Solebo A L, Rahi J, Grehn F
Institute of Child Health, London, England.
Ophthalmologe. 2012 Jan;109(1):83-92. doi: 10.1007/s00347-011-2516-5.
Modern surgical techniques allow congenital cataract surgery to be performed much more successfully. The development of a secondary glaucoma is the most dreaded postoperative complication (one third of all pediatric secondary glaucomas). Due to the limited value of the available literature, data on prevalence are unreliable. A 10-year postoperative incidence of 10-25% is given in the literature for developing secondary glaucoma and the frequency increases with the duration of follow-up. A major risk factor seems to be the age at the time of surgery. The younger the patient is at the time of surgery the higher the risk of secondary glaucoma. A microcornea seems to be another risk factor in multivariate analysis. The following postoperative changes might be involved in the pathogenesis: peripheral anterior synechia, high iris insertion and membranous material over the trabecular meshwork. Additionally postoperative inflammation, reaction to lens epithelial cells, perioperative barotrauma and loss of anterior segment architecture might also be responsible. In order to evaluate the optimal age window for congenital cataract surgery and risk factors for the development of secondary glaucoma, a prospective longitudinal study is mandatory.
现代外科技术使先天性白内障手术的成功率大大提高。继发性青光眼的发生是最可怕的术后并发症（占所有儿童继发性青光眼的三分之一）。由于现有文献价值有限，患病率数据不可靠。文献报道继发性青光眼的术后10年发病率为10% - 25%，且随着随访时间的延长频率增加。一个主要危险因素似乎是手术时的年龄。手术时患者年龄越小，发生继发性青光眼的风险越高。在多变量分析中，小角膜似乎是另一个危险因素。以下术后变化可能参与发病机制：周边前粘连、虹膜高位附着以及小梁网表面的膜状物质。此外，术后炎症、对晶状体上皮细胞的反应、围手术期气压伤以及眼前节结构的丧失也可能起作用。为了评估先天性白内障手术的最佳年龄范围以及继发性青光眼发生的危险因素，必须进行一项前瞻性纵向研究。
