Intraocular lens implantation in children with cataract.
Intraocular lens implantation in children with cataract.
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DOI：
10.1016/s2352-4642(19)30150-6
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发表时间：
2019-07
期刊：
影响因子：
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通讯作者：
A. Mataftsi;A. Haidich;N. Ziakas
中科院分区：
文献类型：
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作者：
A. Mataftsi;A. Haidich;N. Ziakas
在Ameenat Lola Solebo和他的同事的文章中，没有发现1人工晶状体植入对患有双眼白内障的儿童的青光眼有明显的保护作用(调整后的优势比[OR]0·5，95%CI 0·10-1·80，p=0·28)。从数值上讲，这一效应估计可以解释为人工晶状体植入可能会将青光眼的发病率降低50%。由于本研究中青光眼病例数量较少，这一估计不能被证明是显著的，但在一项荟萃分析2中，所有单独的研究都不能证明人工晶状体植入的保护作用，一旦合成，合并效应能够显示其重要性(风险比0·27，95%可信区间0·12-0·61)。单眼白内障的手术可能比双眼白内障的青光眼风险更高，因为单眼白内障的持续性胎儿血管形成的预期比例更高，有时是轻微的或亚临床的。然而，在他们的队列研究中，Solebo和他的同事发现，38名患有单眼白内障并接受植入术的儿童中没有一人出现青光眼，而18名单眼白内障儿童中有5名接受了传统的隐形眼镜或眼镜无晶状体矫正治疗。这一结果本身就支持植入；然而，这些数字太小，不能作为全球建议的基础。在单眼组中，作者发现，无论植入何种人工晶状体，术后强化的类固醇治疗方案均可降低视轴混浊的风险。我们有兴趣知道他们对强化疗法的定义是什么，以及这些儿童是否有更高的青光眼发病率
In the Article by Ameenat Lola Solebo and colleagues, 1 intraocular lens implantation was not found to be significantly protective against glaucoma for children with bilateral cataract (adjusted odds ratio [OR] 0· 5, 95% CI 0· 10–1· 80, p= 0· 28). Numerically, this effect estimate can be interpreted such that intraocular lens implantation might decrease the odds of glaucoma by 50%. Because of the small number of glaucoma cases in this study, this estimate could not be proven to be significant, but in a meta-analysis2 in which all individual studies could not prove the protective effect of intraocular lens implantation, once synthesized, the pooled effect was able to show its significance (hazard ratio 0· 27, 95% CI 0· 12–0· 61).Surgery on a unilateral cataract could possibly infer a higher glaucoma risk than for a bilateral cataract, given an expected higher percentage of persistent fetal vasculature, sometimes mild or subclinical, in unilateral cataract. 3 And yet, in their cohort study, Solebo and colleagues found none of the 38 children who had a unilateral cataract and underwent implantation developed glaucoma, versus five of 18 children with unilateral cataract who underwent conventional treat ment with aphakic correction with contact lenses or glasses. This result by itself speaks in favour of implanting; however, these numbers are too small to base global recommendations on. In the unilateral group, the authors found that an intensive postoperative regimen of steroids reduced the risk of visual axis opacification, irrespective of intraocular lens implantation. We would be interested to know what their definition of intensive regimen was, and whether these children had a higher incidence of glaucoma