Michaelides Michel, Bunce Catey, Adams Gillian G W
Department of Paediatric Ophthalmology and Strabismus, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK.
BMC Ophthalmol. 2007 Sep 11;7:13. doi: 10.1186/1471-2415-7-13.
To determine the rate of glaucoma following congenital cataract surgery at Moorfields Eye Hospital (MEH), and to investigate potential risk factors for glaucoma in our case series.
A retrospective case notes review was undertaken of all congenital cataract lensectomies performed at MEH between 1994 and 2000. The following parameters were ascertained: age at surgery, unilateral or bilateral cataract, whether a posterior capsulotomy (PC) was performed at the time of surgery, whether an intraocular lens (IOL) was inserted, duration of follow-up, and if aphakic glaucoma (AG) developed. All lensectomies were performed through a limbal incision by a single consultant surgeon.
A total of 47 subjects were identified - 40 patients with bilateral cataracts and 7 with unilateral. Of the 40 bilateral cataract patients, 76 eyes had lensectomies; with 37 of these patients (71 lensectomies) having at least 5 year follow-up. Based on patient count, the 5 year risk of AG in at least one eye following surgery was 21.6%. Based on eye count, the 5 year risk of AG after lensectomy was 15.5%. The average age at surgery of patients who did not develop AG, and had at least 5 years follow-up, was 28.7 months (range 2 weeks to 6 years), with 20% having surgery within the first month of life. In comparison, the average age at surgery of patients with at least 5 years follow-up, who developed AG was 1.6 months (range 2 weeks to 7 months), with 60% having surgery within the first month of life. In subjects with at least 5 years follow-up, a PC rate of 100% was identified in the eyes that developed AG, compared to 61% in eyes that did not develop AG. An IOL was inserted in O% of eyes with AG, compared to 57% in eyes that did not develop AG. Onset of AG ranged from one month post surgery to 7 years, with an average yearly incidence of 5.3%.
Early surgery in patients with bilateral cataracts is associated with a marked increase in risk of AG. Our data suggest that an intact posterior capsule may be associated with a lower rate of AG.
确定摩尔菲尔德眼科医院（MEH）先天性白内障手术后青光眼的发生率，并调查我们病例系列中青光眼的潜在危险因素。
对1994年至2000年间在MEH进行的所有先天性白内障晶状体切除术进行回顾性病例记录审查。确定以下参数：手术年龄、单侧或双侧白内障、手术时是否进行了后囊切开术（PC）、是否植入了人工晶状体（IOL）、随访时间以及是否发生无晶状体性青光眼（AG）。所有晶状体切除术均由一位顾问外科医生通过角膜缘切口进行。
共确定47名受试者——40例双侧白内障患者和7例单侧白内障患者。在40例双侧白内障患者中，76只眼进行了晶状体切除术；其中37例患者（71只眼）进行了至少5年的随访。基于患者计数，手术后至少一只眼发生AG的5年风险为21.6%。基于眼计数，晶状体切除术后AG的5年风险为15.5%。未发生AG且至少随访5年的患者手术平均年龄为28.7个月（范围为2周至6岁），其中20%在出生后第一个月内进行手术。相比之下，至少随访5年且发生AG的患者手术平均年龄为1.6个月（范围为2周至7个月），其中60%在出生后第一个月内进行手术。在至少随访5年的受试者中，发生AG的眼中PC率为100%，未发生AG的眼中为61%。发生AG的眼中0%植入了IOL，未发生AG的眼中为57%。AG的发病时间从术后1个月至7年不等，平均年发病率为5.3%。
双侧白内障患者早期手术与AG风险显著增加相关。我们的数据表明，完整的后囊可能与较低的AG发生率相关。
