Wilmer Institute, Johns Hopkins University, Baltimore, Maryland.
Jaeb Center for Health Research, Tampa, Florida.
JAMA Ophthalmol. 2019 Jul 1;137(7):817-824. doi: 10.1001/jamaophthalmol.2019.1220.
Cataract is an important cause of visual impairment in children. Outcomes reported from a large clinical disease-specific registry can provide real-world estimates of visual outcomes and rates of adverse events in clinical practice.
To describe visual acuity and refractive error outcomes, as well as rates of amblyopia, glaucoma, and additional eye surgery, during the first year after lensectomy in children.
DESIGN, SETTING, AND PARTICIPANTS: A prospective observational study was conducted from June 18, 2012, to July 8, 2015, at 61 pediatric eye care practices among 880 children younger than 13 years at the time of lensectomy in at least 1 eye with follow-up within 15 months after surgery. Statistical analysis was performed from December 12, 2016, to December 14, 2018.
Lensectomy with or without implantation of an intraocular lens.
Visual acuity as well as rates of amblyopia, glaucoma, suspected glaucoma, and other intraocular surgery.
Among the 880 children (432 girls and 448 boys; mean [SD] age at annual follow-up, 4.9 [3.8] years) in the study, lens surgery was bilateral in 362 (41.1%; 95% CI, 37.9%-44.4%) children and unilateral in 518 (58.9%; 95% CI, 55.6%-62.1%). An intraocular lens was implanted in 654 of 1132 eyes (60.2%; 95% CI, 57.0%-63.4% [proportions reported for eye-level outcomes account for the potential correlation induced by enrolling both eyes of some individuals; for participants who received bilateral surgery, these numbers will differ from the quotient of the number of cases divided by the total sample size]). Amblyopia was identified in 449 children (51.0%; 95% CI, 47.7%-54.3%). In children age 3 years or older, mean visual acuity was 0.30 logMAR (about 20/40) in 153 bilateral pseudophakic eyes, 0.49 logMAR (about 20/63) in 141 unilateral pseudophakic eyes, 0.47 logMAR (about 20/63) in 21 bilateral aphakic eyes, and 0.61 logMAR (about 20/80) in 17 unilateral aphakic eyes. Mean visual acuity improved with older age at surgery in eyes with bilateral pseudophakia by 0.2 logMAR line (99% CI, 0.02-0.4; P = .005) and by 0.3 logMAR line (99% CI, 0.04-0.60; P = .004) in eyes with unilateral pseudophakia. A new diagnosis of glaucoma or suspected glaucoma was made in 67 of 1064 eyes that did not have glaucoma prior to lensectomy (5.9%; 95% CI, 4.6%-7.7%); 36 of 273 eyes with bilateral aphakia (13.2%; 95% CI, 9.0%-19.0%), 5 of 308 eyes with bilateral pseudophakia (1.5%; 95% CI, 0.6%-4.2%), 14 of 178 eyes with unilateral aphakia (7.9%; 95% CI, 4.7%-12.8%), and 12 of 305 eyes with unilateral pseudophakia (3.9%; 95% CI, 2.2%-6.8%). Additional intraocular surgery, most commonly vitrectomy or membranectomy to clear the visual axis, was performed in 189 of 1132 eyes (17.0%; 95% CI, 14.8%-19.6%).
Amblyopia was frequently observed during the first year after lensectomy in this cohort of children younger than 13 years. For children age 2 years or older at surgery visual acuity was typically less than normal for age and was worse with unilateral cataract. Management of visual axis obscuration was the most common complication requiring surgical intervention during the first year after surgery.
白内障是儿童视力损害的一个重要原因。来自大型临床疾病特定登记处的报告结果可以提供真实世界中临床实践中视力结果和不良事件发生率的估计。
描述儿童晶状体切除术后第一年的视力和屈光不正结果，以及弱视、青光眼和其他眼部手术的发生率。
设计、地点和参与者：这是一项前瞻性观察性研究，于 2012 年 6 月 18 日至 2015 年 7 月 8 日在 880 名年龄均小于 13 岁的儿童中进行，这些儿童在至少一只眼接受晶状体切除术后的 15 个月内进行了随访。研究的 61 家儿科眼科诊所位于 880 名儿童中，其中 61 家位于 880 名儿童中。这些儿童的统计分析于 2016 年 12 月 12 日至 2018 年 12 月 14 日进行。
晶状体切除术伴或不伴人工晶状体植入。
视力以及弱视、青光眼、疑似青光眼和其他眼内手术的发生率。
在这项研究中，880 名儿童（432 名女孩和 448 名男孩；平均[SD]年度随访年龄为 4.9[3.8]岁）中，362 名（41.1%；95%CI，37.9%-44.4%）儿童接受了双侧晶状体手术，518 名（58.9%；95%CI，55.6%-62.1%）儿童接受了单侧晶状体手术。1132 只眼中有 654 只（60.2%；95%CI，57.0%-63.4%[针对眼级结果报告的比例考虑了一些个体同时接受双眼手术所引起的相关性；对于接受双侧手术的参与者，这些数字将与将病例数除以总样本量的商不同]）植入了人工晶状体。449 名儿童（51.0%；95%CI，47.7%-54.3%）被诊断为弱视。在 3 岁或以上的儿童中，153 只双侧后房型人工晶状体眼的平均视力为 0.30 logMAR（约 20/40），141 只单侧后房型人工晶状体眼的平均视力为 0.49 logMAR（约 20/63），21 只双侧无晶状体眼的平均视力为 0.47 logMAR（约 20/63），17 只单侧无晶状体眼的平均视力为 0.61 logMAR（约 20/80）。双眼假性晶状体术后视力随年龄增长而提高，双眼假性晶状体眼提高 0.2 logMAR 线（99%CI，0.02-0.4；P = .005），单侧假性晶状体眼提高 0.3 logMAR 线（99%CI，0.04-0.60；P = .004）。在未行晶状体切除术前未患青光眼或疑似青光眼的 1064 只眼中，有 67 只（5.9%；95%CI，4.6%-7.7%）新诊断为青光眼或疑似青光眼；36 只双侧无晶状体眼（13.2%；95%CI，9.0%-19.0%），5 只双侧后房型人工晶状体眼（1.5%；95%CI，0.6%-4.2%），14 只单侧无晶状体眼（7.9%；95%CI，4.7%-12.8%），12 只单侧后房型人工晶状体眼（3.9%；95%CI，2.2%-6.8%）。189 只（17.0%；95%CI，14.8%-19.6%）眼需要进行额外的眼内手术，最常见的是玻璃体切除术或膜切除术以清除视觉轴。
在这个年龄小于 13 岁的儿童队列中，晶状体切除术后的第一年经常会出现弱视。对于手术时年龄在 2 岁或以上的儿童，视力通常低于年龄正常水平，单侧白内障的视力更差。术后第一年视觉轴混浊的管理是最常见的需要手术干预的并发症。
