[Outcomes of surgical treatment of congenital cataract with microphthalmia in infancy].

Objective: To examine the outcomes of surgical treatment for infants with congenital cataract and microphthalmia (CATM). Methods: It was a retrospective case series study. Data of 28 (55 eyes) CATM children who underwent cataract surgery at the Qingdao Eye Hospital of Shandong First Medical University and were followed up for more than 5 years between January 2010 and December 2014 under the age of 6 months. There were 15 male and 13 female children. The age at the time of surgery was (3.2±1.3) months, and the follow-up time was (8.2±1.7) years. The data included the basic information of the children, the ocular biological parameters before and after surgery and intraocular lens (IOL) implantation, and the occurrence of complications. Paired t-tests or Wilcoxon signed rank tests were used to compare groups, and logistic regression analysis was used to identify factors related to IOL implantation, secondary glaucoma, and visual axis opacification (VAO). Results: The mean preoperative axial length was (16.6±1.0) mm, and the mean horizontal corneal diameter was (9.5±0.9) mm. The axial growth rate within 2 years after the first stage of surgery was (1.4±0.8) mm/year. None of the children had an IOL implanted before the age of 2. Sixty percent of the eyes (33/55) received IOL implantation within 2 to 4 years after the first stage of surgery, while the remaining 40% (22/55) did not receive IOL implantation at the last follow-up. The axial growth rate was (0.9±0.7) mm/year within two years after the second stage of surgery. Postoperative secondary glaucoma occurred in 7 eyes (12.7%), and VAO occurred in 15 eyes (27.3%). IOL implantation was associated with preoperative axial length (OR=0.072, P<0.001) and age at the first stage of surgery (OR=7.270, P<0.001), but not with preoperative corneal diameter (P=0.735). The incidence of VAO was associated with preoperative corneal diameter (OR=4.124, P=0.011), but not with age at the first stage of surgery (P=0.489) or preoperative axial length (P=0.489). No factors related to the occurrence of secondary glaucoma were found. The best corrected visual acuity at the last follow-up after IOL implantation was (0.37±0.28) logMAR, which was better than that of children without IOL implantation (0.67±0.19) logMAR (U=49.50, P=0.003). Conclusions: Children with CATM can obtain the opportunity for IOL implantation through early surgery and ultimately achieve good visual outcomes. Properly selecting the timing for implanting IOL can keep the incidence of secondary glaucoma at an acceptable level.目的： 探讨先天性小眼球合并白内障（CATM）的婴儿期手术治疗后人工晶状体（IOL）的植入情况和治疗效果。 方法： 回顾性病例系列研究。收集2010年1月至2014年12月于山东第一医科大学附属青岛眼科医院在6月龄以内接受白内障摘除术且术后随访满5年的28例（55只眼）CATM患儿资料，其中男性15例，女性13例；接受Ⅰ期白内障摘除术时月龄为（3.2±1.3）个月；随访时间（8.2±1.7）年。记录患儿基础资料、Ⅰ期白内障摘除术和Ⅱ期IOL植入术前后的眼部生物学参数及手术并发症的发生情况。组间比较采用配对t检验或Wilcoxon符号秩检验，使用Logistic回归分析完成Ⅱ期IOL植入、继发性青光眼和视轴区混浊（VAO）的相关因素。 结果： 患儿术前眼轴长度为（16.6±1.0）mm；角膜水平直径为（9.5±0.9）mm。Ⅰ期白内障摘除术后2年内眼轴增长速度为（1.4±0.8）mm/年。所有患儿均未在2周岁前植入IOL，60%的患眼（33/55）在Ⅰ期白内障摘除术后2~4年内完成IOL植入，40%的患眼（22/55）末次随访时仍未植入IOL。Ⅱ期IOL植入术后两年内眼轴增长速度为（0.9±0.7）mm/年。7只眼（12.7%）术后发生继发性青光眼，15只眼（27.3%）发生VAO。能否植入IOL与术前眼轴长度（OR=0.072，P<0.001）和手术时月龄（OR=7.270，P<0.001）相关，与术前角膜直径无关（P=0.735）；VAO的发生与术前角膜直径相关（OR=4.124，P=0.011），与手术月龄（P=0.489）和术前眼轴长度（P=0.489）无关；未发现与术后继发性青光眼发生的相关因素。行Ⅱ期IOL植入术的患儿末次随访时最佳矫正视力为0.37±0.28（最小分辨角的对数），优于未植入IOL患儿的0.67±0.19（U=49.5，P=0.003）。 结论： CATM患儿可通过早期手术刺激眼轴增长，获得IOL植入机会，并获得良好的视力结果。恰当地选择植入IOL的时机，可将继发性青光眼的发生率控制在可接受水平。.