State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong Province, People's Republic of China.
Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, Hainan Province, People's Republic of China.
Br J Ophthalmol. 2024 Feb 21;108(3):476-483. doi: 10.1136/bjo-2022-322589.
To report the incidence and associated risk factors for developing suspected and definitive glaucoma after bilateral congenital cataract (CC) removal with a 5-year follow-up.
Secondary analysis of a prospective longitudinal cohort study. Bilateral CC patients who had undergone cataract surgery between January 2011 and December 2014 at Zhongshan Ophthalmic Centre were recruited. Suspected glaucoma was defined as persistent ocular hypertension requiring medical treatment. Definitive glaucoma was defined as accompanied by the progression of glaucomatous clinical features. According to postoperative lens status in 5 years follow-up: 130 eyes in the aphakia group; 219 in the primary intraocular lens (IOL) implantation group and 337 in the secondary IOL implantation group. The Kaplan-Meier survival and Cox regression analyses were used to explore the cumulative incidence and risk factors for suspected and definitive glaucoma.
Three hundred fifty-one children (686 eyes) with bilateral CCs were enrolled in the study. The mean age at surgery was 1.82±2.08 years, and the mean follow-up duration was 6.26±0.97 years. Suspected and definitive glaucoma developed at a mean time of 2.84±1.75 years (range 0.02-7.33 years) postoperatively. The cumulative incidence of suspected and definitive glaucoma was 9.97% (35 of 351 patients), including 6.12% (42 eyes) for definitive glaucoma and 2.48% (17 eyes) for suspected glaucoma. Microcornea (HR 4.103, p<0.0001), CC family history (HR 3.285, p=0.001) and initial anterior vitrectomy (HR 2.365 p=0.036) were risk factors for suspected and definitive glaucoma. Gender, age at surgery, intraocular surgery frequency, length of follow-up and frequency of neodymium-doped yttrium aluminumaluminium garnet laser were non-statistically significant. Primary IOL implantation was a protective factor (HR 0.378, p=0.007).
Identifying suspected and definitive glaucoma after bilateral CC surgery can lower the risk of secondary blindness in children. Patients with related risk factors need to pay more attention and thus reach early intervention and treatment during clinical practice. Primary IOL implantation may be a potential protective factor, need more clinical trials to be verified.
NCT04342052.
报告 5 年随访中双侧先天性白内障（CC）切除术后疑似和确诊青光眼的发生率及相关危险因素。
这是一项前瞻性纵向队列研究的二次分析。招募了 2011 年 1 月至 2014 年 12 月在中山眼科中心接受白内障手术的双侧 CC 患者。疑似青光眼定义为需要药物治疗的持续性眼高压。确诊青光眼定义为伴有青光眼临床特征进展。根据术后 5 年的晶状体状态：无晶状体组 130 只眼；一期人工晶状体（IOL）植入组 219 只眼；二期 IOL 植入组 337 只眼。采用 Kaplan-Meier 生存分析和 Cox 回归分析探讨疑似和确诊青光眼的累积发生率和危险因素。
本研究共纳入 351 例（686 只眼）双侧 CC 患儿。手术时的平均年龄为 1.82±2.08 岁，平均随访时间为 6.26±0.97 年。术后平均 2.84±1.75 年（0.02-7.33 年）出现疑似和确诊青光眼。疑似和确诊青光眼的累积发生率为 9.97%（35 例患者），其中确诊青光眼 6.12%（42 只眼），疑似青光眼 2.48%（17 只眼）。小角膜（HR 4.103，p<0.0001）、CC 家族史（HR 3.285，p=0.001）和初次前玻璃体切割术（HR 2.365，p=0.036）是疑似和确诊青光眼的危险因素。性别、手术年龄、眼内手术次数、随访时间、钕掺杂钇铝石榴石激光次数与疑似和确诊青光眼无关。一期 IOL 植入是保护性因素（HR 0.378，p=0.007）。
识别双侧 CC 手术后的疑似和确诊青光眼可降低儿童继发性失明的风险。有相关危险因素的患者需要更加注意，以便在临床实践中尽早进行干预和治疗。一期 IOL 植入可能是一个潜在的保护因素，需要更多的临床试验来验证。
NCT04342052。
