Visual outcome following phacoemulsification in English Cocker Spaniels with suspected progressive retinal atrophy: A retrospective multicenter study of 54 cases (2002-2017)
疑似进行性视网膜萎缩的英国可卡犬接受超声乳化术后的视觉效果：54 例病例的多中心回顾性研究（2002-2017 年）

Sarah Koll-Hampp $^{1}$ | Andra-Elena Enache $^{2}$ | Elena Fenollosa-Romero $^{3}$ | Yu-Mei Chang $^{1}$ | Claudia Busse $^{3}$ | James Oliver $^{2}$ | Charlotte Dawson $^{1}^{(D)}$ | Màrian Matas Riera $^{1}$
Sarah Koll-Hampp $^{1}$ | Andra-Elena Enache $^{2}$ | Elena Fenollosa-Romero $^{3}$ | Yu-Mei Chang $^{1}$ | Claudia Busse $^{3}$ | James Oliver $^{2}$ | Charlotte Dawson $^{1}^{(D)}$ | Màrian Matas Riera $^{1}$

^{1}

Ophthalmology Service, Royal Veterinary College (RVC), University of London, North Mymms, UK

^{1}

英国伦敦大学皇家兽医学院（RVC）眼科服务处，北迈姆斯

^{2}

Unit of Comparative Ophthalmology, Animal Health Trust (AHT), Newmarket, UK

^{2}

英国纽马克特动物健康信托基金（AHT）比较眼科部

^{3}

Ophthalmology Service, Dick White Referrals (DWR), Six Mile Bottom, UK

^{3}

眼科服务，迪克-怀特转诊中心（DWR），英国六英里底

Correspondence 通信

Sarah Koll-Hampp, Ophthalmology Service, Royal Veterinary College (RVC), University of London, North Mymms, UK. Email: skoll@rvc.ac.uk
Sarah Koll-Hampp，英国伦敦大学皇家兽医学院（RVC）眼科服务处，北迈姆斯。电子邮件：skoll@rvc.ac.uk

Abstract 摘要

Objective: To describe the visual outcome following phacoemulsification in English Cocker Spaniels (ECS) affected by cataracts and suspected progressive retinal atrophy (PRA). Animals studied: Fifty-four client-owned dogs. Procedures: A multicenter, retrospective study was performed including ECS with suspected PRA which underwent phacoemulsification. PRA was suspected on ophthalmic examination before and after surgery, and/or after electroretinography (ERG) was performed. Visual outcome was assessed by menace response per eye at seven time periods post-surgery $(P 1 = 25 - 90$ days, $P 2 = 91 - 180$ days, $P 3 = 181 - 364$ days, P4 $= 365 - 549$ days, $P 5 = 550 - 729$ days, $P 6 = 730 - 1094$ days, and P7 $\geq 1095$ days). Descriptive statistics were performed. Generalized estimating equations were used to identify predictors associated with vision after surgery. Odds ratio and confidence intervals were reported. Significance was set at $P < 0.05$ . Owners were invited to participate in a questionnaire. Results: Phacoemulsification was performed in 85 eyes. Median age at surgery was 9.09 years (min. 2.17 years, max. 13.49 years). At all re-examinations, up to and including P5, significantly more eyes were visual than before surgery ( $P \leq 0.003$ ). Odds for vision were significantly increased for eyes that underwent surgery. Electroretinograms were performed in 75/85 eyes that underwent surgery, demonstrating low b-wave amplitudes. There was no significant effect of the age, gender, vision before surgery, presence of dazzle reflex, cataract stage or abnormality on gonioscopy on visual outcome. The questionnaire response rate was $48.2 %$ . Most participants ( $92.5 %$ ) felt that cataract surgery led to improvement of the dog’s quality of life.
目的描述对患有白内障和疑似进行性视网膜萎缩（PRA）的英国可卡犬（ECS）进行超声乳化术后的视觉效果。研究动物：54 只客户饲养的狗。手术过程：进行了一项多中心回顾性研究，研究对象包括接受了超声乳化术的疑似 PRA 的可卡犬。手术前后的眼科检查和/或进行视网膜电图（ERG）检查后怀疑有 PRA。通过术后七个时间段（ $(P 1 = 25 - 90$ 天、 $P 2 = 91 - 180$ 天、 $P 3 = 181 - 364$ 天、P4 $= 365 - 549$ 天、 $P 5 = 550 - 729$ 天、 $P 6 = 730 - 1094$ 天和P7 $\geq 1095$ 天）每只眼睛的视力反应来评估视觉结果。进行了描述性统计。使用广义估计方程确定与术后视力相关的预测因素。报告了比值比和置信区间。显著性设定为 $P < 0.05$ 。邀请车主参与问卷调查。结果：85只眼睛接受了乳化手术。手术年龄中位数为 9.09 岁（最小 2.17 岁，最大 13.49 岁）。在所有复查中，包括第五次复查在内，视力明显高于手术前的眼睛( $P \leq 0.003$ )。接受过手术的眼睛视力的几率明显增加。对 75/85 只接受手术的眼睛进行了视网膜电图检查，结果显示 b 波振幅较低。年龄、性别、术前视力、有无眩晕反射、白内障分期或眼底检查异常对视力结果均无明显影响。问卷回复率为 $48.2 %$ 。大多数参与者（ $92.5 %$ ）认为白内障手术提高了狗的生活质量。

