Complications in infants undergoing surgery for congenital cataract in the first 12 weeks of life: Is early surgery better?
Complications in infants undergoing surgery for congenital cataract in the first 12 weeks of life: Is early surgery better?
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DOI：
10.1016/s1091-8531(02)00005-8
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发表时间：
2003-04-01
期刊：
影响因子：
1.6
通讯作者：
Levin, AV
中科院分区：
文献类型：
--
作者：
Watts, P;Abdolell, M;Levin, AV
目的：确定出生后12周内先天性白内障手术干预的时机与术后并发症的患病率之间是否存在关联。方法.我们对1990年至2000年出生后12周内接受先天性白内障手术的婴儿的记录进行了回顾性分析。55例80眼患儿随访至少6个月。25例为双眼白内障，30例为单眼白内障。所有婴儿均行角膜缘入路晶状体玻璃体切除术。无晶状体眼患儿采用接触透镜或眼镜矫正。记录手术和术后并发症，包括青光眼、眼球震颤、斜视、视网膜脱离和后囊膜混浊/继发膜。观察到眼部和全身相关性。采用分类回归树（CART）进行统计分析。结果：手术时的平均年龄为31.5 ± 23.3天（中位数为26.5天，范围为2 - 84天）。从手术开始的平均随访时间为2.85 ± 1.9年（中位数，2年;范围，0.5 - 8年）。14只眼存在持续性胎儿血管（持续性增生性原始玻璃体）。一例双侧持续性胎儿血管的婴儿双侧视网膜发育不良，从分析中排除。12名婴儿（22%）发生青光眼; 18名婴儿（33%）出现眼球震颤; 28名婴儿（52%）发生斜视; 7只眼睛（13%）发生次级膜。CART分析表明，青光眼在出生后13.5天至43天之间进行手术的婴儿中更为普遍（CART = 0.370）;在出生后48 - 84天之间进行手术时发生眼球震颤（CART = 0.500）;在出生后55.5 - 84天之间进行手术时斜视（CART = 0.600）;以及在出生后26.5至40天之间进行手术时的次级膜（CART = 0.4）。结论：我们的数据表明，出生后的前2周是减少出生后12周内出现白内障的婴儿手术干预引起的术后并发症的最有利时间。
Purpose: To determine if there is an association between the timing of surgical intervention for congenital cataract within the first 12 weeks of life and the prevalence of postoperative complications. Methods. We performed a retrospective review of records from 1990 to 2000 of infants who underwent surgery for congenital cataract within the first 12 weeks of life. Eighty eyes in 55 children were involved with a minimum follow up of 6 months. Bilateral cataracts were present in 25 and monocular cataracts in 30 infants. A limbal approach lensectomy-vitrectomy was performed in all infants. Children with aphakia were rehabilitated with contact lens or glasses. Operative and postoperative complications-including glaucoma, nystagmus, strabismus, retinal detachment, and posterior capsule opacification/secondary membranes-were recorded. Ocular and systemic associations were noted. Statistical analysis was carried out with classification and regression trees (CART). Results: The mean age at the time of surgery was 31.5 +/- 23.3 days (median, 26.5,: range, 2 to 84). Mean follow up from the time of surgery was 2.85 +/- 1.9 years (median, 2; range, 0.5 to 8). Persistent fetal vasculature (persistent hyperplastic primary vitreous) was present in 14 eyes. One infant with bilateral persistent fetal vasculature had bilateral retinal dysplasia and was excluded from the analysis. Glaucoma developed in 12 infants (22%); nystagmus was present in 18 infants (33%); strabismus developed in 28 infants (52%); and secondary membranes developed in 7 eyes (13%). CART analysis suggests that glaucoma is more prevalent in infants when the surgery was performed between 13.5 and 43 days of life (CART = 0.370); nystagmus when surgery is performed between 48 and 84 days of life (CART = 0.500); strabismus when surgery is performed between 55.5 and 84 days of life (CART = 0.600); and secondary membranes when surgery is performed between 26.5 and 40 days of life (CART = 0.4). Conclusions: Our data suggest that the first 2 weeks of life comprise the most favorable time for decreasing postoperative complications resulting from surgical intervention for infants presenting with cataracts within the first 12 weeks of life.