VST Centre for Glaucoma, L V Prasad Eye Institute, Hyderabad, India.
Department of Clinical Epidemiology and Biostatistics, L V Prasad Eye Institute, Hyderabad, India.
Br J Ophthalmol. 2018 Jun;102(6):790-795. doi: 10.1136/bjophthalmol-2017-310861. Epub 2017 Sep 19.
To report the outcomes of lensectomy in spherophakic eyes with subluxated or dislocated crystalline lenses and secondary glaucoma.
Lensectomy was performed in 52 eyes, 36 eyes with lens subluxation and 16 eyes with lens dislocation with secondary glaucoma from 1991 to 2016. Glaucoma was diagnosed based on intraocular pressure (IOP) ≥22 mm Hg and/or glaucomatous optic disc damage. Complete success was defined as IOP ≥5 and ≤21 mm Hg without antiglaucoma medications (AGMs) or surgery, and eyes needing oral AGM or surgical intervention for IOP control or those with complication causing loss of light perception were considered failure.
Median (IQR) age at lensectomy was 12 (6-18) years, and median spherical equivalent was -14.5D (-23.7to -13). Median follow-up was 30.6 (5.4-103.4) months. Median logMAR (logarithm of minimal angle of resolution) visual acuity improved from 0.95 (0.6-1.8) to 0.4 (0.2-1.3) after lensectomy (p=0.01). Median IOP decreased from 22 mm Hg (17-31) to 14 mm Hg (11-19) at final follow-up (p=0.01). Median number of AGM decreased from 2 (2-3) to 1 (0-2) at final follow-up (p<0.0001), and glaucoma surgery was needed in four eyes (7.7% eyes). Complete success probability was 69% at 1 year and 51% at 5 years. Younger age (<6 years), higher presenting IOP (>32 mm Hg) and larger cup to disc ratio at presentation were found to be significant risk factors for failure.
Lensectomy was effective in controlling IOP in close to half of all eyes with spherophakia and secondary glaucoma, 40% eyes needed AGM and only 7.7% eyes needed glaucoma surgery for IOP control. In this cohort, younger age, higher IOP and larger cup to disc ratio at presentation were risk factors for poor glaucoma control after lensectomy.
报告晶状体切除治疗晶状体半脱位或全脱位伴发性青光眼的球形晶状体眼的结果。
1991 年至 2016 年，对 52 只眼（36 只眼晶状体半脱位，16 只眼晶状体全脱位伴发性青光眼）进行晶状体切除术。青光眼的诊断基于眼压（IOP）≥22mmHg 和/或青光眼性视盘损伤。完全成功定义为 IOP≥5mmHg 且≤21mmHg，无需抗青光眼药物（AGM）或手术，而需要口服 AGM 或手术干预以控制眼压或因并发症导致光感丧失的眼则视为失败。
晶状体切除时的中位（IQR）年龄为 12（6-18）岁，中位等效球镜度为-14.5D（-23.7 至-13）。中位随访时间为 30.6（5.4-103.4）个月。中位 logMAR（最小分辨角对数）视力从晶状体切除前的 0.95（0.6-1.8）提高到 0.4（0.2-1.3）（p=0.01）。最终随访时，中位 IOP 从 22mmHg（17-31）降至 14mmHg（11-19）（p=0.01）。最终随访时，AGM 的中位数从 2（2-3）减少至 1（0-2）（p<0.0001），4 只眼（7.7%）需要行青光眼手术。1 年时完全成功的概率为 69%，5 年时为 51%。年龄较小（<6 岁）、就诊时较高的 IOP（>32mmHg）和较大的杯盘比是失败的显著危险因素。
晶状体切除术在接近一半的球形晶状体伴发性青光眼的眼有效控制了眼压，40%的眼需要 AGM，只有 7.7%的眼需要青光眼手术来控制眼压。在本队列中，年龄较小、就诊时 IOP 较高和杯盘比较大是晶状体切除后青光眼控制不良的危险因素。
