mmHg, lenticular nucleus classification≥Ⅳ levels were independent risk factors(P < 0.05). Conclusion The preoperative IOP>21 mmHg and pa tients' nucleus classification of lens≥Ⅳ degree, patients with high myopia, uveitis, glaucoma, and ultrasound AECP>7.25(%×min) are main risk factors for AC exudation after PE combined with IOL implantation in cataract patients.Early prevention and treatment should be taken in clinical practice.
Objective To investigate the related influence factors of phacoemulsification(PE) combined with intraocular lens implantation(IOL) on the incidence of exudation in anterior chamber(AC). Methods The clinical data of 389 cataract patients(405 eyes) treated with PE combined with IOL implantation in Liuzhou Liutie Central Hospital from March 2015 to October 2017 were analyzed retrospectively. There were 23 cases(24 eyes) occuring exudation in AC as study group, and 366 cases(381 eyes) without exudation in AC as control group. Statistical analysis of the incidence of AC exudation after surgery were performed. Multivariate Logistic regression analysis was carried out. Results High myopia, glaucoma, preoperative intraocular pressure(IOP)>21 mmHg(1 mmHg=0.133 kPa), preoperative vision<1, posterior capsular rupture(PCR), in ultrasonic accumulated energy complex parameter(AECP)>7.25(%×min), intraoperative pupil diameter <3 mm, uveitis, lenticular nucleus classification ≥ Ⅳ levels, all the 9 indices had significant difference between the two groups(P < 0.05), and they were risk factors of exudation in AC. Among the 9 factors, 7 factors, glaucoma, uveitis, high myopia, PCR, ultrasonic in AECP>7.25(%×min), preoperative IOP>21 mmHg, lenticular nucleus classification≥Ⅳ levels were independent risk factors(P < 0.05). Conclusion The preoperative IOP>21 mmHg and pa tients' nucleus classification of lens≥Ⅳ degree, patients with high myopia, uveitis, glaucoma, and ultrasound AECP>7.25(%×min) are main risk factors for AC exudation after PE combined with IOL implantation in cataract patients.Early prevention and treatment should be taken in clinical practice.
引文
[1]赵冰冰.超声乳化白内障吸除联合IOL植入术后前房渗出发生率及相关因素分析[J].国际眼科杂志,2018,19(2):282-285.
[2]王宏杰.超声乳化白内障吸除术对闭角型青光眼患者术后视力恢复及眼压变化的影响[J].现代诊断与治疗,2018,29(8):1268-1269.
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[7]冯宇宁,周衍文,史庆成,等.多焦点非球面IOL植入术对老年白内障患者视觉功能的影响[J].西南国防医药,2017,27(9):995-997.
[8]张帆,高玮,李雪梅,等.超声乳化白内障吸除及人工晶状体植入术治疗超高度近视合并白内障的研究[J].世界最新医学信息文摘,2018,5(32):57.
[9]党秀红.超声乳化白内障吸除术对青光眼合并白内障患者眼压及视力的改善效果研究[J].临床医药文献电子杂志,2018,5(31):37-40.
[10]Zheng CX,Moster MR,Gogte P,et al.Lantation of trabecularmicro-bypass stent using a novel"landing strip"technique[J].Int J Ophthalmol,2017,10(5):738-741.
[11]张艳红,曾果,刘晖,等.超声乳化白内障吸除术联合人工晶状体植入对青光眼合并白内障患者临床疗效[J].医学综述,2016,22(16):3299-3301.
[12]潘雪峰,翁铭.伴有浅前房的白内障行微切口超声乳化吸除联合IOL植入术的疗效[J].国际眼科杂志,2016,17(6):1102-1105.
[13]柯武忠.超声乳化白内障吸除术后严重并发症的临床探讨[J].中外医学研究,2016,6(31):120-121.
[14]张思毅,高炜,陈莲,等.超声乳化白内障吸除术与人工晶状体植入术联合治疗急性闭角型青光眼患者的疗效及安全性评价[J].中国医刊,2016,66(11):69-72.
[15]李玉梅,杨杰华,许惠方,等.超声乳化吸除术联合人工晶状体植入治疗年龄相关性白内障的临床效果[J].中国当代医药,2015,7(11):81-83.
[16]许钟毓,廖达思,刘佳,等.白内障囊内摘除术后Ⅱ期I-OL植入术中角膜弧形切开减少散光的作用[J].国际眼科杂志,2014,15(7):1236-1238.
