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近代的なファコ乳化術後の術後眼瞼下垂症
Postoperative Blepharoptosis After Modern Phacoemulsification Procedure.
PMID: 31926884 DOI: 10.1016/j.ajo.2019.12.023.
抄録
目的:
透明角膜無縫合乳化術後の術後眼瞼下垂の一過性(1ヶ月)と持続性(6ヶ月以上)の頻度を調査し、それらに影響を与える要因を分析すること。
PURPOSE: To investigate the frequency of transient (1 month) and persistent (at least 6 months) postoperative ptosis following clear corneal sutureless phacoemulsification and to analyze the factors affecting them.
デザイン:
コホート研究。
DESIGN: Cohort study.
方法:
2016年10月から2018年6月までに三次医療センターでファコ乳化白内障手術を受けた患者を登録した。余白反射距離1(MRD1)、MRD2、レベーター機能を測定し、手術前、1ヶ月後、少なくとも6ヶ月後に顔面写真を撮影した。臨床的眼瞼下垂は術後にMRD1が低下したものと定義し、臨床的に有意な眼瞼下垂はMRD1が2mm以上低下したものと定義した。写真ベースの眼瞼下垂は、研究終了時にマスクをした眼輪顔面形成外科医によって評価されました。
METHODS: Patients who underwent phacoemulsification cataract surgery from October 2016 to June 2018 in a tertiary center were enrolled. Margin reflex distance 1 (MRD1), MRD2, and levator function were measured and facial photography was taken before, 1 month, and at least 6 months after the surgery. Clinical ptosis was defined as any postoperative drop of MRD1 and clinically significant ptosis as MRD1 drop of ≥2 mm. Photo-based ptosis was assessed by a masked oculofacial plastic surgeon at the end of the study.
結果:
総症例数は 234 例(313 例のまぶた)であった。手術の大部分は上級研修医(65.5%、205/313)、局所麻酔下(78.0%、244/313)であった。持続性の臨床的、臨床的に有意な眼瞼下垂は25.4%(71/279)、3.2%(9/279)、3.3%(9/276)であった。術後眼瞼下垂が持続したまぶたでは、術前の浮腫機能が有意(P=0.03)に低かった(13.9 vs 15.8mm)。術後眼瞼下垂のあるまぶたとないまぶたでは、他の因子に有意な差は認められなかった。
RESULTS: A total of 234 patients (313 eyelids) were included. The majority of surgeries were performed by senior residents (65.5%, 205/313) and under topical anesthesia (78.0%, 244/313). Persistent clinical, clinically significant, and photo-based ptosis were 25.4% (71/279), 3.2% (9/279), and 3.3% (9/276). Eyelids with persistent postoperative ptosis showed a significantly (P = .03) lower preoperative levator function (13.9 vs 15.8 mm). No other factor was significantly different between the eyelids with and without postoperative ptosis.
結論:
透明角膜無縫合ファコ乳化白内障手術を受けた患者の3%以上に持続的な臨床的に有意な眼瞼下垂が認められた。術前にカウンセリングを行う必要がある。術前のレベーター機能の低下は、術後眼瞼下垂の頻度の高さと有意に関連していた。手術期間、外科医のレベル、その他の変数は術後眼瞼下垂の頻度に有意な影響を与えなかった。
CONCLUSION: Persistent clinically significant ptosis was observed in more than 3% of patients undergoing clear corneal sutureless phacoemulsification cataract surgery. It should be counseled preoperatively. Lower preoperative levator function was significantly associated with a higher frequency of postoperative ptosis. Duration of surgery, level of surgeons, and other variables did not have any significant effect on the frequency of postoperative ptosis.
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