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目的分析硬核白内障在接受复明手术人群中的分布特点、术中主要并发症的发生率和视力预后。设计回顾性病例系列。研究对象上海爱尔眼科医院完成的市级白内障防盲复明项目中接受白内障手术的1061例白内障患者中,四级以上硬核白内障267例(267眼),其余794例非硬核白内障患者作为对照。方法对研究对象的术前眼部特点、术中、术后并发症发生率和术后视力进行回顾性分析,计算其脱盲率和脱残率,并与本复明项目的非硬核白内障者进行比较,脱盲的标准为矫正视力>0.05;脱残的标准为矫正视力>0.3。主要指标临床特征、并发症、术后视力。结果 267例硬核白内障患者中,术前矫正视力低于眼前指数者124例(46.3%),≤0.1者89例(33.3%),0.1以上者54例(20.4%)。白内障伴晶状体不全脱位2例,既往青光眼滤过手术史6例(1.2%)。接受超声乳化手术254例(95.1%),13例综合考虑术前检查结果、术中具体情况改行白内障囊外摘除术。主要手术并发症:后囊膜破裂14例(5.24%),发生率明显高于同批非硬核白内障患者(13/794例,1.64%)(χ2=10.33,P<0.01);术后1天角膜水肿35例(13.1%),显著高于同批非硬核白内障患者(19/794例,2.4%)(χ2=46.98,P<0.01)。术后1个月矫正视力>0.05者261例,脱盲率97.4%;矫正视力>0.3者234例,脱残率87.6%。其中72例(27.0%)矫正视力高于0.6,视力状态与术前相比存在显著差异(χ2=367.51,P<0.01)。结论本防盲复明项目中,硬核白内障的手术比例高,手术难度高于常规白内障手术。对术眼复杂状态的充分预测和估计、术中及时转换术式能提高大批量复明手术中硬核白内障的手术成功率,改善患者的生活质量。
Objective To analyze the distribution characteristics of hard nuclear cataract in patients receiving Fuming surgery, the incidence of major complications and the prognosis of vision. Design retrospective case series. Among 1066 cataract patients who underwent cataract surgery, 267 eyes (267 eyes) with above-grade-4 hard nuclear cataracts and the remaining 794 patients with non-cataractous cataract served as controls . Methods The characteristics of preoperative eye, intraoperative and postoperative complication rates and postoperative visual acuity were retrospectively analyzed, and the rate of blindness and disability were calculated and compared with those of non-hard nucleus cataracts The standard of blindness was corrected visual acuity> 0.05; the standard of disability was corrected visual acuity> 0.3. The main indicators of clinical features, complications, postoperative visual acuity. Results Among 267 cases with hard cataract, 124 cases (46.3%) had preoperative corrected visual acuity less than the anterior index, 89 (33.3%) ≤ 0.1, and 54 (20.4%) with 0.1 or more. Cataracts with dislocation of the lens in 2 cases, past glaucoma filtration surgery in 6 cases (1.2%). 254 patients (95.1%) underwent phacoemulsification surgery. Thirteen patients underwent preoperative cataract examination and extracapsular cataract extraction under the specific conditions during operation. The main complications were: posterior capsular rupture in 14 cases (5.24%), the incidence was significantly higher than that in the same group of non-hard nuclear cataract (13/794 cases, 1.64%) (χ2 = 10.33, P <0.01) Incidence of corneal edema in 35 cases (13.1%) was significantly higher than that in non-hard nucleus cataract patients (19/794 cases, 2.4%) (χ2 = 46.98, P <0.01). One month after operation, corrected visual acuity was> 0.05 in 261 cases, the blindness rate was 97.4%; corrected visual acuity was> 0.3 in 234 cases, the disability rate was 87.6%. The corrected visual acuity was higher than 0.6 in 72 cases (27.0%), and the visual acuity was significantly different from preoperative (χ2 = 367.51, P <0.01). Conclusion In this anti-blind blind project, the proportion of hard-core cataract surgery is high, and the operation difficulty is higher than that of conventional cataract surgery. Full prediction and estimation of the complex state of the eye surgery, intraoperative and timely conversion surgery can improve the high-volume surgery complicated with cataract surgery success rate and improve the quality of life of patients.