Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.
The Affiliated Hospital of Guizhou Medical University, Guizhou, China.
Eye (Lond). 2021 Jun;35(6):1659-1665. doi: 10.1038/s41433-020-01140-2. Epub 2020 Aug 24.
The objective of this study is to determine the factors that predict long-term changes in refraction after lamellar keratoscleroplasty in paediatric patients with limbal dermoids.
A retrospective study of 66 children with limbal dermoids who had lamellar keratoscleroplasty correction with more than 1-year follow-up. Univariate and multivariate regression analyses were performed to investigate factors associated with the long term in refractive parameters, including spherical equivalent, astigmatism, and mean keratometry. The change value was defined as the postoperative refractive value minus the preoperative refractive value. The lower the value of changes, the more satisfied the effects on the correction of the preoperative refraction.
A total of 66 patients (mean surgical age: 3.5 ± 2.1 years) were assessed with at least 1-year follow-up. Amblyopia treatment duration was the only independent factor predicting the long-term changes in spherical equivalent between baseline and last follow-up visit (β = -0.030, P < 0.001). Lesion encroachment on the central and paracentral cornea (β = 0.502, P = 0.024), suture-related complications (β = 1.571, P < 0.001) and graft rejection (β = 0.983, P = 0.035) were significantly correlated with long-term changes in astigmatism. The long-term changes in refraction were not correlated with surgical age, lesion size, lesion depth, steroid-induced high intraocular pressure and changes in mean keratometry.
Suture-related complications and graft rejection should be carefully observed and appropriately treated in order to avoid the possible postoperative increase in astigmatism, especially for patients with lesion encroachment on the central and paracentral cornea. The long-duration amblyopia treatment after surgery appears to have a better correction effect on spherical equivalent in the long term, compared with astigmatism.
本研究旨在确定预测儿童角膜缘皮样瘤行板层角巩膜成形术后屈光变化的因素。
回顾性分析 66 例接受板层角巩膜成形术矫正且随访时间超过 1 年的角膜缘皮样瘤患儿。采用单因素和多因素回归分析探讨与长期屈光参数（包括等效球镜、散光和平均角膜曲率）相关的因素。变化值定义为术后屈光值减去术前屈光值。变化值越低，对术前屈光的矫正效果越满意。
共 66 例患者（平均手术年龄：3.5±2.1 岁）接受了至少 1 年的随访。弱视治疗时间是预测从基线到最后随访时等效球镜长期变化的唯一独立因素（β=-0.030，P<0.001）。病变向中央和旁中央角膜侵袭（β=0.502，P=0.024）、缝线相关并发症（β=1.571，P<0.001）和移植物排斥（β=0.983，P=0.035）与散光的长期变化显著相关。屈光变化与手术年龄、病变大小、病变深度、类固醇诱导的高眼压和平均角膜曲率变化均无相关性。
应仔细观察和适当处理缝线相关并发症和移植物排斥，以避免术后散光可能增加，特别是对于病变向中央和旁中央角膜侵袭的患者。与散光相比，术后长期弱视治疗对等效球镜的长期矫正效果更好。
