联合晶状体-玻璃体切除术的考虑随环境而变化

Combinedphaco-vitrectomy considerations vary with circumstance

January 19, 2017

KOLOA, Hawaii — Overall, the majority ofpatients with cataract who undergo vitrectomy have progression of theircataract postoperatively, so it is reasonable for patients with significantcataract to undergo both procedures at the same time, Rajendra S. Apte, MD,PhD, said at Retina 2017.

“It would definitely be more convenient forthe patient,” Apte said.

There are manythings to think about in patients who need vitrectomy and cataract surgery andwhether to perform the operations singly or simultaneously.

In favor of the dual procedure is thepotential for a more complete peripheral vitrectomy in a phakic eye, he said.

Another factor to consider that would favorthe dual procedure is the need to avoid multiple surgeries in patients withcomorbidities, such as diabetes, who are “medically relatively unstable,” hesaid.

From the cataract surgeon’s perspective,“Most cataract surgeons don’t like operating in post-vitrectomy eyes,” Aptesaid. They have concerns about weak zonules, unstable posterior capsules andpotential defects in the posterior capsule.

Reasons to consider that could sway againstthe decision, particularly for anterior segment surgeons, is that the cataractmay be borderline rather than significant, vitreous hemorrhage could cause apoor red reflex, making cataract surgery more difficult, and presence of aretinal detachment and hypotony could make management of the bag moredifficult, he said.

“Most cataract surgery now is sutureless,”Apte said. “If you’re doing the combined procedure, then you may need totemporarily suture the corneal wound.” – by Patricia Nale, ELS

翻译：

2015级临床16班

魏媛春

指导教师：

大连何氏眼科医院 单良 教授

联合晶状体-玻璃体切除术的考虑随环境而变化

洛亚，夏威夷--总的来说，大多数接受白内障手术的患者都有白内障术后的进展，所以对白内障患者来说，同时进行白内障及玻璃体切除手术是合理的，Rajendra S.Apte，医学博士，博士，在2017年的视网膜上说。

Apte说：“对病人来说，这绝对是更方便的。”

在需要进行玻璃体切除术和白内障手术的患者中，需要考虑很多事情，以及是否单独或同时进行手术。

他说，同期联合手术比晶体单纯玻切手术更能完整切除周边玻璃体。

另一个需要考虑双重手术的因素是，需要避免在患有合并症的患者中进行多次手术，比如糖尿病，这些患者“在医学上相对不稳定”。（注释：糖尿病的患者因为手术前需要全身状态调整到一定程度才可以做手术，比如血糖需要控制到一定程度才可以手术，但是患者血糖经常控制不稳定，不能手术。就会产生这种医学上相当不稳定的情况）

Apte说，从白内障手术医生的角度来看，“大多数白内障手术医生不喜欢给玻切术后的患者做白内障手术”（注释：没有玻璃体的支撑白内障手术中出现并发症几率大大增加，因此医生不喜欢），担忧玻切术后的白内障患者的悬韧带脆弱，后囊膜不稳定，出现潜在后囊膜破裂的风险。

周边部白内障而不是典型的白内障，玻璃体出血可能导致较差的眼底红光反射，使白内障手术更困难，出现视网膜脱落和低眼压会使囊袋的处理更难，特别是前段的外科医生考虑到这一点可能会影响到联合手术的决定，他说。

“大多数白内障手术现在是无缝线的”Apte说。“如果你正在做联合手术，那么你可能需要暂时缝合角膜伤口。”–Patricia Nale，埃尔斯。

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