IRIS 注册研究中儿童白内障手术后青光眼诊断和手术干预的风险因素。
Risk Factors for Glaucoma Diagnosis and Surgical Intervention following Pediatric Cataract Surgery in the IRIS® Registry.
机构信息
Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
出版信息
Ophthalmol Glaucoma. 2024 Mar-Apr;7(2):131-138. doi: 10.1016/j.ogla.2023.08.009. Epub 2023 Sep 6.
PURPOSE
To compare demographic and clinical factors associated with glaucoma following cataract surgery (GFCS) and glaucoma surgery rates between infants, toddlers, and older children using a large, ophthalmic registry.
DESIGN
Retrospective cohort study.
PARTICIPANTS
Patients in the IRIS® Registry (Intelligent Research in Sight) who underwent cataract surgery at ≤ 17 years old and between January 1, 2013 and December 31, 2020.
METHODS
Glaucoma diagnosis and procedural codes were extracted from the electronic health records of practices participating in the IRIS Registry. Children with glaucoma diagnosis or surgery before cataract removal were excluded. The Kaplan-Meier estimator was used to determine the cumulative probability of GFCS diagnosis and glaucoma surgery after cataract surgery. Multivariable Cox regression was used to identify factors associated with GFCS and glaucoma surgery.
MAIN OUTCOME MEASURES
Cumulative probability of glaucoma diagnosis and surgical intervention within 5 years after cataract surgery.
RESULTS
The study included 6658 children (median age, 10.0 years; 46.2% female). The 5-year cumulative probability of GFCS was 7.1% (95% confidence interval [CI], 6.1%-8.1%) and glaucoma surgery was 2.6% (95% CI, 1.9%-3.2%). The 5-year cumulative probability of GFCS for children aged < 1 year was 22.3% (95% CI, 15.7%-28.4%). Risk factors for GFCS included aphakia (hazard ratio [HR], 2.63; 95% CI, 1.96-3.57), unilateral cataract (HR, 1.48; 95% CI, 1.12-1.96), and Black race (HR, 1.61; 95% CI, 1.12-2.32). The most common surgery was glaucoma drainage device insertion (32.6%), followed by angle surgery (23.3%), cyclophotocoagulation (15.1%), and trabeculectomy (5.8%).
CONCLUSIONS
Glaucoma following cataract surgery diagnosis in children in the IRIS Registry was associated with young age, aphakia, unilateral cataract, and Black race. Glaucoma drainage device surgery was the preferred surgical treatment, consistent with the World Glaucoma Association 2013 consensus recommendations for GFCS management.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的
利用大型眼科注册中心，比较白内障手术后青光眼（GFCS）和青光眼手术率在婴儿、幼儿和大龄儿童中相关的人口统计学和临床因素。
设计
回顾性队列研究。
参与者
在 2013 年 1 月 1 日至 2020 年 12 月 31 日期间，在 IRIS®注册中心（智能眼科研究）接受≤17 岁白内障手术的患者。
方法
从参与 IRIS 注册中心的实践的电子健康记录中提取青光眼诊断和程序代码。排除白内障切除前有青光眼诊断或手术的儿童。使用 Kaplan-Meier 估计器确定白内障手术后 5 年内青光眼诊断和手术干预的累积概率。多变量 Cox 回归用于确定与 GFCS 和青光眼手术相关的因素。
主要观察指标
白内障手术后 5 年内青光眼诊断和手术干预的累积概率。
结果
本研究纳入了 6658 名儿童（中位年龄 10.0 岁；46.2%为女性）。5 年累积 GFCS 发生率为 7.1%（95%置信区间[CI]，6.1%-8.1%），青光眼手术发生率为 2.6%（95%CI，1.9%-3.2%）。1 岁以下儿童的 5 年累积 GFCS 发生率为 22.3%（95%CI，15.7%-28.4%）。GFCS 的危险因素包括无晶状体（风险比[HR]，2.63；95%CI，1.96-3.57）、单侧白内障（HR，1.48；95%CI，1.12-1.96）和黑种人（HR，1.61；95%CI，1.12-2.32）。最常见的手术是青光眼引流装置植入术（32.6%），其次是角切开术（23.3%）、睫状体光凝术（15.1%）和小梁切除术（5.8%）。
结论
IRIS 注册中心中儿童白内障手术后的青光眼诊断与年龄较小、无晶状体、单侧白内障和黑种人有关。青光眼引流装置手术是首选的手术治疗方法，这与 2013 年世界青光眼协会对 GFCS 管理的共识建议一致。
财务披露
本文末尾的脚注和披露中可能包含专有或商业披露。
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