Morales-Fernández Laura, Martínez-de-la-Casa José María, Benito-Pascual Blanca, Saénz-Francés Federico, Santos-Bueso Enrique, Arriola-Villalobos Pedro, Escribano-Martínez Julio, García-Feijoo Julián
Ophthalmology Department, Clínico San Carlos Hospital, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
Genetics Department, University of Castilla-La Mancha, Ciudad Real, Spain.
Eur J Ophthalmol. 2020 May;30(3):525-532. doi: 10.1177/1120672119841190. Epub 2019 Apr 7.
To assess incidence and risk factors of cataract extraction in patients with primary congenital glaucoma, surgical outcome, and complications.
Retrospective cohort study, in which 108 patients with primary congenital glaucoma were included. Data collected were need for cataract extraction and at what age, intraocular pressure at diagnosis of primary congenital glaucoma, required antiglaucomatous surgeries, possible mutation in the CYP1B1 gene, and final visual acuity. Among the patients who required cataract extraction were visual acuity, intraocular pressure, and complications, evaluated preoperatively and postoperatively. The data were analysed with STATA.
A total of 198 eyes of 108 patients were included, with a median follow-up of 8 years (range: 5-53). In all, 32 eyes (16.2%) of 24 patients (22%) required cataract extraction. The median age for cataract extraction was 12.94 years (interquartile range: 2.42-22). The main identified risk factors associated with cataract extraction were antiglaucomatous surgeries (hazard ratio 1.48, < 0.001) and valvular implant (hazard ratio 2.78, < 0.001). Lens was implanted in 30/32 eyes and the main complications were intraocular pressure decontrol ( = 13), capsular fibrosis ( = 7), corneal decompensation ( = 4), lens subluxation ( = 4), and endophthalmitis ( = 1). Visual acuity improvement was observed after cataract extraction in 66.67% of eyes.
There is a high incidence of cataract surgery in patients with primary congenital glaucoma, but generally outside of pediatric age. A greater risk of cataract extraction was identified in those patients with a greater number of antiglaucomatous surgeries, especially after valvular implantation. Despite the high rate of complications related to cataract extraction in primary congenital glaucoma, good visual improvement was observed after surgery.
评估原发性先天性青光眼患者白内障摘除的发生率、危险因素、手术效果及并发症。
回顾性队列研究，纳入108例原发性先天性青光眼患者。收集的数据包括白内障摘除的必要性及年龄、原发性先天性青光眼诊断时的眼压、所需的抗青光眼手术、CYP1B1基因可能的突变以及最终视力。对需要进行白内障摘除的患者，评估术前和术后的视力、眼压及并发症。数据采用STATA进行分析。
共纳入108例患者的198只眼，中位随访时间为8年（范围：5 - 53年）。共有24例患者（22%）的32只眼（16.2%）需要进行白内障摘除。白内障摘除的中位年龄为12.94岁（四分位间距：2.42 - 22岁）。与白内障摘除相关的主要危险因素为抗青光眼手术（风险比1.48，P < 0.001）和瓣膜植入（风险比2.78，P < 0.001）。32只眼中的30只眼植入了人工晶状体，主要并发症包括眼压失控（n = 13）、囊膜纤维化（n = 7）、角膜失代偿（n = 4）、晶状体半脱位（n = 4）和眼内炎（n = 1）。66.67%的患眼白内障摘除术后视力得到改善。
原发性先天性青光眼患者白内障手术的发生率较高，但通常在儿童期之后。抗青光眼手术次数较多的患者，尤其是瓣膜植入术后，白内障摘除的风险更高。尽管原发性先天性青光眼白内障摘除相关并发症发生率较高，但术后视力仍有较好改善。
