Prospective analysis of pediatric pseudophakia: Myopic shift and postoperative outcomes
Prospective analysis of pediatric pseudophakia: Myopic shift and postoperative outcomes
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DOI：
10.1067/mpa.2002.126492
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发表时间：
2002-10-01
期刊：
影响因子：
1.6
通讯作者：
Pressman, SH
中科院分区：
文献类型：
--
作者：
Crouch, ER;Crouch, ER;Pressman, SH
目的：关于儿童眼内透镜（IOL）植入术后长期屈光变化的数据有限。术后结果的信息应能更准确地预测儿童IOL植入的屈光度。还应报告有关IOL并发症的数据，包括继发性膜、近视移位、立体视和人工晶状体青光眼。方法.在一项前瞻性研究中，在4周、3个月、6个月、1年和此后每6个月评价了所有12个月至18岁之间接受白内障手术和IOL植入术的儿童患者的屈光不正。所有患者均随访至少3年。结果42例患者的52只眼符合入选标准。42只眼患有发育性白内障。有10例双侧病例。在52只眼中，85%的视力为20/40或更好。95%的双眼视力达到20/30或更好。在单侧白内障中，74%的眼睛的视力为20/50或更好。平均随访时间为5.45年，范围为3 - 10.5年。按年龄组划分的平均随访时间范围为4.38 - 6.35年。在12个月至2岁时手术的儿童的平均近视偏移为-5.96 D;在3岁和4岁时手术的儿童的平均近视偏移为-3.66 D;在5岁和6岁时手术的儿童的平均近视偏移为-3.40 D;在7岁和8岁时手术的儿童的平均近视偏移为-2.03 D; 9岁和10岁手术的儿童平均位移为-1.88 D; 11至14岁手术的儿童位移为-0.97 D; 15至18岁手术的儿童位移为-0.38 D。未观察到儿童人工晶状体青光眼病例。当囊膜完整时，72%的眼发生次级膜。手术眼比非手术眼显示更大的平均近视移位。弱视眼与非弱视眼或外伤性白内障与非外伤性白内障的屈光变化无统计学显著差异。结论：屈光度增长或变化的最大速率发生在1至3岁之间。3岁以后，屈光增长率呈线性趋势。基于这项研究，我们提供了使用当前公式在儿童白内障病例中选择IOL屈光度的指南，并理解需要设计新公式以更好地预测儿童IOL屈光度。
Purpose: Limited data exist about long-term refractive changes in eyes of children with intraocular lens (IOL) implantation. Information of postoperative results should allow more accurate predictions for IOL power implantation in children. Data regarding IOL complications, including secondary membranes, myopic shift, stereopsis, and pseudophakic glaucoma should also be reported. Methods. In a prospective study, the refractive errors of all pediatric patients between 12 months and 18 years who had cataract surgery and IOL implantation were evaluated at 4 weeks, 3 months, 6 months, 1 year, and every 6 months thereafter. All patients were followed for a minimum of 3 years. Results. Fifty-two eyes of 42 patients met inclusion criteria. Forty-two eyes had developmental cataracts. There were 10 bilateral cases. Of the 52 eyes, 85% had 20/40 vision or better. Visual acuity of 20/30 or better was achieved in 95% of bilateral eyes. In unilateral cataracts, visual acuity was 20/50 or better in 74% of eyes. Mean follow-up time was 5.45 years with a range of 3 to 10.5 years. Mean follow-up by age group ranged between 4.38 and 6.35 years. Children operated on at 12 months to 2 years of age had a mean myopic shift of -5.96 D; children operated on at 3 and 4 years of age had a -3.66 D shift; children operated on at 5 and 6 years of age had a shift of -3.40 D; children operated on at 7 and 8 years of age had a shift of -2.03 D; children operated on at 9 and 10 years of age had a mean shift of -1.88 D; children operated on at 11 to 14 years of age had a shift of -0.97 D; children operated on at 15 to 18 years of age had -0.38 D shift. No cases of pediatric pseudophakic glaucoma were observed. Secondary membrane occurred in 72% of eyes when the capsule was left intact. The operated eye showed a greater mean myopic shift than the nonoperated eye. No statistically significant difference in refractive change was found comparing amblyopic to nonamblyopic eyes or traumatic to nontraumatic cataracts. Conclusions: The greatest rate of refractive growth or change occurred between 1 and 3 years of age. After age 3 years, the rate of refractive growth followed a more linear trend. Based on this study, we have provided a guide for selecting IOL power in pediatric cataract cases using current formulas with the understanding that new formulas will need to be devised to better predict IOL power in children.