Oshika Tetsuro, Kiuchi Gaku
Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan.
Ophthalmol Ther. 2023 Dec;12(6):3337-3345. doi: 10.1007/s40123-023-00826-6. Epub 2023 Oct 12.
We investigated the long-term outcomes of pediatric cataract surgeries performed with modern surgical techniques involving in-the-bag implantation of a foldable intraocular lens (IOL).
Data were retrospectively collected from 42 eyes in 30 patients who underwent surgery at 6 years and younger (average 2.5 ± 2.3 years) and were followed up for an average of 12.2 ± 2.4 years (10-17 years). Surgical procedures included anterior continuous curvilinear capsulorhexis (CCC), lens removal, posterior CCC, anterior vitrectomy, and in-the-bag IOL implantation. There were 18 unilateral (2.7 ± 2.3 years) and 12 bilateral cases (2.3 ± 2.3 years), with no significant age difference between groups (p = 0.462).
The mean best-corrected visual acuity (BCVA) at the final visit was 0.453 ± 0.488 (logMAR), correlating significantly with the age at surgery (r = -0.307, p = 0.048). The unilateral group had a worse BCVA (0.658 ± 0.615) than the bilateral group (0.298 ± 0.294) (p < 0.001). On average, eyes showed a myopic shift of -6.0 ± 6.3D, which significantly correlated with surgical age (r = 0.402, p = 0.008). While the myopic shift was -8.2 ± 6.1 D in the unilateral group and -4.9 ± 6.4 D in the bilateral group, the net shift for unilateral cases (comparing pseudophakic and fellow eyes) was -4.8 D. Three eyes (7.1%) exhibited suspected glaucoma (increased intraocular pressure), but no glaucoma or other severe complications were noted. IOL exchange surgery was necessary in two eyes (4.8%) due to pronounced myopic drift and significant IOL decentration. Three eyes (7.1%) required surgery for significant visual axis opacification.
Contemporary surgical strategies appear to yield promising long-term outcomes in patients with infantile cataracts.
我们研究了采用现代手术技术进行小儿白内障手术的长期效果，这些技术包括在囊袋内植入可折叠人工晶状体（IOL）。
回顾性收集了30例患者42只眼的数据，这些患者在6岁及以下接受手术（平均2.5±2.3岁），平均随访12.2±2.4年（10 - 17年）。手术操作包括连续环形撕囊（CCC）、晶状体摘除、后囊膜连续环形撕囊、前部玻璃体切除术和囊袋内人工晶状体植入。有18例单侧病例（2.7±2.3岁）和12例双侧病例（2.3±2.3岁），两组间年龄无显著差异（p = 0.462）。
末次随访时平均最佳矫正视力（BCVA）为0.453±0.488（logMAR），与手术时年龄显著相关（r = -0.307，p = 0.048）。单侧组的BCVA（0.658±0.615）比双侧组（0.298±0.294）差（p < 0.001）。平均而言，患眼出现了-6.0±6.3D的近视漂移，这与手术年龄显著相关（r = 0.402，p = 0.008）。单侧组的近视漂移为-8.2±6.1D，双侧组为-4.9±6.4D，单侧病例（比较假晶状体眼和对侧眼）的净漂移为-4.8D。三只眼（7.1%）出现疑似青光眼（眼压升高），但未发现青光眼或其他严重并发症。由于明显的近视漂移和显著的人工晶状体偏心，两只眼（4.8%）需要进行人工晶状体置换手术。三只眼（7.1%）因明显的视轴混浊需要手术。
当代手术策略似乎能为婴儿白内障患者带来有前景的长期效果。
