小儿白内障手术后青光眼相关不良事件发生时间的相关因素及首选的抗青光眼手术选择。
Factors associated with the time of glaucoma-related adverse events onset after pediatric cataract surgery and the preferred anti-glaucomatous surgical selection.
作者信息
Wu Na, Sun Xinghuai
机构信息
Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China.
出版信息
Int Ophthalmol. 2025 Jan 20;45(1):28. doi: 10.1007/s10792-025-03412-w.
PURPOSE
To describe the clinical characteristics of glaucoma-related adverse events (GRAE) after pediatric cataract surgery. More importantly, to identify the factors associated with the time of GRAE onset and the preferred anti-glaucomatous surgical procedure for this disease.
METHODS
Hospitalized medical records of patients who developed GRAE, which include glaucoma and glaucoma suspect, after pediatric cataract surgery (surgical age ≤ 14 years) between 1994 and 2021 were retrospectively reviewed. If the interval between cataract surgery and GRAE diagnosis was less than one year, early-onset GRAE was diagnosed, otherwise it was late-onset type. Multivariate logistic regression analysis was performed to investigate the possible associated factors for the type of GRAE onset. Chi-square test was used to evaluate the differences of the re-operation rate between the two surgical groups of glaucoma valve implantation and trabeculectomy for controlling elevated intraocular pressure (IOP).
RESULTS
125 eyes in 94 patients with GRAE following pediatric cataract surgery were included in the study. Among them, 25 patients had unilateral cataracts and 100 eyes in 69 patients were bilateral. Of the 125 eyes, 63 (50.4%) had initial cataract surgery under 6 months of age, and 97 (77.6%) under 2 years of age. 76 eyes (60.8%) were aphakic, and 21 (16.8%) were with primary intraocular lens (IOL) implantation and the remaining 28 (22.4%) with secondary IOL implantation. More than half of the eyes (69/104, 66.3%) belonged to the group of late-onset GRAE. Multivariate analysis showed that a younger age at cataract surgery was associated with early-onset GRAE (P = 0.041). Closed angles were found in 72.1% (44/61) of eyes before the first anti-glaucomatous surgeries. 50% eyes (9/18) after trabeculectomy needed re-operation to control IOP compared with 12.1% (4/33) after glaucoma valve implantation (P = 0.003).
CONCLUSIONS
An earlier age at pediatric cataract surgery is more likely to develop early-onset GRAE. Glaucoma valve implantation seemed to be a preferred surgical intervention for patients with GRAE.
目的
描述小儿白内障手术后青光眼相关不良事件（GRAE）的临床特征。更重要的是，确定与GRAE发病时间相关的因素以及针对该疾病的首选抗青光眼手术方式。
方法
回顾性分析1994年至2021年间小儿白内障手术（手术年龄≤14岁）后发生GRAE（包括青光眼和青光眼可疑病例）患者的住院病历。如果白内障手术与GRAE诊断之间的间隔小于1年，则诊断为早发性GRAE，否则为迟发性类型。进行多因素逻辑回归分析以探讨GRAE发病类型的可能相关因素。采用卡方检验评估青光眼瓣膜植入术和小梁切除术两组手术控制眼压升高的再次手术率差异。
结果
本研究纳入了94例小儿白内障手术后发生GRAE患者的125只眼。其中，25例患者为单眼白内障，69例患者的100只眼为双眼白内障。在这125只眼中，63只（50.4%）在6个月龄以下接受了初次白内障手术，97只（77.6%）在2岁以下接受了手术。76只眼（60.8%）为无晶状体眼，21只眼（16.8%）为一期人工晶状体（IOL）植入，其余28只眼（22.4%）为二期IOL植入。超过一半的眼（69/104，66.3%）属于迟发性GRAE组。多因素分析显示，白内障手术时年龄较小与早发性GRAE相关（P = 0.041）。在首次抗青光眼手术前，72.1%（44/61）的眼中发现闭角。小梁切除术后50%的眼（9/18）需要再次手术以控制眼压，而青光眼瓣膜植入术后为12.1%（4/33）（P = 0.003）。
结论
小儿白内障手术年龄越小，越易发生早发性GRAE。青光眼瓣膜植入术似乎是GRAE患者的首选手术干预方式。
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