Lin Hao-Tian, Long Er-Ping, Chen Jing-Jing, Liu Zhen-Zhen, Lin Zhuo-Ling, Cao Qian-Zhong, Zhang Xia-Yin, Wu Xiao-Hang, Wang Qi-Wei, Lin Duo-Ru, Li Xiao-Yan, Liu Jin-Chao, Luo Li-Xia, Qu Bo, Chen Wei-Rong, Liu Yi-Zhi
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China.
Int J Ophthalmol. 2017 Dec 18;10(12):1835-1843. doi: 10.18240/ijo.2017.12.08. eCollection 2017.
To compare visual prognoses and postoperative adverse events of congenital cataract surgery performed at different times and using different surgical approaches.
In this prospective, randomized controlled trial, we recruited congenital cataract patients aged 3mo or younger before cataract surgery. Sixty-one eligible patients were randomly assigned to two groups according to surgical timing: a 3-month-old group and a 6-month-old group. Each eye underwent one of three randomly assigned surgical procedures, as follows: surgery A, lens aspiration (I/A); surgery B, lens aspiration with posterior continuous curvilinear capsulorhexis (I/A+PCCC); and surgery C, lens aspiration with posterior continuous curvilinear capsulorhexis and anterior vitrectomy (I/A+PCCC+A-Vit). The long-term best-corrected visual acuity (BCVA) and the incidence of complications in the different groups were compared and analyzed.
A total of 57 participants (114 eyes) with a mean follow-up period of 48.7mo were included in the final analysis. The overall logMAR BCVA in the 6-month-old group was better than that in the 3-month-old group (0.81±0.28 0.96±0.30; =0.02). The overall logMAR BCVA scores in the surgery B group were lower than the scores in the A and C groups (A: 0.80±0.29, B: 1.02±0.28, and C: 0.84±0.28; =0.007). A multivariate linear regression revealed no significant relationships between the incidence of complications and long-term BCVA.
It might be safer and more beneficial for bilateral total congenital cataract patients to undergo surgery at 6mo of age than 3mo. Moreover, with rigorous follow-up and timely intervention, the postoperative complications in these patients are treatable and do not compromise visual outcomes.
比较在不同时间并采用不同手术方式进行先天性白内障手术的视觉预后及术后不良事件。
在这项前瞻性随机对照试验中，我们在白内障手术前招募了3个月及以下的先天性白内障患者。61例符合条件的患者根据手术时机随机分为两组：3个月龄组和6个月龄组。每只眼睛接受以下三种随机分配的手术之一：手术A，晶状体抽吸术（I/A）；手术B，晶状体抽吸联合后囊连续环形撕囊术（I/A+PCCC）；手术C，晶状体抽吸联合后囊连续环形撕囊术及前部玻璃体切除术（I/A+PCCC+A-Vit）。比较并分析不同组别的长期最佳矫正视力（BCVA）及并发症发生率。
最终分析纳入了57名参与者（114只眼），平均随访期为48.7个月。6个月龄组的总体logMAR BCVA优于3个月龄组（0.81±0.28对0.96±0.30；P=0.02）。手术B组的总体logMAR BCVA评分低于A组和C组（A组：0.80±0.29，B组：1.02±0.28，C组：0.84±0.28；P=0.007）。多因素线性回归显示并发症发生率与长期BCVA之间无显著关系。
对于双侧完全性先天性白内障患者，6个月龄时进行手术可能比3个月龄时更安全且更有益。此外，通过严格的随访和及时的干预，这些患者的术后并发症是可治疗的，且不会影响视觉预后。
