Zhang J, Sun J F, Wan X M, Ding Y C, Xie L X
Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Qingdao 266071, China.
Department of Ophthalmology, Yantaishan Hospital, Yantai 264003, China.
Zhonghua Yan Ke Za Zhi. 2023 Feb 11;59(2):102-109. doi: 10.3760/cma.j.cn112142-20220602-00276.
To examine the outcomes of surgical treatment for infants with congenital cataract and microphthalmia (CATM). It was a retrospective case series study. Data of 28 (55 eyes) CATM children who underwent cataract surgery at the Qingdao Eye Hospital of Shandong First Medical University and were followed up for more than 5 years between January 2010 and December 2014 under the age of 6 months. There were 15 male and 13 female children. The age at the time of surgery was (3.2±1.3) months, and the follow-up time was (8.2±1.7) years. The data included the basic information of the children, the ocular biological parameters before and after surgery and intraocular lens (IOL) implantation, and the occurrence of complications. Paired -tests or Wilcoxon signed rank tests were used to compare groups, and logistic regression analysis was used to identify factors related to IOL implantation, secondary glaucoma, and visual axis opacification (VAO). The mean preoperative axial length was (16.6±1.0) mm, and the mean horizontal corneal diameter was (9.5±0.9) mm. The axial growth rate within 2 years after the first stage of surgery was (1.4±0.8) mm/year. None of the children had an IOL implanted before the age of 2. Sixty percent of the eyes (33/55) received IOL implantation within 2 to 4 years after the first stage of surgery, while the remaining 40% (22/55) did not receive IOL implantation at the last follow-up. The axial growth rate was (0.9±0.7) mm/year within two years after the second stage of surgery. Postoperative secondary glaucoma occurred in 7 eyes (12.7%), and VAO occurred in 15 eyes (27.3%). IOL implantation was associated with preoperative axial length (=0.072, <0.001) and age at the first stage of surgery (=7.270, <0.001), but not with preoperative corneal diameter (=0.735). The incidence of VAO was associated with preoperative corneal diameter (=4.124, =0.011), but not with age at the first stage of surgery (=0.489) or preoperative axial length (=0.489). No factors related to the occurrence of secondary glaucoma were found. The best corrected visual acuity at the last follow-up after IOL implantation was (0.37±0.28) logMAR, which was better than that of children without IOL implantation (0.67±0.19) logMAR (=49.50, =0.003). Children with CATM can obtain the opportunity for IOL implantation through early surgery and ultimately achieve good visual outcomes. Properly selecting the timing for implanting IOL can keep the incidence of secondary glaucoma at an acceptable level.
探讨先天性白内障合并小眼球（CATM）患儿的手术治疗效果。这是一项回顾性病例系列研究。收集了2010年1月至2014年12月在山东第一医科大学附属青岛眼科医院接受白内障手术且随访时间超过5年、年龄在6个月以下的28例（55只眼）CATM患儿的数据。其中男性患儿15例，女性患儿13例。手术时年龄为（3.2±1.3）个月，随访时间为（8.2±1.7）年。数据包括患儿的基本信息、手术前后的眼部生物学参数及人工晶状体（IOL）植入情况、并发症发生情况。采用配对t检验或Wilcoxon符号秩检验进行组间比较，采用Logistic回归分析确定与IOL植入、继发性青光眼和视轴混浊（VAO）相关的因素。术前平均眼轴长度为（16.6±1.0）mm，平均角膜水平直径为（9.5±0.9）mm。一期手术后2年内眼轴生长速率为（1.4±0.8）mm/年。所有患儿在2岁前均未植入IOL。60%的眼（33/55）在一期手术后2至4年内接受了IOL植入，而其余40%（22/55）在最后一次随访时未接受IOL植入。二期手术后2年内眼轴生长速率为（0.9±0.7）mm/年。术后7只眼（12.7%）发生继发性青光眼，15只眼（27.3%）发生VAO。IOL植入与术前眼轴长度（β =0.072，P<0.001）和一期手术时年龄（β =7.270，P<0.001）相关，但与术前角膜直径（β =0.735）无关。VAO的发生率与术前角膜直径（β =4.124，P =0.011）相关，但与一期手术时年龄（β =0.489）或术前眼轴长度（β =0.489）无关。未发现与继发性青光眼发生相关的因素。IOL植入后最后一次随访时的最佳矫正视力为（0.37±0.28）logMAR，优于未植入IOL患儿的（0.67±0.19）logMAR（t =49.50，P =0.003）。CATM患儿可通过早期手术获得IOL植入机会并最终取得良好的视觉效果。合理选择IOL植入时机可使继发性青光眼的发生率保持在可接受水平。
