Phacoemulsification in posterior polar cataract

ABSTRACT Purpose: To evaluate the results and complications of phacoemulsification surgery in eyes with posterior polar cataracts and compare the techniques of viscodissection and hydrodissection. Methods: The medical records of 29 consecutive patients (16 males, 13 females) with posterior polar cataracts (44 eyes) who had undergone cataract surgery were retrospectively reviewed. Patients were divided into two groups according to the technique used; viscodissection was applied to the experimental group (group 1) and hydrodissection to the control group (group 2). Results: The postoperative best corrected visual acuity (BCVA) was 0.19 ± 0.22 logMAR (mean ± standard deviation) (range 0.00-0.70) in group 1 and 0.25 ± 0.18 logMAR (range 0.00-0.70) in group 2. Although the mean postoperative BCVA in group 1 was greater than that in group 2, the difference was not statistically significant (p=0.165). The mean postoperative BCVA was significantly greater than the mean preoperative BCVA in both groups (p=0.00). Intraoperatively, posterior capsular rupture occurred during the removal of the cortex in three eyes (13%) of group 1 patients, with vitreous loss and anterior vitrectomy in one eye only. In group 2, six eyes (28.5%) presented posterior capsular rupture, and anterior vitrectomy was performed because of vitreous loss in three eyes. Although the percentage of posterior capsular rupture was greater in group 2, the difference was not statistically significant (p=0.207). Conclusions: Complications in posterior polar cataract surgeries can be overcome by being careful throughout the surgery and using proper techniques. Viscodissection may be better for avoiding posterior capsular rupture than hydrodissection.

摘要
研究目的：评估后极性白内障（posterior polar cataracts）患者行超声乳化吸除术（phacoemulsification surgery）的手术效果与并发症，并比较黏弹剂分离术（viscodissection）与水分离术（hydrodissection）的操作技术差异。
方法：回顾性分析44眼（29例连续入组患者，其中男性16例、女性13例）后极性白内障患者的临床病历资料，所有患者均接受白内障手术。根据术中采用的手术技术将患者分为两组：实验组（组1）采用黏弹剂分离术（viscodissection），对照组（组2）采用水分离术（hydrodissection）。
结果：实验组术后最佳矫正视力（best corrected visual acuity, BCVA）为0.19±0.22 logMAR（均值±标准差，范围0.00~0.70），对照组为0.25±0.18 logMAR（范围0.00~0.70）。尽管实验组术后平均最佳矫正视力优于对照组，但组间差异无统计学意义（p=0.165）。两组患者术后平均最佳矫正视力均显著高于术前基线水平（p=0.00）。术中并发症情况：实验组3眼（13%）在皮质抽吸过程中发生后囊膜破裂，其中仅1眼伴玻璃体脱出，并行前段玻璃体切除术；对照组6眼（28.5%）发生后囊膜破裂，其中3眼因玻璃体脱出而行前段玻璃体切除术。尽管对照组后囊膜破裂发生率更高，但组间差异无统计学意义（p=0.207）。
结论：后极性白内障手术的相关并发症可通过术中精细化操作与合理选用手术技术加以有效防控。相较于水分离术（hydrodissection），黏弹剂分离术（viscodissection）或可更有效地降低后囊膜破裂的发生风险。