Glaucoma-Related Adverse Events in the First 5 Years After Unilateral Cataract Removal in the Infant Aphakia Treatment Study.
Glaucoma-Related Adverse Events in the First 5 Years After Unilateral Cataract Removal in the Infant Aphakia Treatment Study.
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DOI：
10.1001/jamaophthalmol.2015.1329
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发表时间：
2015-08
影响因子：
8.1
通讯作者：
Infant Aphakia Treatment Study Group
中科院分区：
文献类型：
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作者：
Freedman SF;Lynn MJ;Beck AD;Bothun ED;Örge FH;Lambert SR;Infant Aphakia Treatment Study Group
青光眼相关的不良事件构成了婴儿期白内障摘除术中威胁视力的主要并发症，但它们与无晶状体眼和一期人工透镜（IOL）植入术的关系仍不确定。在婴儿无晶状体眼治疗研究（IATS）中，确定并描述5岁以下儿童的青光眼和青光眼相关不良事件（青光眼+疑似青光眼）病例。一项对114名手术时年龄在1-6个月之间的单侧先天性白内障婴儿进行的多中心随机对照试验。参与者在白内障手术时被随机分配至一期IOL或无IOL植入（接触透镜[CL]）。青光眼和疑似青光眼的标准化定义被创建为IATS并应用于监测和诊断。5岁以下患眼发生青光眼和青光眼+疑似青光眼，5岁时发生眼内压、视力和眼轴长度。术后4.8年青光眼和青光眼+疑似青光眼风险的乘积限估计值分别为17%（95%CI=11%-25%）和31%（95%CI=24%-41%）。CL组和IOL组的两种结局均无显著差异：青光眼（风险比（HR）=0.8[95%CI=0.3-2.0]，p=0.62）;青光眼+疑似青光眼：（HR=1.3[95%CI=0.6-2.5]，p=0.58）。手术时年龄越小（相对于年龄越大），青光眼风险越高（术后4.8年分别为26%和9%（HR=3.2[95%CI=1.2-8.3]）），角膜直径越小（相对于较大），青光眼+疑似青光眼风险越高（HR=2.5[95%CI=1.3-5.0]）。年龄与角膜直径呈显著正相关。青光眼主要为开角型（19/20例，95%），大多数眼睛接受药物治疗（19/20例，95%），8/20例（40%）眼睛接受手术。这些结果表明，青光眼相关的不良事件很常见，在1-6个月大的单侧白内障摘除术后的婴儿中，1 - 5岁之间的不良事件会增加;初次IOL植入并不能降低其风险，但在更小的年龄进行手术会增加风险。这些儿童的长期随访可能进一步表征风险因素、长期结局、原发性IOL与无晶状体眼之间的潜在差异以及单侧先天性白内障摘除的最佳时机。
Glaucoma-related adverse events constitute major sight-threatening complications of cataract removal in infancy, yet their relationship to aphakia versus primary intraocular lens (IOL) implantation remains unsettled. To identify and characterize cases of glaucoma and glaucoma-related adverse events (glaucoma+glaucoma suspect) among children in the Infant Aphakia Treatment Study (IATS) by the age of five years. A multicenter randomized controlled trial of 114 infants with unilateral congenital cataract who were between age 1–6 months at surgery. Participants were randomized at cataract surgery to either primary IOL, or no IOL implantation (contact lens [CL]). Standardized definitions of glaucoma and glaucoma suspect were created for IATS and applied for surveillance and diagnosis. Development of glaucoma and glaucoma+glaucoma suspect in operated eyes up to age five years, plus intraocular pressure, visual acuity, and axial length at age five years. Product limit estimates of the risk of glaucoma and glaucoma+glaucoma suspect at 4.8 years after surgery were 17% (95%CI=11%–25%) and 31% (95%CI=24%–41%), respectively. The CL and IOL groups were not significantly different for either outcome: glaucoma (hazard ratio(HR)=0.8[95%CI=0.3–2.0],p=0.62); glaucoma+glaucoma suspect: (HR=1.3[95%CI=0.6–2.5],p=0.58). Younger (versus older) age at surgery conferred increased risk of glaucoma (26% versus 9%, respectively at 4.8 years after surgery (HR=3.2[95%CI=1.2–8.3]), and smaller (versus larger) corneal diameter showed increased risk for glaucoma+glaucoma suspect (HR=2.5[95%CI=1.3–5.0]). Age and corneal diameter were significantly positively correlated. Glaucoma was predominantly open angle (19/20 cases, 95%), most eyes received medication (19/20, 95%), and 8/20 (40%) eyes had surgery. These results suggest that glaucoma-related adverse events are common and increase between one and five years in infants after unilateral cataract removal at 1–6 months of age; primary IOL placement does not mitigate their risk, but surgery at a younger age increases the risk. Longer follow-up of these children may further characterize risk factors, long-term outcomes, potential differences between eyes having primary IOL vs. aphakia, and optimal timing of unilateral congenital cataract removal.