目的报道对平部玻璃体切割术后病人施行白内障超声乳化术的经验.方法1994年6月至1998年6月共为26倒平部玻璃体切割术后的病人施行了白内障超声乳化术,并进行回顾性分析.所有病人的原始指征及睫状体平坦部手术的次数,白内障类型及术前视力均予记录,并分析术中及术后并发症,还对比分析了最终视力与术前潜在视力测量仪(PAM)的预测视力.结果本文26例中有18例(69.2%)曾作过1次平部玻璃体切割术,7例(26.9%)作过2次,1例(3.8%)作过3次.增殖性糖尿病视网膜病变(38.5%)及视网膜脱离(23.7%)是常见的玻璃体切割术指征;后囊下白内障是主要类型,共13例(50%).术中并发症包括小瞳孔4例(1 5.5%),后囊玻裂1例(3.8%),可见度不良2例(7.7%),后囊斑2例(7.7%)及前房过深2例(7.7%).术后早期主要并发症有1 3例(50%)出现角膜水肿并持续1周,但所有病例至术后第4周角膜透明.后囊混浊5例(19%).9例最终视力≤0.5,另8例发现患有明显的视网膜及视神经病变.其中1 3例最终最好的矫正视力等于或超过PAM预测视力,而另2例却低于PAM视力.结论白内障超声乳化吸出术对玻璃体切割术后眼的白内障是一种安全有效的方法.后囊下白内障是这类患者中最主要的类型.小瞳孔,可以抛光的后囊斑及前房过深是常见的术中并发症.角膜水肿和后囊混浊是术后最明显的并发症.先存的视网膜及视神经病变限定了最终视力.在多数病人中潜在视力测量仪(PAM)可准确地预测术后最终视力.%Purpose To report our experience of phacoemulsification in patients who had previously undergone parsplana vitrectomysurgery. Methods Medical records of 26 consecutive cases of phacoemulsification operated on between July 1994 and July 1998, who hadpreviously undergone parsplana vitrectomy, were retrospectively analysed. Patient demographics, the initial indication and number ofparsplana surgeries, type of cataract and preoperative visual acuity were noted for all patients. The intraoperative, early, and latepostoperative complications were analysed. The final visual acuity and its correlation to the preoperative potential acuity meter (PAM)visual acuity were analysed. Results Outof26, 24 were males and 2 were females, ranging in age from19 to 63 years. 18patients(69.2%) had undergone parsplana vitrectomy once, 7 (26.9%) twice and (3.8%) three times. Proliferative diabetic retinopathy (38.5%) andretinal detachment (23.7%) were the common indications for parsplana vitrectomy. Posterior subcapsular cataract was the predominanttype seen in 13 patients (50%). Intraoperative complications included small pupil in 4 (15.5%), posterior capsular break in 1 (3.8%), poorvisibility in 2 (7.7%), posterior capsular plaques in 2 (7.7%), and excessive deep anterior chamber in 2 (7.7%). The notable earlypostoperative complication was corneal edema existing at one week in 13 patients (50%) which cleared in all cases by the 4th week.Posterior capsular opacification was seen in 5 cases (19%). 9 patients had a final visual acuity of ≤ 20/100 and in 8 of these patients,significant retinal or optic nerve pathology was noted. In 13 patients, the final best corrected visual acuity was equal to or better than PAMacuity whereas in 2 cases, the best corrected visual acuity was less than the PAM acuity. Conclusions Phacoemulsification is a safe andeffective surgical procedure in post-vitrectomised eyes. Posterior subcapsular cataract is the predominant type of cataract seen in thisseries. Small pupils, posterior capsular plaques which can not be polished and excessive deep anterior chambers are commonintraoperative complications. Corneal edema and posterior capsular opacification are significant postoperative complications. Preexistingretinal or optic nerve pathology determin the final visual acuity and potential acuity meter can correctly predicts the final visual acuity inmost patients.
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