[17]孙秋萍,雷英,杨云,等.维吾尔族独眼白内障患者超声乳化+IOL植入术围手术期的护理[J].西北国防医学杂志,2015,36(5):342-343.
[18]罗俊.IOL植入术与超声乳化吸除方法结合用于高度近视合并白内障治疗效果评价[J].中外医学研究,2016,6(28):21-22.
[19]韩兆玲.IOL植入术与超声乳化吸除方法结合用于高度近视合并白内障的治疗效果评价[J].中国医药指南,2017,15(4):143.
[20]谭泳昌.IOL植入术与超声乳化吸除方法结合用于高度近视合并白内障治疗效果[J].中国医药科学,2017,7(16):235-238.
[2]王宏杰.超声乳化白内障吸除术对闭角型青光眼患者术后视力恢复及眼压变化的影响[J].现代诊断与治疗,2018,29(8):1268-1269.
[3]Ogurel T,Ogurel R,Onaran Z,et al.Safety of hydroimplantation incataract surgery in patients with pseudoexfoliation syndrome[J].Int J Ophthalmol,2017,10(5):723-727.
[4]黄芹.超声乳化白内障吸除人工晶状体植入治疗闭角型青光眼患者的疗效[J].医疗装备,2017,31(2):98-99.
[5]Altintas AK,Ciritoglu MY,Beyazyildiz O,et al.Toxic AnteriorSegment Syndrome Outbreak after Cataract Surgery Triggered by Viscoelastic Substance[J].Middle East Afr JOphthalmol,2017,24(1):43-47.
[6]邓慧华.晶状体超声乳化联合人工晶状体植入术治疗高度近视白内障的临床效果[J].医学理论与实践,2017,30(2):245-246.
[7]冯宇宁,周衍文,史庆成,等.多焦点非球面IOL植入术对老年白内障患者视觉功能的影响[J].西南国防医药,2017,27(9):995-997.
[8]张帆,高玮,李雪梅,等.超声乳化白内障吸除及人工晶状体植入术治疗超高度近视合并白内障的研究[J].世界最新医学信息文摘,2018,5(32):57.
[9]党秀红.超声乳化白内障吸除术对青光眼合并白内障患者眼压及视力的改善效果研究[J].临床医药文献电子杂志,2018,5(31):37-40.
[10]Zheng CX,Moster MR,Gogte P,et al.Lantation of trabecularmicro-bypass stent using a novel"landing strip"technique[J].Int J Ophthalmol,2017,10(5):738-741.
[11]张艳红,曾果,刘晖,等.超声乳化白内障吸除术联合人工晶状体植入对青光眼合并白内障患者临床疗效[J].医学综述,2016,22(16):3299-3301.
[12]潘雪峰,翁铭.伴有浅前房的白内障行微切口超声乳化吸除联合IOL植入术的疗效[J].国际眼科杂志,2016,17(6):1102-1105.
[13]柯武忠.超声乳化白内障吸除术后严重并发症的临床探讨[J].中外医学研究,2016,6(31):120-121.
[14]张思毅,高炜,陈莲,等.超声乳化白内障吸除术与人工晶状体植入术联合治疗急性闭角型青光眼患者的疗效及安全性评价[J].中国医刊,2016,66(11):69-72.
[15]李玉梅,杨杰华,许惠方,等.超声乳化吸除术联合人工晶状体植入治疗年龄相关性白内障的临床效果[J].中国当代医药,2015,7(11):81-83.
[16]许钟毓,廖达思,刘佳,等.白内障囊内摘除术后Ⅱ期I-OL植入术中角膜弧形切开减少散光的作用[J].国际眼科杂志,2014,15(7):1236-1238.
[17]孙秋萍,雷英,杨云,等.维吾尔族独眼白内障患者超声乳化+IOL植入术围手术期的护理[J].西北国防医学杂志,2015,36(5):342-343.
[18]罗俊.IOL植入术与超声乳化吸除方法结合用于高度近视合并白内障治疗效果评价[J].中外医学研究,2016,6(28):21-22.
[19]韩兆玲.IOL植入术与超声乳化吸除方法结合用于高度近视合并白内障的治疗效果评价[J].中国医药指南,2017,15(4):143.
[20]谭泳昌.IOL植入术与超声乳化吸除方法结合用于高度近视合并白内障治疗效果[J].中国医药科学,2017,7(16):235-238.