Watts Patrick, Abdolell Mohamed, Levin Alex V
Department of Ophthalmology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
J AAPOS. 2003 Apr;7(2):81-5. doi: 10.1016/mpa.2003.S1091853102420095.
To determine if there is an association between the timing of surgical intervention for congenital cataract within the first 12 weeks of life and the prevalence of postoperative complications.
We performed a retrospective review of records from 1990 to 2000 of infants who underwent surgery for congenital cataract within the first 12 weeks of life. Eighty eyes in 55 children were involved with a minimum follow up of 6 months. Bilateral cataracts were present in 25 and monocular cataracts in 30 infants. A limbal approach lensectomy-vitrectomy was performed in all infants. Children with aphakia were rehabilitated with contact lens or glasses. Operative and postoperative complications-including glaucoma, nystagmus, strabismus, retinal detachment, and posterior capsule opacification/secondary membranes-were recorded. Ocular and systemic associations were noted. Statistical analysis was carried out with classification and regression trees (CART).
The mean age at the time of surgery was 31.5 +/- 23.3 days (median, 26.5; range, 2 to 84). Mean follow up from the time of surgery was 2.85 +/-1.9 years (median, 2; range, 0.5 to 8). Persistent fetal vasculature (persistent hyperplastic primary vitreous) was present in 14 eyes. One infant with bilateral persistent fetal vasculature had bilateral retinal dysplasia and was excluded from the analysis. Glaucoma developed in 12 infants (22%); nystagmus was present in 18 infants (33%); strabismus developed in 28 infants (52%); and secondary membranes developed in 7 eyes (13%). CART analysis suggests that glaucoma is more prevalent in infants when the surgery was performed between 13.5 and 43 days of life (CART = 0.370); nystagmus when surgery is performed between 48 and 84 days of life (CART = 0.500); strabismus when surgery is performed between 55.5 and 84 days of life (CART = 0.600); and secondary membranes when surgery is performed between 26.5 and 40 days of life (CART = 0.4).
Our data suggest that the first 2 weeks of life comprise the most favorable time for decreasing postoperative complications resulting from surgical intervention for infants presenting with cataracts within the first 12 weeks of life.
确定出生后12周内先天性白内障手术干预的时机与术后并发症发生率之间是否存在关联。
我们对1990年至2000年期间出生后12周内接受先天性白内障手术的婴儿记录进行了回顾性研究。涉及55名儿童的80只眼，最小随访时间为6个月。25名婴儿为双侧白内障，30名婴儿为单眼白内障。所有婴儿均采用角膜缘入路晶状体切除术-玻璃体切除术。无晶状体儿童采用隐形眼镜或眼镜进行视力康复。记录手术及术后并发症，包括青光眼、眼球震颤、斜视、视网膜脱离以及后囊混浊/继发性膜形成。记录眼部和全身的相关情况。采用分类回归树（CART）进行统计分析。
手术时的平均年龄为31.5±23.3天（中位数为26.5天；范围为2至84天）。从手术时起的平均随访时间为2.85±1.9年（中位数为2年；范围为0.5至8年）。14只眼中存在永存原始玻璃体增生症（永存胎儿血管系统）。一名患有双侧永存原始玻璃体增生症的婴儿伴有双侧视网膜发育异常，被排除在分析之外。12名婴儿（22%）发生青光眼；18名婴儿（33%）存在眼球震颤；28名婴儿（52%）出现斜视；7只眼（13%）形成继发性膜。CART分析表明，出生后13.5至43天进行手术时，婴儿患青光眼的概率更高（CART = 0.370）；出生后48至84天进行手术时，患眼球震颤的概率更高（CART = 0.500）；出生后55.5至84天进行手术时，出现斜视的概率更高（CART = 0.600）；出生后26.5至40天进行手术时，形成继发性膜的概率更高（CART = 0.4）。
我们的数据表明，对于出生后12周内患有白内障的婴儿，出生后的前2周是减少手术干预术后并发症最有利的时间。
