Hwang Bryce, Oke Isdin, Lambert Scott R
Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.
Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
Ophthalmol Sci. 2023 Jan 11;3(2):100271. doi: 10.1016/j.xops.2023.100271. eCollection 2023 Jun.
To determine the cumulative incidence of strabismus surgery after pediatric cataract surgery and identify the associated risk factors.
US population-based insurance claims retrospective cohort study.
Patients ≤ 18 years old who underwent cataract surgery in 2 large databases: Optum Clinformatics Data Mart (2003-2021) and IBM MarketScan (2007-2016).
Individuals with at least 6 months of prior enrollment were included, and those with a history of strabismus surgery were excluded. The primary outcome was strabismus surgery within 5 years of cataract surgery. The risk factors investigated included age, sex, persistent fetal vasculature (PFV), intraocular lens (IOL) placement, nystagmus and strabismus diagnoses before cataract surgery, and cataract surgery laterality.
Kaplan-Meier estimated cumulative incidence of strabismus surgery 5 years after cataract surgery and hazard ratios (HRs) with 95% confidence intervals (CIs) from multivariable Cox proportional hazards regression models.
Strabismus surgery was performed on 271/5822 children included in this study. The cumulative incidence of strabismus surgery within 5 years after cataract surgery was 9.6% (95% CI, 8.3%-10.9%). Children who underwent strabismus surgery were more likely to be of younger age at the time of cataract surgery, of female sex, have a history of PFV or nystagmus, have a pre-existing strabismus diagnosis, and less likely to have an IOL placed (all < 0.001). Factors associated with strabismus surgery in the multivariable analysis included age 1 to 4 years (HR, 0.50; 95% CI, 0.36-0.69; < 0.001) and age > 5 years (HR, 0.13; 95% CI, 0.09-0.18; < 0.001) compared with age < 1 year at time of cataract surgery, male sex (HR, 0.75; 95% CI, 0.59-0.95; < 0.001), IOL placement (HR, 0.71; 95% CI, 0.54-0.94; = 0.016), and strabismus diagnosis before cataract surgery (HR, 4.13; 95% CI, 3.17-5.38; < 0.001). Among patients with strabismus diagnosis before cataract surgery, younger age at cataract surgery was the only factor associated with increased risk of strabismus surgery.
Approximately 10% of patients will undergo strabismus surgery within 5 years after pediatric cataract surgery. Children of younger age, female sex, and with a pre-existing strabismus diagnosis undergoing cataract surgery without IOL placement are at greater risk.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
确定小儿白内障手术后斜视手术的累积发生率，并识别相关危险因素。
基于美国人群保险理赔的回顾性队列研究。
在两个大型数据库（Optum Clinformatics Data Mart，2003 - 2021年；IBM MarketScan，2007 - 2016年）中接受白内障手术的18岁及以下患者。
纳入至少提前6个月入组的个体，排除有斜视手术史者。主要结局为白内障手术后5年内的斜视手术。所研究的危险因素包括年龄、性别、永存原始玻璃体增生症（PFV）、人工晶状体（IOL）植入、白内障手术前的眼球震颤和斜视诊断，以及白内障手术的眼别。
白内障手术后5年斜视手术的Kaplan - Meier估计累积发生率，以及多变量Cox比例风险回归模型得出的风险比（HRs）及95%置信区间（CIs）。
本研究纳入的5822例儿童中有271例接受了斜视手术。白内障手术后5年内斜视手术的累积发生率为9.6%（95% CI，8.3% - 10.9%）。接受斜视手术的儿童在白内障手术时年龄更可能较小、为女性、有PFV或眼球震颤病史、有既往斜视诊断，且植入IOL的可能性较小（均P < 0.001）。多变量分析中与斜视手术相关的因素包括白内障手术时年龄1至4岁（HR，0.50；95% CI，0.36 - 0.69；P < 0.001）和年龄>5岁（HR，0.13；95% CI，0.09 - 0.18；P < 0.001），与白内障手术时年龄<1岁相比，男性（HR，0.75；95% CI，0.59 - 0.95；P < 0.001），IOL植入（HR，0.71；95% CI，0.54 - 0.94；P = 0.016），以及白内障手术前斜视诊断（HR，4.13；95% CI，3.17 - 5.38；P < 0.001）。在白内障手术前有斜视诊断的患者中，白内障手术时年龄较小是与斜视手术风险增加相关的唯一因素。
约10%的患者在小儿白内障手术后5年内将接受斜视手术。年龄较小、女性、白内障手术前有斜视诊断且未植入IOL的儿童风险更高。
作者对本文讨论的任何材料均无所有权或商业利益。