Conclusions: English Cocker Spaniels with suspected PRA may benefit from phacoemulsification with vision up to 2 years following surgery.
结论：疑似患有 PRA 的英国可卡犬可从乳化手术中获益，术后视力可达 2 年。

KEYWORDS 关键词

cataract, phacoemulsification, progressive retinal atrophy
白内障、超声乳化术、进行性视网膜萎缩

1 | INTRODUCTION 1 简介

Cataracts are a common cause of blindness in dogs. Possible causes of cataract include inherited, congenital, aging, progressive retinal atrophy (PRA), and diabetes mellitus.

^{1, 2}

As the cataract progresses, secondary complications such as lens-induced uveitis and secondary glaucoma can develop, which may cause ocular discomfort or pain.

^{1, 2}

Surgical removal of the cataract holds the best prognosis for restoring vision and improving the overall ocular health, compared to medical management only or no treatment at all.

^{3}

Surgical success rates of

85 % - 90 %

have been reported.

^{4, 5}

Long-term complications after phacoemulsification include posterior capsular opacification, corneal lipid opacity, intraocular hemorrhage, glaucoma, and retinal detachment, which may lead to blindness or enucleation.

^{4, 6, 7}

白内障是导致狗狗失明的常见原因。导致白内障的可能原因包括遗传、先天、衰老、进行性视网膜萎缩 (PRA) 和糖尿病。

^{1, 2}

随着白内障的发展，会出现继发性并发症，如透镜引起的葡萄膜炎和继发性青光眼，这可能会引起眼部不适或疼痛。

^{1, 2}

与只进行药物治疗或不进行任何治疗相比，手术摘除白内障在恢复视力和改善眼部整体健康方面的预后最好。

^{3}

据报道，手术成功率为

85 % - 90 %

。

^{4, 5}

乳化术后的长期并发症包括后囊不透明、角膜脂质不透明、眼内出血、青光眼和视网膜脱离，这些并发症可能导致失明或眼球摘除。

^{4, 6, 7}

Progressive retinal atrophy is a broad term for a variety of progressive, inherited diseases of the retina, that manifest as degeneration of the photoreceptor layer and/ or the retinal pigmented epithelium in many different dog breeds.

^{10, 11}

It has been reported to be the third most common cause of cataracts accounting for

7.6 %

and

12.5 %

of cases in two retrospective studies.

^{12, 13}

Cataracts secondary to PRA have been described to develop at advanced stages of PRA in some breeds.

^{11, 14}

Historically, cataract surgery has not been recommended routinely in dogs affected by PRA, as these dogs will progressively lose vision despite the surgery.

^{15}

Disease onset and progression, as well as the underlying genetic mutations causative of PRA, vary between and within breeds.

^{16, 17}

Many breeds are affected by a progressive rod-cone degeneration (prcd) with an identical mutation in the prcd locus, which is responsible for a late-onset form PRA.

^{17}

Interestingly, phenotypic differences have also been reported between breeds affected by the same prcd mutation. The English Cocker Spaniel (ECS) demonstrated a slower rate of photoreceptor degeneration histologically, compared to the Miniature Poodle (MP) and American Cocker Spaniel (ACS).

^{17, 19}

Furthermore, ECS showed a mosaic of disease stages across the meridians of the fundus, with areas of delayed retinal degeneration. On ERG examination, MP’s lost their remaining b-wave function twice as fast as ECS.

