Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand.
J Neuroophthalmol. 2023 Mar 1;43(1):17-28. doi: 10.1097/WNO.0000000000001625. Epub 2022 Jun 23.
Nonarteritic anterior ischemic optic neuropathy (NAION) has been reported to occur after cataract surgery. It is not clearly established whether cataract surgery increases the risk of NAION over baseline.
Medline, PubMed, Embase, and Cochrane Central registers were systematically searched for eligible studies reporting on postcataract surgery NAION (psNAION) within 1 year. All peer-reviewed publications with events n ≥ 10 were included. Pooled incidence and odds/hazard ratios and 95% confidence intervals (CIs) were extracted and calculated using random effect models for early and delayed psNAION. Time to event data were pooled for temporal analysis of psNAION events within the first year. This systematic review was registered (PROSPERO CRD42021274383).
Nine articles met the selection criteria with five studies suitable for meta-analysis. A total of 320 psNAION cases, 1,307 spontaneous NAION (sNAION) cases, 1,587,691 cataract surgeries, and 1,538,897 noncataract surgery controls were included. Pooling of 63,823 cataract surgeries and 161,643 controls showed a hazard ratio of 4.6 (95% CI 2.7-7.8) of psNAION within 1 year of surgery. Pooled unadjusted incidence of psNAION within 2 months was 99.92 (95% CI 38.64-161.19) per 100,000/year, psNAION within 1 year was 32.36 (95% CI 9.38-55.34) per 100,000/year, and sNAION was 8.87 (95% CI 2.12-15.62) per 100,000/year. psNAION cases were older by a mean of 7.6 years; otherwise, pooled odds ratios for baseline risk factors in psNAION vs. sNAION cases were not statistically significant. psNAION within the first year peaked within 72 hrs and at 6 weeks after the surgery with 73% of cases occurring within 6 months.
The risk of NAION after cataract surgery is four times greater within the first year and usually occurs within 6 months. However, the absolute risk remains low at 1 in 1,000-3,100 surgeries and is unlikely to warrant extra mention for consenting.
非动脉炎性前部缺血性视神经病变（NAION）在白内障手术后已有报道。目前尚不清楚白内障手术是否会使 NAION 的风险相对于基线增加。
系统地检索了 Medline、PubMed、Embase 和 Cochrane 中心注册库，以获取报告白内障手术后 1 年内发生的 NAION（psNAION）的合格研究。纳入了所有符合条件的事件 n≥10 的同行评审出版物。使用随机效应模型提取并计算了早期和延迟 psNAION 的汇总发病率和比值比及 95%置信区间（CI）。对第一年中 psNAION 事件的时间进行了时间分析。该系统评价已在 PROSPERO（CRD42021274383）上进行了注册。
9 篇文章符合入选标准，其中 5 篇适合进行荟萃分析。共有 320 例 psNAION 病例、1307 例自发性 NAION（sNAION）病例、1587691 例白内障手术和 1538897 例非白内障手术对照纳入分析。对 63823 例白内障手术和 161643 例对照进行汇总分析显示，术后 1 年内发生 psNAION 的风险比为 4.6（95%CI 2.7-7.8）。术后 2 个月内未调整的 psNAION 发病率为每年每 100000/人 99.92（95%CI 38.64-161.19），术后 1 年内为每年每 100000/人 32.36（95%CI 9.38-55.34），sNAION 为每年每 100000/人 8.87（95%CI 2.12-15.62）。psNAION 病例的平均年龄大 7.6 岁；否则，psNAION 病例与 sNAION 病例的基线危险因素汇总比值比无统计学意义。术后 1 年内的 psNAION 风险在 72 小时内和术后 6 周达到峰值，其中 73%的病例发生在术后 6 个月内。
白内障手术后 1 年内发生 NAION 的风险增加 4 倍，通常发生在术后 6 个月内。然而，手术风险仍然较低，每 1000-3100 例手术中发生 1 例，不太可能需要额外告知同意。
