先天性白内障手术后计划外再手术原因及相关危险因素研究

目的　探讨先天性白内障手术后计划外再手术的原因及相关危险因素，为先天性白内障手术提供参考。方法　回顾性研究。收集2009年1月至2018年12月于青岛眼科医院就诊并行先天性白内障手术后计划外再次入院手术治疗的患者资料，分析患者再手术发生率、再手术时间以及发生原因等。结果　将白内障手术后计划外再手术36例（42眼）患者纳入本研究。计划外再手术占前三位的疾病分别为:后发性白内障(54.76%,23/42）、继发性青光眼(21.43%,9/42)、瞳孔闭锁（14.29%，6/42）；其他原因有人工晶状体异位（7.14%,3/42）、视网膜脱离（2.38%,1/42）。计划外再手术发生率在0～3个月龄组为13.29%，显著高于4～12个月龄组（3.82%）和>12个月龄组（1.96%），组间差异有统计学意义（P=0.00）；低月龄（≤3个月）白内障手术、一期未植入人工晶状体与后发性白内障、继发性青光眼和瞳孔闭锁均高度相关（均为P＜0.05）。结论　后发性白内障、瞳孔闭锁和继发性青光眼为先天性白内障手术后计划外再手术的主要原因，低月龄（≤3个月）患者行白内障手术与计划外再手术高度相关。

Causes of unplanned reoperations for congenital cataract and its related factors

Objective　To investigate the causes and related risk factors of unplanned reoperations after congenital cataract surgery to provide reference for the surgery treatment of congenital cataract.Methods　This was a retrospective cohort study. Data of patients admitted to Qingdao Eye Hospital from January 2009 to December 2018 who underwent unplanned readmission after congenital cataract surgery were collected to analyze the incidence of reoperation and the time and causes of reoperation.Results　Thirty-six patients (42 eyes) with unplanned reoperations were included in the study. The top three causes for unscheduled reoperations were posterior capsule opacification (54.76%, 23/42), secondary glaucoma (21.43%, 9/42) and seclusion of pupil (14.29%, 6/42), while others were mainly caused by ectopic intraocular lens (7.14%, 3/42) and retinal detachment (2.38%, 1/42). The incidence of unplanned reoperation was 13.29% in the group aged between 0 to 3 months, 3.82% for the group aged 4 to 12 months and 1.96% for group aged over 12 months. There was significant difference between the groups (P=0.00). Cataract surgery for patients younger than 3 months and unimplanted intraocular lens at stage I cataract showed high correlativeness with posterior capsule opacification, secondary glaucoma and seclusion of pupils (all P<0.05).Conclusion　Posterior capsule opacification, seclusion of pupils and secondary glaucoma are three main causes for unplanned reoperation of congenital cataract. Cataract surgery performed on patients aged less than 3 months presents a higher incidence for unplanned reoperations.