^{19}

Supported by these findings in the ECS, the frequent presentation of this breed with cataracts and anecdotal clinical experiences of late-onset vision loss, the authors have performed cataract surgery in ECS following careful owner counseling.
进行性视网膜萎缩是多种进行性遗传性视网膜疾病的统称，表现为许多不同犬种的感光层和/或视网膜色素上皮变性。

^{10, 11}

据报道，它是白内障的第三大常见病因，在两项回顾性研究中分别占

7.6 %

和

12.5 %

例。

^{12, 13}

据描述，继发于 PRA 的白内障会在某些品种的 PRA 晚期出现。

^{11, 14}

一直以来，我们都不建议对患有 PRA 的狗进行白内障手术，因为尽管进行了手术，这些狗的视力还是会逐渐下降。

^{15}

疾病的发生和发展以及导致 PRA 的潜在基因突变在不同品种之间和品种内部都各不相同。

^{16, 17}

许多犬种都会受到进行性杆-锥体变性（prcd）的影响，prcd 基因座上的相同突变会导致晚发型 PRA。

^{17}

有趣的是，受相同prcd基因突变影响的犬种之间也存在表型差异。与迷你贵宾犬（MP）和美国可卡犬（ACS）相比，英国可卡犬（ECS）在组织学上表现出的光感受器退化速度较慢。

^{17, 19}

此外，ECS在眼底各经络中表现出不同的疾病阶段，并有延迟视网膜变性的区域。在 ERG 检查中，MP 患者丧失剩余 b 波功能的速度是 ECS 的两倍。

^{19}

基于在 ECS 身上的这些发现、该犬种经常出现的白内障以及晚期视力丧失的临床经验，作者在仔细咨询了犬主之后，为 ECS 实施了白内障手术。

The main objective of this retrospective study was to describe the visual outcome at various re-examination periods following phacoemulsification in ECS with suspected PRA. The second objective was to investigate any predictors associated with a positive visual outcome following surgery.
这项回顾性研究的主要目的是描述疑似 PRA 的 ECS 患者在接受超声乳化术后不同复查时期的视觉结果。第二个目的是研究与术后积极视觉结果相关的任何预测因素。

2 | MATERIALS AND METHODS
2 材料和方法

A retrospective multicenter study was performed. Databases of the Royal Veterinary College (RVC), the Animal Health Trust (AHT), and Dick White Referrals (DWR) were searched for ECS with suspected progressive retinal atrophy and cataracts, which underwent phacoemulsification between 2002 and 2017. Ethical approval was obtained from the RVC Clinical Research Ethical Review Board (CRERB, URN: M2015 0073) and AHT Clinical Research Ethics Committee (41-2016).
我们进行了一项回顾性多中心研究。研究人员在皇家兽医学院（RVC）、动物健康信托基金（AHT）和迪克-怀特转诊（DWR）的数据库中搜索了2002年至2017年期间接受过超声乳化术的疑似进行性视网膜萎缩和白内障的ECS。该研究获得了RVC临床研究伦理审查委员会（CRERB，URN：M2015 0073）和AHT临床研究伦理委员会（41-2016）的伦理批准。

Dogs were included if they underwent a full ophthalmic examination including slit-lamp biomicroscopy, indirect binocular ophthalmoscopy, and tonometry before and after surgery by a diplomate or a resident under the supervision of a diplomate of the European College of Veterinary Ophthalmologists (ECVO). Gonioscopy (Koeppe lens; Ocular Instruments Inc, Washington, DC) and ocular ultrasound results were reported from examinations before surgery. Furthermore, information about the presence of concurrent systemic disease or ocular diseases was collected.
由欧洲兽医眼科医师学会 (ECVO) 的认证医师或在认证医师监督下的住院医师在手术前后对犬只进行全面的眼科检查，包括裂隙灯生物显微镜检查、间接双目眼底镜检查和眼压测量。巩膜镜检查（Koeppe lens；Ocular Instruments Inc，华盛顿特区）和眼部超声波检查结果均来自手术前的检查报告。此外，还收集了有关并发全身性疾病或眼部疾病的信息。

