Klein Ronald, Klein Barbara E K, Wong Tien Y, Tomany Sandra C, Cruickshanks Karen J
Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, 610 N Walnut St, 460 WARF, Madison, WI 53726-2397, USA.
Arch Ophthalmol. 2002 Nov;120(11):1551-8. doi: 10.1001/archopht.120.11.1551.
To examine the association between cataract and cataract surgery and the 10-year incidence of age-related maculopathy (ARM).
A population-based cohort study of persons aged 43 to 86 years at baseline, living in Beaver Dam, Wis, of whom 3684 participated in a 5-year and 2764 in a 10-year follow-up. We used standardized protocols for physical examination, blood collection, health history, slitlamp and retroillumination photography of the lenses to determine the presence of cataract, and stereoscopic color fundus photography to determine the presence of ARM. We used the Kaplan-Meier (product-limit) survival approach and discrete linear logistic regression in analyses.
The risk ratios (RRs) of persons with cataract or cataract surgery at baseline.
While controlling for age, sex, systolic blood pressure, history of heavy drinking and smoking, and vitamin use, cataract at baseline was associated with incidence of early ARM (RR, 1.30; 95% confidence interval [CI], 1.04-1.63), soft indistinct drusen (RR, 1.38; 95% CI, 1.08-1.75), increased retinal pigment (RR, 1.38; 95% CI, 1.07-1.79), and progression of ARM (RR, 1.37; 95% CI, 1.06-1.77). We found no association with the incidence of late ARM. In contrast, cataract surgery before baseline was associated with incidence of late ARM (RR, 3.81; 95% CI, 1.89-7.69), increased retinal pigment (RR, 1.89; 95% CI, 1.18-3.03), retinal pigment epithelial depigmentation (RR, 1.95; 95% CI, 1.17-3.25), pure geographic atrophy (RR, 3.18; 95% CI, 1.33-7.60), exudative macular degeneration (RR, 4.31; 95% CI, 1.71-10.9), and progression of ARM (RR, 1.97; 95% CI, 1.29-3.02), but not with the incidence of early ARM.
These findings indicate an association of cataract with subsequent risk for early ARM. Cataract surgery increased the risk for late ARM.
研究白内障及白内障手术与年龄相关性黄斑病变（ARM）10年发病率之间的关联。
基于人群的队列研究，基线时年龄在43至86岁之间，居住在威斯康星州比弗代尔姆，其中3684人参与了为期5年的随访，2764人参与了为期10年的随访。我们使用标准化方案进行体格检查、血液采集、健康史询问、晶状体裂隙灯和后照法摄影以确定白内障的存在，以及立体彩色眼底摄影以确定ARM的存在。我们在分析中使用了Kaplan-Meier（乘积限）生存方法和离散线性逻辑回归。
基线时患有白内障或接受过白内障手术者的风险比（RRs）。
在控制年龄、性别、收缩压、大量饮酒和吸烟史以及维生素使用情况后，基线时的白内障与早期ARM的发病率相关（RR，1.30；95%置信区间[CI]，1.04 - 1.63）、软性不清晰玻璃膜疣（RR，1.38；95%CI，1.08 - 1.75）、视网膜色素增加（RR，1.38；95%CI，1.07 - 1.79）以及ARM的进展（RR，1.37；95%CI，1.06 - 1.77）。我们未发现与晚期ARM的发病率相关。相比之下，基线前的白内障手术与晚期ARM的发病率相关（RR，3.81；95%CI，1.89 - 7.69）、视网膜色素增加（RR，1.89；95%CI，1.18 - 3.03）、视网膜色素上皮色素脱失（RR，1.95；95%CI，1.17 - 3.25）、单纯性地图样萎缩（RR，3.18；95%CI，1.33 - 7.60）、渗出性黄斑变性（RR，4.31；95%CI，1.71 - 10.9）以及ARM的进展（RR，1.97；95%CI，1.29 - 3.02），但与早期ARM的发病率无关。
这些发现表明白内障与随后发生早期ARM的风险相关。白内障手术增加了发生晚期ARM的风险。
