摘要
目的评价严重全身病患者的白内障围手术期处理的效果。方法对新疆巴州地区严重全身疾病40例（55眼）行白内障手术的临床资料进行回顾分析。术前处理方法：冠状动脉支架植入术后及脑梗死患者术前7d停用抗凝药物，术后3d观察无眼部出血后恢复原治疗。肾透析患者术前1d～术后7d肾透析时行无肝素透析，观察无眼部出血后恢复肝素透析。特发性血小板减少性紫癜患者术前经输血后血小板达到50×10^9／L以上，白血病患者经系统治疗处于稳定期可进行。接受晶状体超声乳化吸出术38例（52眼），白内障囊外摘出术2例（3眼）。所有术眼均囊袋内植入后房型人工晶状体。术后随访2～4个月。结果术后3d并发症包括角膜水肿6眼、前房渗出3眼和一过性高眼压I眼。术后1周并发症包括前房大量渗出2眼和病毒性角膜炎1眼。术后随访全身疾病无明显进展，术后视力均有明显提高。结论对于严重全身病患者的白内障术前积极控制全身病，可使手术顺利进行，手术安全有效。
Objective To evaluate the efficacy of perioperative management in cataract patients with severe systemic diseases. Methods Data of 55 eyes of 40 cataract patients with severe systemic diseases in Bazhou Area of Xinjiang were collected and retrospectively analyzed. They underwent cataract surgery. The preoperative managements included discontinuing anticoagulant drugs 7 days preoperatively in patients with coronary artery stent implantation and postoperatively, the anticoagulant drugs were restarted cerebral infarction. If there was no bleeding 3 days No Heparin used during renal dialysis in patients with renal insufficiency from 1 day before surgery to 7 days after surgery. If there was no bleeding 7 days postoperatively, the Heparin dialysis was restarted. Patients with idiopathic thrombocytopenic purpura accepted blood transfusion preoperatively, which made platelets reaching more than 50 × 10^9/L. Patients with leukemia in plateau were kept in a stable phase after systemic treatment preoperatively. The surgical options included phacoemulsifieation in 52 eyes of 38 patients and extracapsular cataract extraction in 3 eyes of 2 patients. Posterior chamber intraocular lens were implanted in capsular bag of all patients. The follow-up time was 2 - 4 months. Results Three days postoperatively, cornea edema occurred in 6 eyes, anterior chamber exudates in 3 eyes, and temporary elevation of intraocular pressure in 1 eye respectively. One week postoperatively, severe anterior chamber exudates in 2 eyes, viral keratitis in 1 eye. No obvious progression of systemic disease observed during fbllow-up period. The visual accuity was improved after surgery. Conclusion Systemic diseases are positive controlled, they can undergo cataract surgery successfully and gain better prognosis.
出处
《中华眼外伤职业眼病杂志》
2017年第11期837-839,共3页
Chinese Journal of Ocular Trauma and Occupational Eye Disease
关键词
白内障
围手术期
全身病
严重
Cataract
Perioperative period
Systemic diseases, severe
