Pediatric Ophthalmology and Strabismus Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India.
Pediatric Ophthalmology and Strabismus Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India.
Ophthalmol Glaucoma. 2024 Nov-Dec;7(6):602-607. doi: 10.1016/j.ogla.2024.07.001. Epub 2024 Jul 14.
To compare the incidence of secondary glaucoma after cataract surgery performed in infancy in children with congenital rubella syndrome (CRS) and children with nonrubella cataracts and to identify associated risk factors.
Retrospective case control study.
Children with CRS who had undergone cataract surgery in infancy and age-matched infants who had undergone cataract surgery for infantile cataracts were included.
Incidence of glaucoma and probability of survival was compared among the 2 groups.
Risk factors for the development of glaucoma were assessed. The minimum follow-up was 1 year after cataract surgery.
The study included 211 eyes of 115 children. The CRS group (cases) had 101 eyes (58 children) and the nonrubella cataract group (controls) included 110 eyes (57 children). There was no significant difference in the mean age at surgery among the 2 groups (P = 0.96). Cumulative incidence of secondary childhood glaucoma for the entire study period of 14 years was 32.7% in the CRS group and 24.5% in the control group (P = 0.19). Mean follow-up was 5.8 ± 3.7 years for CRS group and 6.4 ± 3.4 years for the nonrubella group. A significant difference in the cumulative probability of glaucoma free survival at 10 years after cataract surgery (cases 0.53 vs controls 0.8; log rank P = 0.034) was present. Both groups had no significant difference in the time of onset of secondary glaucoma, average number of intraocular pressure lowering medications and number of eyes with surgical intervention for glaucoma (P > 0.05). Microcornea was associated with the development of glaucoma (hazard ratio 2.83; 95% confidence interval, 1.44-5.57; P = 0.002) in CRS eyes.
There was no significant difference in the incidence of secondary glaucoma after cataract surgery performed in infants with CRS compared with infants who had undergone surgery for infantile cataracts. Because the 10-year probability of glaucoma free survival was significantly less in children with CRS, a closer and longer follow-up is recommended especially in eyes with at-risk features.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
比较先天性风疹综合征（CRS）患儿与非风疹性白内障患儿在婴儿期行白内障手术后继发性青光眼的发生率，并确定相关的危险因素。
回顾性病例对照研究。
纳入在婴儿期行白内障手术的 CRS 患儿和行婴儿白内障手术的年龄匹配的婴儿。
比较两组青光眼的发生率和生存率。
评估青光眼发生的危险因素。白内障手术后的最低随访时间为 1 年。
本研究共纳入 115 例患儿的 211 只眼。CRS 组（病例）有 101 只眼（58 例患儿），非风疹性白内障组（对照组）有 110 只眼（57 例患儿）。两组手术时的平均年龄无显著差异（P=0.96）。在 14 年的整个研究期间，CRS 组儿童青光眼的累积发病率为 32.7%，对照组为 24.5%（P=0.19）。CRS 组的平均随访时间为 5.8±3.7 年，非风疹组为 6.4±3.4 年。白内障手术后 10 年时无青光眼生存的累积概率存在显著差异（病例组为 0.53，对照组为 0.8；对数秩 P=0.034）。两组继发性青光眼的发病时间、降眼压药物的平均使用次数和青光眼手术干预的眼数均无显著差异（P>0.05）。在 CRS 眼中，小角膜与青光眼的发生有关（风险比 2.83；95%置信区间，1.44-5.57；P=0.002）。
与行婴儿白内障手术的患儿相比，CRS 患儿在婴儿期行白内障手术后，继发性青光眼的发生率无显著差异。由于 CRS 患儿 10 年无青光眼生存的概率明显降低，因此建议进行更密切和更长时间的随访，尤其是对有风险特征的眼。
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