A diagnosis or suspicion of PRA was made based on the patient history, signalment, and full ophthalmic examination before or after surgery and, in the majority of cases, supported by the ERG results. In all referral centers, a short “yes/ no” ERG protocol was employed to assess gross photoreceptor function. The protocols used among the centers varied. A summary of the ERG protocols used is demonstrated in Table 1. ERGs were performed in conscious dogs at the AHT and at DWR and under general anesthesia at the RVC. The ERG machines used were HMsERG system (Model 2000; OcuScience, Henderson, NV) at the RVC and DWR, and Photic stimulator (SLE, CPS-20; Medilec Synergy, VIASYS, Madison, WI) at the AHT. Dogs with a b-wave amplitude below 40 mV were included. The b-wave amplitude of the mixed/rod-cone response was used at the RVC, and the bwave amplitude of a cone dominated ERG curve was assessed at the AHT and DWR. The cases with no ERG, but with suspected PRA, were included following careful selection based on their history, signalment, full ophthalmic examination, the presence of attenuated retinal vascularization, and tapetal hyper-reflectivity on funduscopy and if visual deficits in low light were reported. ECS with uni-or bilateral phacoemulsification were evaluated.
PRA的诊断或怀疑是根据患者的病史、信号和手术前或手术后的全面眼科检查做出的，在大多数情况下，ERG结果也支持这一诊断或怀疑。所有转诊中心都采用简短的 "是/否 "ERG方案来评估大体感光器功能。各中心采用的方案各不相同。表 1 显示了所使用的 ERG 方案摘要。在 AHT 和 DWR，ERG 是在意识清醒的狗身上进行的，在 RVC 则是在全身麻醉的情况下进行的。RVC 和 DWR 使用的 ERG 仪器是 HMsERG 系统（2000 型；OcuScience，Henderson，NV），AHT 使用的是光刺激器（SLE，CPS-20；Medilec Synergy，VIASYS，Madison，WI）。b 波振幅低于 40 mV 的狗也被包括在内。在 RVC 使用混合/杆锥反应的 b 波振幅，在 AHT 和 DWR 评估锥体主导 ERG 曲线的 b 波振幅。根据病史、信号、全面的眼科检查、是否存在衰减的视网膜血管、眼底检查是否存在视网膜高反射以及是否有弱光下视力障碍的报告，经过仔细筛选，将没有ERG但疑似PRA的病例纳入其中。对采用单侧或双侧超声乳化术的 ECS 进行了评估。

Visual outcome post-surgery was assessed in all ECS presented at re-examinations by ophthalmic examination, particularly the menace response, at seven time periods post-surgery (

P 1 = 25 - 90

days,

P 2 = 91 - 180

days,

P 3 =

181 - 364

days,

P 4 = 365 - 549

days,

P 5 = 550 - 729

days,

P 6 =

730-1094 days, and p7

\geq 1095

days). Other methods of visual assessment (obstacle/maze tests, tracking response, and visual placing response) were also reported in a number of cases, but not consistently in all dogs. The results of genetic testing were reported if available.
在手术后的七个时间段（

P 1 = 25 - 90

天、

P 2 = 91 - 180

天、

P 3 =

181 - 364

天、

P 4 = 365 - 549

天、

P 5 = 550 - 729

天、

P 6 =

730-1094天和p7

\geq 1095

天），通过眼科检查，特别是威胁反应，对所有接受复查的 ECS 进行手术后视觉结果评估。一些病例中还报告了其他视觉评估方法（障碍/迷宫测试、追踪反应和视觉放置反应），但并非所有狗都采用了这些方法。如果有基因检测结果，也会报告。

TABLE 1 Summary of ERG protocols used at the RVC, AHT and DWR
表 1 英国皇家癌症研究中心、英国皇家高山医院和英国皇家西北地区医院使用的 ERG 协议摘要

Mcd s/m², millicandelas second/square meter; s, second; ms, millisecond; Hz, Herz.
Mcd s/m²，毫坎德拉秒/平方米；s，秒；ms，毫秒；Hz，赫兹。

Owners were invited to participate in a simple questionnaire by email, letter, or telephone call, asking:
我们通过电子邮件、信件或电话邀请业主参与一份简单的问卷调查，内容包括

Is your pet still visual or how long has he/she been visual in your opinion?
在您看来，您的宠物还能看见东西吗？
Do you feel that cataract surgery has improved your pet’s quality of life?
您觉得白内障手术提高了宠物的生活质量吗？

Frequencies and percentages were reported for the categorical variables: gender, operated eye, menace response per eye, ERG, the presence of a flat trace, and postoperative complications. The RVC databank RxWorks 5.2.4195 was searched to investigate the frequency of ECS presented to the RVC in general and to the ophthalmology department between 2002 and 2017. Medians (minimum, maximum) were reported for numerical variables like age and ERG b-wave amplitudes per eye. McNemar’s tests were performed to compare visual outcome before and after surgery. Generalized estimating equations (GEE) with binomial logit link function were used to assess association between age,
报告了以下分类变量的频数和百分比：性别、手术眼、每只眼的威胁反应、ERG、是否存在平迹以及术后并发症。为了调查2002年至2017年期间向皇家眼科中心和眼科部门报告的ECS频率，我们搜索了皇家眼科中心数据库RxWorks 5.2.4195。报告了每只眼睛的年龄和ERG b波振幅等数字变量的中位数（最小值、最大值）。为比较手术前后的视觉效果，进行了 McNemar 检验。使用带有二叉对数链接函数的广义估计方程（GEE）来评估年龄与ERG b波振幅之间的关系、
gender, center, the presence of a dazzle reflex, cataract grade, abnormalities on gonioscopy or ocular ultrasound, the presence of vision before surgery, or a flat trace on ERG with the postoperative visual outcome. Odds ratio (OR) and

