ABSTRACT

Purpose

To determine incidence, risk factors for, and outcomes of dropped nucleus (DN) during cataract surgery.

Methods

This is a matched case–control study at the Aravind Eye Hospital in Madurai, India. Out of 184 consecutive DN cases, 171 were included. The case immediately preceding the DN case by the same surgeon served as matched concurrent control. The proportion of cataract surgeries with DN was calculated with a 95% confidence interval (CI). Conditional logistic regression was used to generate odds ratios for potential risk factors.

Results

Among 415,487 consecutive cataract surgeries, incidence risk of DN was 0.044% [95% CI 0.038%, 0.051%], or 0.44 per 1,000 surgeries in 52 months. Significant preoperative risk factors were posterior polar cataract (adjusted odds ratio [aOR] 21.73, p = .003); suspected loose zonules (aOR 8.85, p < .001); older age (aOR 1.57, p = .001); and presence of diabetes mellitus (aOR 1.79, p = .03). Associated intraoperative complications included zonular dialysis (OR 34.49, p < .001), vitreous disturbance (OR 193.36, p < .001), and posterior capsule rent (OR 384.39, p < .001). Phacoemulsification and manual small incision cataract surgery did not significantly differ in DN incidence. DN most commonly occurred during nucleus removal (35.1%) or during/immediately following hydrodissection (24.0%). Visual outcomes of DN were worse than controls on average, but 51.9% achieved visual acuity 20/40 or better at 1 month.

Conclusions

DN occurred rarely, with low absolute risk even when a strong risk factor was present. Nearly all cases followed posterior capsular rent or zonular dialysis, usually with observed vitreous loss. In spite of increased risk of postoperative complications in the DN group, the majority achieved favorable results.

中文翻译：

---

印度南部白内障手术期间的核脱落：发病率、风险因素和结果

摘要

目的

确定白内障手术期间脱核 (DN) 的发生率、危险因素和结果。

方法

这是在印度马杜赖的 Aravind 眼科医院进行的匹配病例对照研究。在 184 例连续 DN 病例中，包括 171 例。同一外科医生在 DN 病例之前的病例作为匹配的并发对照。以 95% 置信区间 (CI) 计算伴有 DN 的白内障手术比例。条件逻辑回归用于生成潜在风险因素的优势比。

结果

在 415,487 例连续白内障手术中，DN 的发病风险为 0.044% [95% CI 0.038%, 0.051%]，即 52 个月内每 1,000 例手术 0.44 例。显着的术前危险因素是后极白内障（调整优势比 [aOR] 21.73，p = .003）；疑似松散小带 (aOR 8.85, p < .001)；年龄较大（aOR 1.57，p = .001）；和糖尿病的存在（aOR 1.79，p = .03）。相关的术中并发症包括小带透析 (OR 34.49, p < .001)、玻璃体障碍 (OR 193.36, p < .001) 和后囊裂 (OR 384.39, p< .001)。超声乳化和手动小切口白内障手术在 DN 发生率方面没有显着差异。DN 最常发生在去核期间 (35.1%) 或水切割期间/之后 (24.0%)。DN 的视觉结果平均比对照组差，但 51.9% 的患者在 1 个月时视力达到 20/40 或更好。

结论

DN 很少发生，即使存在强风险因素，绝对风险也很低。几乎所有病例都发生后囊膜撕裂或小带透析，通常观察到玻璃体丢失。尽管 DN 组术后并发症的风险增加，但大多数都取得了良好的效果。