Faktor Anästhesie in der Kataraktchirurgie — Eine prospektive Studie über 3193 extrakapsuläre Kataraktextraktionen

Zusammenfassung

Bei einer prospektiven Untersuchung von geplanten extrakapsulären Kataraktextraktionen mit Implantation einer Hinterkammerlinse (ECCE/HKL) wurden 3193 standardisierte Operationsberichte ausgewertet. Unter Einbeziehung der Faktoren Operateur, Alter, okuläre Diagnose [Cat.matura, Cat.complicata, Cat.traumatica, Subluxatio lentis, PEX, Nanophthalmus (AL <22 mm), Myopia magna (AL >27 mm)], Anästhesie (ITN, RBA) chirurgisches Vorgehen (korneosklerale bzw. korneale Inzision, Synechiolyse, Sektoriridektomie), intraoperativer Verlauf (intraoperative Miosis, intraoperative Blutung, Vis a tergo, intraoperativer arterieller Blutdruck, Glaskörperverlust) wurde eine multivariate Faktorenanalyse in Richtung GK-Verlust durchgeführt. Signifikante Risikofaktoren für GK-Verlust sind (p < 0,001): Cat.traumatica, Subluxatio lentis, intraoperative Synechiolyse, Vis a tergo. Bei Bewertung der GK-Verlustrate in Abhängigkeit von der Anästhesieart (Intubationsnarkose bzw. Retrobulbäranästhesie) zeigten sich bei ECCEs ohne Risikofaktoren (ohne Cat.traumatica, Subluxatio lentis, intraoperative Synechiolyse) ähnliche, nicht signifikant verschiedene GK-Verlustraten: ECCE in ITN: 1,1%, ECCE in RBA 1,4%.

Summary

3193 unselected computerized surgical procedures of planned extracapsular cataract surgery performed by 12 surgeons were analysed. The data of age, additional cataract diagnosis [cataracta matura, cataracta complicata, Cataracta traumatica, subluxatio lentis, exfoliation Syndrome, nanophthalmus (eye length <22 mm), myopia magna (eye length >27 mm)], sort of anesthesia (general anesthesia, retrobulbär anesthesia), sort of incision (corneal, corneoscleral), synechiolysis, sector iridectomy, intraoperative miosis, intraoperative bleeding in the anterior Chamber, intraoperative arterial blood pressure and operative complications (forward movement of the ins lens diaphragm FMILD, vitreous loss VL) were processed. After identifying the pre- and intra-operative risk factors (Discriminant Analysis, SPSS) we evaluate the influence of anesthesia on the development of vitreous loss in a group of cataracts with equal rates of risk factors. Significant preoperative and intraoperative risk factors for VL were: cataracta traumatica, subluxatio lentis, synechiolysis, “Forward Movement of the Iris Lens Diaphragm”. In cataracts after excluding the riskfactors cataracta traumatica, subluxatio lentis, synechiolysis the rates of vitreous loss were: GA: 1.1%, RA: 1.4%. After additional exclusion of the riskfactor FMILD the rates of VL were: GA: 1.1%, RA: 0.9%. No significant correlations were found to age, cataracta matura, cataracta complicata, exfoliation Syndrome, nanophthalmus, myopia magna, operative opening, arterial blood pressure and the sort of anesthesia. Summarizing the Statistical analysis shows that cataract surgery in retrobulbär anesthesia in cases without cataracta traumatica, subluxatio lentis and posterior synechia showed slightly inceased rates of VL than cataract surgery performed in general anesthesia. In cases without cataracta traumatica, subluxatio lentis, posterior synechia and FMILD cataract surgery performed in RA show slightly deceased rates of VL in relation to cataract surgery in GA. The rate of the significant risk factor FMILD for VL may be reduced by carefully preoperative widening the pupils and by control and therapy of intraoperative blood pressure.