Risk factors for endothelial cell loss after phacoemulsification surgery by a junior resident
Risk factors for endothelial cell loss after phacoemulsification surgery by a junior resident
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DOI：
10.1016/s0886-3350(03)00648-5
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发表时间：
2004-04-01
影响因子：
2.8
通讯作者：
Beatty, S
中科院分区：
文献类型：
--
作者：
O'Brien, PD;Fitzpatrick, P;Beatty, S
目的：评估一名初级住院医师行超声乳化白内障手术后内皮细胞丢失的危险因素。单位：爱尔兰都柏林眼科教学医院。方法：这项前瞻性研究包括一名初级住院医师在一位经验丰富的外科医生的指导下进行分而治之的超声乳化白内障手术的40只眼。检查9个变量以评估术后角膜内皮细胞丢失的风险。结果：平均总的内皮细胞丢失为11.6%。单因素分析显示，较长的手术时间、较长的绝对和有效超声时间、较高的平均超声功率和较高的白内障密度与内皮细胞丢失显著相关。多变量分析发现，3级核(严重致密)和较长的绝对超声乳化时间是内皮细胞丢失的独立预测因素，绝对超声乳化时间越长，预测越强。结论：分而治之的超声乳化白内障手术在眼科实习生手中是一种安全的手术方法。这项研究支持初级外科医生的建议，选择密度较低的白内障，因为这将有助于减少绝对超声乳化时间，从而将内皮细胞损失降至最低。
Purpose: To assess the risk factors for endothelial cell loss after phacoemulsification cataract surgery performed by a junior resident.Setting: Ophthalmic teaching hospital, Dublin, Ireland.Methods: This prospective study included 40 eyes having divide-and-conquer phacoemulsification cataract surgery by a junior resident under the supervision of an experienced surgeon. Nine variables were examined to assess the risk for corneal endothelial cell loss postoperatively.Results: The mean overall endothelial cell loss was 11.6%. Longer surgery time, longer absolute and effective phaco time, higher mean ultrasound power, and higher cataract density were significantly associated with endothelial cell loss on univariate analysis. Multivariate analysis identified a grade 3 nucleus (severely dense) and long absolute phaco time as independent predictors for endothelial cell loss, with longer absolute phaco time the stronger predictor.Conclusions: Divide-and-conquer phacoemulsification cataract surgery was a safe technique in the hands of an ophthalmic trainee. This study supports advice to junior surgeons to choose cases with less dense cataracts as this will help reduce the absolute phaco time and thus minimize endothelial cell loss.