Application Of Circular Pupillary Resection In Uveitis Complicated Cataract Surgery

ObjectiveTo observe the clinical effect of the annular cutting of pupillary margin in the phacoemulsification of uveitis complicated cataract,and to provide objective data for clinical work and research.Methodselected 50 cases(60 eyes)of uveitis complicated cataract from the ophthalmology departrment of the first affiliated hospital of Zhengzhou university from February 2016 to October 2017,use the annular cutting of pupillary margin in the phacoemulsification.The disease is due to various types of uveitis(including 12 eyes of Behcet’s disease,20 eyes of VKH’s disease,28 eyees of idiopathic uveitis),and the primary disease is stable for more than 3 months.There were 22 males and 28 females,aged 23～62 years,with an average age of 42.8±9.5 years.The most of the iris is adhesions,and the pupil diameter is less than 4mm.The hardness of the lens nucleus was grade Ⅱ to Ⅳ.Without systemic disease affected the operation.All patients received detailed ophthalmological examinations before the operation,including visual acuity,slit lamp microscopy examination,fundus examination,intraocular pressure,corneal endothelial cell count,intraocular lens measurement,and ocular B-ultrasound.All the patients used glucocorticoid or immunosuppressant to control the inflammation for more than 3 months before operation.Using the Stellaris phacoemulsification equipment of the US company,the improved clipper scissors were used to cut off the pupillary margins.The operation was performed by the same surgeon.Follow up was performed first day and first week,1 month and 3 months after operation.The examination included visual acuity,pupil form and activity,corneal endothelial cell count,corneal edema,anterior chamber reaction,intraocular pressure,and the occurrence of complications.Statistical analysis:SPSS 17.0 software package was used for statistical analysis.Count data between groups were compared by chi square test.The measurement data using mean standard deviation(x±s)to express,the two groups were compared using the two sample mean comparison of t test.The α=0.05 level to determine whether there was significant difference between.ResultThe best corrected visual acuity was improved at 1 day,lweek,1month and 3 months after operation.The difference was statistically significant(P<0.05).There was no significant difference between the intraocular pressure and the corneal endothelial cell density at 1 day,1 week,1 month and 3 months after the operation(P>0.05).Intraoperative pupil diameter can be extended to 6-8mm;postoerative pupil diameter is between 3-4mm;After medication,the pupil can be enlarged to 5-7mm,and pupillary light reflection part exists.No complications such as iris injury and massive anterior chamber bleeding occurred during the operation.No inflammation of anterior chamber was found after operation,and no posterior capsular rupture occurred.The IOL is maintain its normal position,the pupil was enlarged and the pupil was round or near circle,and the pupil light reflex was restored to a certain extent after the operation.ConclusionsIn the phacoemulsification of uveitis complicated cataract,the corneal endothelial injury is small,the posterior edge of the iris is smooth and the pupil is close to the circle after the operation,and the reflex function of the pupil is preserved;and the postoperative inflammation is light,the incidence of once again pupillary adhesion is low,and the pupil can be expanded after the operation for the observation of the fundus.At the same time with using corticosteroids,annular pupil margin cutting is a safe and effective method to expand the pupil during the operation of uveitis complicated cataract surgery,which can improve the success rate of the operation.