ABSTRACT

Introduction: The indications for pars plana vitrectomy (PPV) have increased over the years. The vitreous is no longer considered an inert ocular structure and it is well known that its removal has anatomical and physiological consequences. The vitreous is no longer considered an inert ocular structure. The vitreous plays a key role as an intraocular physiologic oxygen regulator. In order to maintain its transparency, the crystalline lens needs protection from an excessive oxygen exposure. PPV leads to progression of nuclear sclerosis in most eyes.

Methods: A systematic review of the literature was conducted using Embase and Medline databases. Articles studying the physiology, pathogenesis and surgical treatment of cataract after PPV were included in this review.

Results: The pathogenesis of cataract formation after PPV remains unclear. Predisposing factors include advanced patient age, preexisting nuclear sclerosis, light toxicity, intraoperative oxidation of lens proteins, use of silicone oil or intravitreal gas, mechanical trauma and the duration of exposure to an irrigating solution.

Conclusion: Cataract surgery in vitrectomized eyes presents with more technical difficulties, is more challenging and often has a higher risk of intraoperative and postoperative complications than in non vitrectomized eyes. There is no standardized technique or management in these cases; therefore, it requires more precautions during surgery.

摘要

简介： 平部玻璃体切除术 (PPV) 的适应症多年来有所增加。玻璃体不再被认为是一种惰性的眼部结构，众所周知，玻璃体的去除具有解剖学和生理学的后果。玻璃体不再被认为是一种惰性的眼部结构。玻璃体作为眼内生理氧调节器起着关键作用。为了保持其透明度，晶状体需要防止过度暴露于氧气中。在大多数眼睛中，PPV 会导致核硬化的进展。

方法：使用 Embase 和 Medline 数据库对文献进行系统回顾。本综述纳入了研究 PPV 后白内障的生理学、发病机制和手术治疗的文章。

结果：PPV后白内障形成的发病机制尚不清楚。诱发因素包括高龄患者、先前存在的核硬化、光毒性、术中晶状体蛋白氧化、使用硅油或玻璃体内气体、机械创伤和暴露于冲洗液的持续时间。

结论：与非玻璃体切除术相比，玻璃体切除术眼白内障手术技术难度更大，更具挑战性，术中和术后并发症的风险也更高。在这些情况下，没有标准化的技术或管理；因此，在手术过程中需要更多的预防措施。