Chak Melanie, Rahi Jugnoo Sangeeta
Centre for Paediatric Epidemiology, Institute of Child Health, London, United Kingdom.
Ophthalmology. 2008 Jun;115(6):1013-1018.e2. doi: 10.1016/j.ophtha.2007.09.002. Epub 2007 Dec 27.
To report the incidence of and factors associated with postoperative open-angle glaucoma in a nationally representative group of children undergoing surgery for congenital or infantile cataract.
Noncomparative interventional cohort study.
All children in the United Kingdom who were newly diagnosed with congenital or infantile cataract in a 12-month period in 1995 and 1996 (the British Congenital/Infantile Cataract Study) were eligible for this study. One hundred sixty-five children with congenital or infantile cataract underwent cataract surgery.
All the children were traced through their managing ophthalmologists. Standardized outcome data were collected at least 6 years after diagnosis. For children undergoing cataract extraction, Cox regression analysis was performed to determine incidence of postoperative open-angle glaucoma and the effect of key factors considered, a priori, potentially to be associated with it (i.e., age at detection and surgery, type of cataract surgery, primary intraocular lens implantation, severe postoperative uveitis, and microphthalmia).
Development of open-angle glaucoma after cataract surgery.
Postoperative glaucoma developed in 27 of 275 eyes of 165 children who underwent cataract surgery. The overall annual incidence of postoperative glaucoma was 5.25 per 100 cataract operations. The median time to development of postoperative glaucoma was 1.34 years (range, 0.39 months-6.73 years). Younger age at detection of cataract was the only factor independently associated with the development of glaucoma when all other factors of interest (which were all statistically associated with age at detection) were accounted for. A 10-fold increase in the age at detection (for example, 30 days compared with 3 days) was associated with a 64% decrease in the hazard ratio (95% confidence interval, 41%-79%; P<0.001).
Median time to development of postoperative open-angle glaucoma in the present study was lower than that reported previously, emphasizing the need for vigilance from the early postoperative period. Earlier detection of cataract was the only significant factor associated with the development of glaucoma after surgery for congenital cataract.
报告在全国具有代表性的接受先天性或婴儿性白内障手术的儿童中，术后开角型青光眼的发病率及相关因素。
非对比性干预队列研究。
1995年和1996年12个月期间在英国新诊断为先天性或婴儿性白内障的所有儿童（英国先天性/婴儿性白内障研究）均符合本研究条件。165例先天性或婴儿性白内障患儿接受了白内障手术。
通过负责的眼科医生对所有儿童进行追踪。在诊断后至少6年收集标准化结局数据。对于接受白内障摘除术的儿童，进行Cox回归分析以确定术后开角型青光眼的发病率以及事先认为可能与之相关的关键因素（即发现和手术时的年龄、白内障手术类型、一期人工晶状体植入、严重术后葡萄膜炎和小眼症）的影响。
白内障手术后开角型青光眼的发生情况。
165例接受白内障手术的儿童的275只眼中，有27只发生了术后青光眼。术后青光眼的总体年发病率为每100例白内障手术5.25例。术后青光眼发生的中位时间为1.34年（范围为0.39个月至6.73年）。在考虑了所有其他感兴趣的因素（这些因素均与发现时的年龄有统计学关联）后，发现白内障时年龄较小是与青光眼发生独立相关的唯一因素。发现时年龄增加10倍（例如，30天与3天相比）与风险比降低64%相关（95%置信区间，41% - 79%；P<0.001）。
本研究中术后开角型青光眼发生的中位时间低于先前报道，强调术后早期需保持警惕。早期发现白内障是先天性白内障手术后青光眼发生的唯一重要相关因素。
