婴幼儿先天性白内障手术后视力和继发青光眼的临床分析

Clinical analysis of the secondary glaucoma and postoperative visual acuity after infantile congenital cataract surgery

目的:探讨婴幼儿先天性白内障手术后视力和继发青光眼的相关分析。方法:回顾性系列病例研究。观察我院2006-05/2018-01期间收治的婴幼儿先天性白内障患儿48例86眼,均行白内障吸除、后囊膜及前段玻璃体切除手术及人工晶状体(IOL)植入术。术后随访最长13a。对最佳矫正视力(BCVA,LogMAR),继发性青光眼进行临床观察。数据采用独立样本t检验、Fisher确切概率法分析、Logistic多元回归分析进行统计学分析。结果:继发青光眼13眼(15%),BCVA 0.63±0.20;无继发青光眼73眼(85%),BCVA 0.44±0.27;两组BCVA比较有差异(t=2.417,P<0.05)。白内障摘除手术年龄≤3、>3~12、>12月龄,继发青光眼概率分别29%(6/21)、18%(6/34)、3%(1/31);Fisher分析,手术年龄≤3月龄继发青光眼概率要高于手术年龄>12月龄的(P<0.05)。继发青光眼组眼轴长度(AL)长于未继发青光眼组(t=-2.92,P=0.004);继发青光眼组屈光度小于未继发青光眼组(t=4.00,P=0.0001)。Logistic多元回归分析显示:白内障手术年龄≤12月龄是术后继发青光眼的危险因素,发生率是手术年龄>12月龄的8.372倍(OR=8.372,95%CI:1.033~67.864,P=0.047)。结论:婴幼儿先天性白内障术后可获得一定视力并有一定继发性青光眼发生率,青光眼对术后视力有极大影响。白内障手术年龄≤12月龄是术后继发青光眼的危险因素,尤其3月龄前手术的青光眼发生率远高于12月龄以后。继发青光眼患儿AL更长,屈光度更小,有着更明显的近视漂移。

AIM:To analyze correlation of secondary glaucoma and postoperative visual acuity after infantile congenital cataract surgery.METHODS:Retrospective case series.Totally 48 cases(86 eyes)were observed in our hospital from May 2006 to January 2018.All patients received intraocular lens(IOL)implantation with posterior continuous curvilinear capsulorhexies and anterior vitrectomy after cataract extraction.The best corrected visual acuity(BCVA)was determined,secondary glaucoma was evaluated during the 13a follow-up period.The independent samples t-test,Fisher exact test and multivariate Logistic regression were used to analyze the data.RESULTS:Thirteen eyes(15%)with secondary glaucoma postoperative BCVA(LogMAR)were 0.63±0.20.And 73 eyes(85%)without secondary glaucoma postoperative BCVA were 0.44±0.27,there was statistically significant difference in BCVA between the two groups(t=2.417,P<0.05).Glaucoma occurred in 29%,18%and 3%of patients with cataract extraction≤3mo,3-12mo and>12mo,respectively.Fisher analysis there was statistically significant difference between operation age≤3mo and>12mo(P<0.05).The difference of axial length(AL)and refraction diopter between with and without secondary glaucoma were statistically significant(t=-2.92,P=0.004).Multivariate Logistic regression analysis showed surgery age≤12mo was the risk factor(OR=8.372,95%CI:1.033-67.864,P=0.047).Cataract surgery age below 12mo is 8.372 times the probability of secondary glaucoma than surgery age above 12mo.CONCLUSION:Most children can achieve good postoperative visual acuity and the secondary glaucoma occurred after surgery.The age of cataract surgery more than 12mo is a risk factor for postoperative secondary glaucoma,especially cataract surgery age below 3mo is much higher the probability of secondary glaucoma than above 12mo.Patients with secondary glaucoma have longer AL,smaller refraction diopter and more pronounced myopia drift than patients without secondary glaucoma.