Immediate Sequential Bilateral Surgery in Refractive Lens Exchange Patients: Clinical Outcomes and Adverse Events

Ophthalmology Volume 130, Number 9, September 2023

屈光性晶體交換患者的即時連續雙側手術

中文摘要

該研究旨在評估在2018年3月至2021年12月間進行了即時連續雙側屈光性晶體交換（immediate sequential bilateral refractive lens exchange, RLE）手術的患者的臨床結果和不良事件（adverse events, AE）的發生率。該研究重點關注那些沒有明顯視力影響的白內障或者輕度白內障的患者，主要是為了屈光目的或老花矯正而接受手術。手術過程中最常見的事件是後囊破裂，發生在0.107％的眼睛中。未觀察到眼內炎、aqueous misdirection或脈絡膜出血的病例。

該研究得出結論，選擇性同日雙側RLE手術在嚴重不良事件的發生率低且屈光結果良好，因此對於年輕、活躍且術前視力良好的患者來說，這是一個合理的選擇。該研究具有重要意義，因為它是首批在私人患者設置 (private patient setting)中評估同日雙側RLE的安全性和有效性。該研究建議，在沒有顯著白內障的情況下，即時連續雙側手術是一個可行的選擇，特別是考慮到年輕患者且併發症發生率較低。

English Abstract

The study aimed to evaluate the clinical outcomes and incidence of adverse events (AEs) in patients who underwent immediate sequential bilateral refractive lens exchange (RLE) surgery between March 2018 and December 2021. The study focused on patients without visually significant cataracts or those with mild cataracts, primarily undergoing surgery for refractive reasons or presbyopia correction. A total of 17330 patients (34660 eyes) wereincludedintheanalysis.Ofthese,28827eyesreceived amul tifocal intraocular lens(IOL), and 5833 eyes had a monofocal IOL. The percentage of eyes within 0.50 diopters (D) of intended refraction was 85.5% and 86.2% for monofocal and multifocal IOL eyes,respectively. There was a total of 55 intraoperative AEs recorded in 55 eyes of 54 patients (per-eyeincidence:0.159%).The most common intraoperative event was a posterior capsule tear, occurring in 0.107% of the eyes. No cases of endophthalmitis, aqueous misdirection, or choroidal hemorrhage were observed. The most common secondary intervention was the rotation of a misaligned toricIOL (24 eyes;0.069%).

The study concluded that elective same-day bilateral RLE had a low incidence of serious AEs and high refractive outcomes, making it a reasonable option for younger, more active patients with good preoperative vision. The study is significant as it is one of the first to assess the safety and efficacy of same-day bilateral RLE in a private patient setting. It suggests that immediate sequential bilateral surgery is a viable option for patients without significant cataracts, especially given the lower complication rates in younger patients with fewer comorbidities.