白内障手术并发角膜后弹力层脱离行前房注气术治疗效果的回顾性分析

A Retrospective Analysis of the Efficacy of Anterior Chamber Air Injection for Post-Cataract Surgery Descemet’s Membrane Detachment

摘要: 目的：探讨白内障超声乳化术后角膜后弹力层脱离(Descemet’s membrane detachment, DMD)患者接受前房注气术的解剖复位和视功能恢复情况。方法：本研究回顾性分析了2014年10月至2019年10月期间在汕头国际眼科中心诊断白内障术后角膜后弹力层脱离并接受了前房注气术治疗患者的临床资料。主要观察指标为角膜后弹力层是否重新附着以及术后最佳矫正视力。结果：患者平均年龄为70.16 ± 9.99岁，男女比例为9:16。在首次前房注气术后，25例患者中有18例(72%)角膜后弹力层成功复位。常见并发症包括持续性DMD (24%)、气体相关性瞳孔阻滞(8%)、接触式房角关闭(4%)、角膜内皮失代偿(4%)和葡萄膜炎(4%)。复位成功率与患者年龄、性别和干预时间无显著相关性。6例患者因持续性DMD接受了二次的前房注气术，6名(100%)均成功重新附着。在解剖上成功复位的患者，72%在术后一个月的最佳矫正视力优于0.5。结论：前房注气术是治疗角膜后弹力层脱离的一种安全有效方法，即便面对脱离时间长的病例。

Abstract: Purpose: To evaluate the anatomical reattachment and visual recovery outcomes of Descemet’s membrane detachment (DMD) after phacoemulsification cataract surgery treated with anterior chamber air injection. Methods: This retrospective study analyzed the clinical data of patients diagnosed with post-cataract surgery DMD who underwent anterior chamber air injection at Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong from October 2014 to October 2019. The primary outcomes included the rate of anatomical reattachment of Descemet’s membrane and the postoperative best-corrected visual acuity (BCVA). Results: The mean age of patients was 70.16 ± 9.99 years, with a male-to-female ratio of 9:16. After the first anterior chamber air injection, 18 of 25 patients (72%) achieved successful Descemet’s membrane reattachment. Common complications included persistent DMD (24%), gas-induced pupillary block (8%), acute angle-closure glaucoma (4%), corneal endothelial decompensation (4%), and uveitis (4%). The success rate of reattachment was not significantly correlated with age, gender, or timing of intervention. Six patients underwent a second anterior chamber air injection for persistent DMD and all of them (100%) achieved successful reattachment. Among patients with successful anatomical reattachment, 72% achieved BCVA better than 0.5 one month postoperatively. Conclusion: Anterior chamber air injection is a safe and effective treatment for DMD, even in cases with prolonged detachment.