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目的:探讨白内障超声乳化术后前房膜形成的危险因素。方法:对1356例行白内障超声乳化+单片式PMMA人工晶体植入术患者进行前瞻性研究。假性囊膜剥脱综合症,核硬度,瞳孔大小,超声时间,实际超声时间,系统性疾病,术中并发症(囊膜撕裂,悬韧带断裂,后囊破裂伴玻璃体丢失),IOL植入位置和术后并发症(眼内压变化,粘连形成)作为膜形成的危险因素分析。结果:观察到111例患者(8.1%)术后出现伴有膜形成的纤维素性前葡萄膜炎。膜形成平均时间是术后第2d(术后第1～7d),膜存在持续时间平均为5.2d(1～48d)。在膜形成病例中,+4级核病例占45%,而在无膜形成病例中仅为13.5%,差异具有显著统计学意义(P<0.05)。在膜形成组,平均超声时间为2.4min,平均实际超声时间为32.8s,而无膜形成组分别为1.8min和22.1s。这两项参数在膜形成组均明显较长(P<0.05)。在膜形成组中,出现后囊破裂伴玻璃体丢失和IOL睫状沟植入者占33%,而无膜形成组为11%(P<0.05)。其他危险因素在膜形成组和无膜形成组中的比较无统计学意义。在术后第1d和第7d,平均最佳矫正视力(Snellen视力表)在膜形成组分别为0.2和0.4,无膜形成组为0.4和0.6(P<0.05)。但术后3mo,平均最佳矫正视力在膜形成组和无膜形成组中结果相似(分别为0.8和0.9)。结论:晶状体核硬度较高,较长超声时间和实际超声时间,术中后囊破裂是术后前房纤维膜形成的明显相关性危险因素。
Objective: To explore the risk factors of anterior chamber membrane formation after phacoemulsification. Methods: A prospective study of 1356 patients with cataract phacoemulsification and monolithic PMMA intraocular lens implantation was performed. Pseudomembranous exfoliation syndrome, nuclear hardness, pupil size, sonication time, actual sonication time, systemic disease, intraoperative complications (capsular tears, suspensory ligament rupture, posterior capsular rupture with vitreous loss), IOL implantation Location and postoperative complications (changes in intraocular pressure, adhesion formation) were analyzed as risk factors for membrane formation. RESULTS: Cellullar anterior uveitis associated with membrane formation was observed in 111 patients (8.1%). The average time of membrane formation was 2 days after operation (1st ~ 7 days after operation), and the average duration of membrane formation was 5.2 days (1 ~ 48 days). In the case of membrane formation, grade +4 nuclear cases accounted for 45%, while in the case of no membrane formation was only 13.5%, the difference was statistically significant (P <0.05). In the membrane-forming group, the average sonication time was 2.4 min, the average actual sonication time was 32.8 s, and the no-membrane-forming group was 1.8 min and 22.1 s, respectively. Both parameters were significantly longer in the membrane-forming group (P <0.05). Posterior capsular rupture with a loss of posterior vitreous and IOL ciliary sulcus implantation occurred in 33% of the patients in the membrane-forming group compared to 11% in the non-membrane-forming group (P <0.05). Other risk factors in the film-forming group and no film-forming group was not statistically significant. The mean best corrected visual acuity (Snellen) was 0.2 and 0.4 in the group of membrane formation and 0.4 and 0.6 (p <0.05) in the group without membrane formation at the 1st and 7th day after operation. However, at 3 months postoperatively, the mean best corrected visual acuity was similar in the film-forming and non-film-forming groups (0.8 and 0.9, respectively). CONCLUSION: High hardness, longer ultrasound time and actual ultrasound time and posterior capsular rupture are the significant risk factors for postoperative anterior chamber fibrous membrane formation.