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小儿白内障手术后视网膜脱离的发生率,危险因素和预后

Agarkar, S., Gokhale, V.V., Raman, R., Bhende, M., Swaminathan, G., Jain, M.

期刊名称:Ophthalmology

卷期:2018年第125卷第1期

摘要

摘要:目的:旨在报道小儿白内障术后视网膜脱离(RD)的发生率,并评估其长期风险,易感因素及手术预后。设计:回顾性连续介入病例系列。研究对象:1996年至2007年研究期间,在一所三级眼科医院对29516岁以下没有发生其他眼部和全身异常的儿童的481只眼行晶状体切除术,后囊膜切开术和玻璃体切除联合原发性人工晶状体植入术。中位随访时间为66个月。方法:采用Kaplan-Meier估计和Cox比例风险回归模型分别估计累积风险和风险比(HR)。计算术前眼轴长度与年龄相匹配的平均眼轴长度之间的差异(既往研究),这种差异定义为年龄校正轴长差(ALD)(分别表示近视和远视)。主要观察指标:累计风险和潜在风险因素。结果:9例儿童的12眼在白内障术后发生RD,中位时间70个月。白内障术后10RD的总体风险为5.5%。所有9名儿童都是男性。智力障碍儿童RD风险升高相关多点调整风险为12.4295%可信区间[CI]2.91-53.01; P = 0.001),经年龄校正的ALD <-1mm(近视)儿童眼为21.9395CI2.95-162.80; P = 0.003)。玻璃体后脱离诱发相关的视网膜脱离是RD最常见的(8只眼)原因。 2只眼睛没有进行手术干预。4只眼和6只眼分别进行巩膜扣带术和玻璃体切除联合巩膜扣带术。在末次随访中,5只和9只眼的视力优于或等于6/186/60。结论:没有已知的眼部和全身异常儿童白内障手术后前10RD的风险为5.5%。男性,近视和智障儿童的风险显着增加。我们强调小儿白内障手术后需要定期和长期随访。

PURPOSE:To report the incidence of, and to estimate the long-term risk and predisposing factors and the surgical outcomes for, retinal detachment (RD) after pediatric cataract surgery.DESIGN:Retrospective consecutive interventional case series.PARTICIPANTS:During the study period 1996 to 2007 at a tertiary eye care institute, 481 eyes of 295 children aged below 16 years with no other ocular and systemic anomalies who underwent lensectomy, posterior capsulorrhexis, and anterior vitrectomy combined with primary intraocular lens implantation were included. The median follow-up was 66 months.METHODS:Kaplan-Meier estimates and Cox proportional hazard regression model were used for estimating cumulative risk and hazard ratio (HR), respectively. Difference between measured preoperative axial length and age-matched mean axial length (prior studies) was calculated, and was defined as age-adjusted axial length difference (ALD) (minus and plus denotes myopia and hypermetropia, respectively).MAIN OUTCOME MEASURES:Cumulative risk and potential risk factors for RD.RESULTS:Of the total, 12 eyes of 9 children developed RD after cataract surgery, with a median time of 70 months. The overall risk of RD was 5.5% at 10 years after cataract surgery. All 9 children were male. The multi-adjusted HR associated with increased risk of RD was 12.42 (95% confidence interval [CI], 2.91-53.01; P = 0.001) for eyes of children with intellectual disability and 21.93 (95% CI, 2.95-162.80; P = 0.003) for eyes of children with age-adjusted ALD < -1 mm (myopic). Retinal break associated with induction of posterior vitreous detachment was the most common (8 eyes) cause of RD. No surgical intervention was done in 2 eyes. Scleral buckle and vitrectomy combined with belt buckle were performed in 4 and 6 eyes, respectively. At final follow-up, 5 and 9 eyes had a visual acuity better than or equal to 6/18 and 6/60, respectively.CONCLUSIONS:A 5.5% risk for RD is estimated for the first 10 years after cataract surgery in children with no known ocular and systemic anomalies. The risk significantly increases in a male, myopic, and intellectual disabled child. We emphasize the need for regular and long-term follow-up after pediatric cataract surgery.


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