Weakley David R, Lynn Michael J, Dubois Lindreth, Cotsonis George, Wilson M Edward, Buckley Edward G, Plager David A, Lambert Scott R
Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Ophthalmology. 2017 Jun;124(6):822-827. doi: 10.1016/j.ophtha.2016.12.040. Epub 2017 Feb 16.
To report the myopic shift at 5 years of age after cataract surgery with intraocular lens (IOL) implantation for infants enrolled in the Infant Aphakia Treatment Study (IATS).
Refractions were performed at 1 month and every 3 months postoperatively until age 4 years and then at ages 4.25, 4.5, and 5 years. The change in refraction over time was estimated by linear mixed model analysis.
Intraocular lens implantation was completed in 56 eyes; 43 were analyzed (median age, 2.4 months; range, 1.0-6.8 months). Exclusions included 11 patients with glaucoma, 1 patient with Stickler syndrome, and 1 patient with an IOL exchange at 8 months postoperatively. The mean rate of change in a myopic direction from 1 month after cataract surgery to age 1.5 years was 0.35 diopters (D)/month (95% confidence interval [CI], 0.29-0.40 D/month); after age 1.5 years, the mean rate of change in a myopic direction was 0.97 D/year (95% CI, 0.66-1.28 D/year). The mean refractive change was 8.97 D (95% CI, 7.25-10.68 D) at age 5 years for children 1 month of age at surgery and 7.22 D (95% CI, 5.54-8.91 D) for children 6 months of age at surgery. The mean refractive error at age 5 years was -2.53 D (95% CI, -4.05 to -1.02).
After IOL implantation during infancy, the rate of myopic shift occurs most rapidly during the first 1.5 years of life. Myopic shift varies substantially among patients. If the goal is emmetropia at age 5 years, then the immediate postoperative hypermetropic targets should be +10.5 D at 4 to 6 weeks and +8.50 D from 7 weeks to 6 months. However, even using these targets, it is likely that many children will require additional refractive correction given the high variability of refractive outcomes.
报告婴儿无晶状体治疗研究（IATS）中接受白内障手术并植入人工晶状体（IOL）的患儿5岁时的近视漂移情况。
术后1个月及之后每3个月进行验光，直至4岁，然后在4.25岁、4.5岁和5岁时进行验光。通过线性混合模型分析估计屈光随时间的变化。
56只眼完成了人工晶状体植入；43只眼进行了分析（中位年龄2.4个月；范围1.0 - 6.8个月）。排除标准包括11例青光眼患者、1例施蒂克勒综合征患者和1例术后8个月进行人工晶状体置换的患者。白内障手术后1个月至1.5岁近视方向的平均变化率为0.35屈光度（D）/月（95%置信区间[CI]，0.29 - 0.40 D/月）；1.5岁之后，近视方向的平均变化率为0.97 D/年（95% CI，0.66 - 1.28 D/年）。手术时1个月大的儿童5岁时平均屈光变化为8.97 D（95% CI，7.25 - 10.68 D），手术时6个月大的儿童5岁时平均屈光变化为7.22 D（95% CI，5.54 - 8.91 D）。5岁时的平均屈光不正为 -2.53 D（95% CI， -4.05至 -1.02）。
婴儿期植入人工晶状体后，近视漂移率在生命的前1.5年最为迅速。近视漂移在患者之间差异很大。如果目标是5岁时达到正视，则术后即刻远视目标应为4至6周时 +10.5 D，7周龄至6个月时 +8.50 D。然而，即使采用这些目标，鉴于屈光结果的高度变异性，许多儿童可能仍需要额外的屈光矫正。
