关于马来西亚医院白内障手术并发症的研究:相关因素、类型及预后

The temerloh hospital cataract complications study: factors associated with, types and outcomes of cataract surgery complications

摘要:

目的：研究白内障手术并发症的发生率及其相关影响因素，包括手术经验、手术类型、麻醉方式和术后视力。

方法：回顾性分析在马来西亚地区医院行白内障手术逾2a的患者。查看病人基本信息、手术类型、麻醉方式和医生手术经验，记录术中和术后的并发症以及术后最佳矫正视力。

结果：在1 007名行白内障手术的患者中，并发症发生率为11.1%，其中以后囊破裂最为常见(3.6%)。术中医生的手术经验及麻醉方式对并发症的发生不存在影响。白内障囊内摘除术(ICCE)、白内障超声乳化吸除术失败后转为白内障囊外摘除术(ECCE)，均是与白内障并发症发生密切相关的两种手术方式(P<0.001)，并且发生并发症的患者术后视力均不理想(P<0.001)。

结论：术中并发症的发生可显著影响术后视力，并与手术方式密切相关，但与医生手术经验和麻醉方式无关。建议今后行白内障囊内摘除术、白内障超声乳化吸除术失败后转为白内障囊外摘除术时，需格外注意并发症的发生，以期减少术后不良视力发生的可能性。

Abstract:

AIM: To study the prevalence of complications of cataract surgery and any association between the occurrence of complications and experience of surgeon, type of surgery, type of anaesthesia and visual outcome.

METHODS: This was a retrospective study of patients who underwent cataract surgery over a period of two years in a district hospital in Malaysia. The demographic details of patients, type of surgery done, as well as type of anaesthesia used and experience of the surgeon were noted. The types of intraoperative and postoperative complications were recorded. The final best corrected visual outcome was recorded.

RESULTS: Complications occurred in 11.1% of the total 1007 patients operated. Posterior capsule rupture(3.6%)was the most common complication. The experience of the surgeon and the type of anaesthesia used did not affect complications during surgery. Intracapsular cataract extraction(ICCE)and phacoemulsification converted to extracapsular cataract extraction(ECCE)were significantly associated with more complications(P<0.001). The visual outcome was significantly poor in patients with complications(P<0.001).

CONCLUSION: The occurrence of complications during cataract surgery significantly affected the visual outcome. The type of surgery done was associated by the occurrence of complications. However, the experience of the surgeon and the type of anaesthesia used did not affect the occurrence of complications. We recommend that particular attention be given to ICCE and phacoemulsification converted to ECCE to minimise the complications and thereby reducing the chances of poor vision postoperatively.