Forster J E, Abadi R V, Muldoon M, Lloyd I C
Faculty of Life Sciences, University of Manchester, PO Box 88, Manchester, M60 1QD, UK.
Ophthalmic Physiol Opt. 2006 Jul;26(4):372-9. doi: 10.1111/j.1475-1313.2006.00370.x.
To introduce and describe two methods of grading the severity of infantile cataracts, and thereby propose a useful clinical guide for early surgical intervention.
Thirty-three subjects, aged 1 week to 8 years, participated in the study. Twenty-two were evaluated soon after birth (1 week), and 11 in childhood (3-8 years). All had isolated infantile cataracts, of which 16 were bilateral and 17 unilateral. Nine cataract types were examined; nuclear (n = 9), lamellar (n = 9), posterior lenticonus (n = 4), persistent hyperplastic primary vitreous (n = 4), posterior polar (n = 3) and single cases of total, cortical, sutural and anterior polar. Grading the infantile cataracts was performed subjectively based on the cataract morphology, density and position using an 11-point (0-10) ordinal scale. Objective measures of the cataracts were performed by scanning and then digitising photo-slit lamp images to provide cataract intensity profiles. Subjects without cataracts acted as controls.
Subjective gradings of 0 and 10 were assigned to the clear, cataract-free lens and the total cataract, respectively. Fixed grades of 1 (anterior polar, sutural) and 6 (posterior polar) were assigned to the three remaining cataracts with static morphologies. The five cataracts which were all progressive were given grading ranges, reflecting the initial and likely final morphological states. Objective measures were found to be valuable in indicating the exact position and relative density of the cataract, as well as accurately defining boundaries.
The magnitude and severity of infantile cataracts can be usefully characterised by an 11-point ordinal subjective grading scale. Although subjective grading alone is satisfactory, it can be greatly assisted by objective measures, particularly in the documentation of cataract progression. Cataracts assigned grades 1-4 were considered minor obstructions to vision and therefore not candidates for early surgery. Cataracts graded 5 and above were considered major visual defects, and ideally should be removed early in life.
介绍并描述两种评估婴儿白内障严重程度的方法，从而为早期手术干预提出实用的临床指南。
33名年龄在1周龄至8岁的受试者参与了该研究。其中22名在出生后不久（1周龄）接受评估，11名在儿童期（3 - 8岁）接受评估。所有受试者均患有孤立性婴儿白内障，其中16例为双侧，17例为单侧。检查了9种白内障类型；核性（n = 9）、板层状（n = 9）、后圆锥形晶状体（n = 4）、永存原始玻璃体增生症（n = 4）、后极性（n = 3）以及全白内障、皮质性白内障、缝性白内障和前极性白内障各1例。根据白内障的形态、密度和位置，使用11分（0 - 10）序数尺度对婴儿白内障进行主观分级。通过扫描然后将光隙灯图像数字化来对白内障进行客观测量，以提供白内障强度剖面图。无白内障的受试者作为对照。
分别将0级和10级主观分级赋予透明、无白内障的晶状体和全白内障。对于其余三种形态静止的白内障，分别固定为1级（前极性、缝性）和6级（后极性）。5种均为进行性的白内障给出了分级范围，反映了初始和可能的最终形态状态。发现客观测量在指示白内障的确切位置和相对密度以及准确界定边界方面很有价值。
婴儿白内障的大小和严重程度可用11分序数主观分级量表进行有效表征。虽然仅主观分级就足够了，但客观测量可对其有很大帮助，特别是在记录白内障进展方面。分级为1 - 4级的白内障被认为对视力影响较小，因此不是早期手术的候选对象。分级为5级及以上的白内障被认为是主要的视觉缺陷，理想情况下应在生命早期摘除。