95 %

confidence intervals (CI) are presented for results of the generalized estimating equation. Statistical significance was set at

P < 0.05

. All analyses were performed with IBM SPSS Statistics (Version 24; IBM Corp., Armonk, NY). Graphic illustrations were created with GraphPad Prism (Version 7.00 for Windows, GraphPad Software, La Jolla, CA) and R (Version 3.4.2, R Foundation for Statistical Computing, Vienna, Austria).
性别、中心、有无眩晕反射、白内障等级、眼底镜检查或眼部超声波检查有无异常、术前有无视力或 ERG 平扫与术后视力结果的关系。概括估计方程的结果显示了比值比（OR）和

95 %

置信区间（CI）。统计显著性设定为

P < 0.05

。所有分析均使用 IBM SPSS 统计软件（第 24 版；IBM 公司，纽约州阿蒙克市）进行。图表使用 GraphPad Prism（Windows 7.00 版，GraphPad Software，La Jolla，CA）和 R（3.4.2 版，R Foundation for Statistical Computing，Vienna，Austria）制作。

3 | RESULTS 3 结果

There were 54 ECS included in this study (RVC 14 cases, AHT 32 cases, and DWR 8 cases), comprising 28 (51.9%) males and 26 (

48.1 %

) females. Phacoemulsification was performed in 85 of 108 eyes, comprising 41 right eyes (48.2%)
本研究共纳入 54 例 ECS（RVC 14 例、AHT 32 例和 DWR 8 例），其中男性 28 例（51.9%），女性 26 例（

48.1 %

）。108 只眼睛中有 85 只进行了乳化手术，其中 41 只为右眼（48.2%）。
and 44 left eyes (51.8%). Bilateral phacoemulsification was performed in 31 dogs (57.4%) and unilateral in 23 dogs (42.6%). Seventy-three (85.9%) intraocular lenses (IOL) were placed. Phacoemulsification was performed on separate days in

8 / 54

dogs (

14.8 %

) and on the same day in

46 / 54

dogs (

85.2 %

). The median age at surgery was 9.09 years (Min. 2.17 years, Max. 13.49 years).
其中 31 只狗（57.4%）进行了双侧乳化手术，23 只狗（42.6%）进行了单侧乳化手术。31只狗（57.4%）进行了双侧乳化手术，23只狗（42.6%）进行了单侧乳化手术。安置了 73 个（85.9%）眼内人工晶体 (IOL)。

8 / 54

犬（

14.8 %

）的超声乳化手术在不同的日子进行，

46 / 54

犬（

85.2 %

）的超声乳化手术在同一天进行。手术时的中位年龄为 9.09 岁（最小 2.17 岁，最大 13.49 岁）。

The ECS was the fourth most common breed (4% of the total population), presented to the RVC between 2002 and 2017 and the second most common breed (

7 %

of the total population) presented to the ophthalmology department of the RVC during the same time period. Funduscopy supported the suspicion of PRA in all operated eyes either before surgery (4/85, 4.7%) or at re-examinations (81/85, 95.3%) following surgery. Funduscopic details like tapetal hyper-reflectivity (78/85, 91.8%), attenuated retinal vascularization (67/85,

78.8 %

), and a pale or atrophied optic nerve head (11/85,

12.9 %

) were described in most patient records. Clinicians have used the general term progressive retinal atrophy to describe funduscopic findings in all cases.
2002年至2017年期间，ECS是RVC最常见的第四大犬种（占总人口的4%），也是同期RVC眼科最常见的第二大犬种（占总人口的

7 %

）。眼底检查结果显示，所有接受手术的眼睛在术前（4/85，4.7%）或术后复查时（81/85，95.3%）均怀疑患有 PRA。大多数患者的病历中都描述了眼底细节，如视网膜反射过强（78/85，91.8%）、视网膜血管减弱（67/85，

78.8 %

）、视神经头苍白或萎缩（11/85，

12.9 %

）。临床医生使用进行性视网膜萎缩这一通用术语来描述所有病例的眼底检查结果。

An ERG was performed in 75/85 (88.2%) operated eyes. All ERGs were consistent with reduced retinal function, and the median ERG b-wave amplitude was 10 mV (Min. 0 mV ,

max 40 mV

) in all eyes. A flat ERG trace was found in 30 (40%) of the operated eyes. One dog was tested positive for the prcd gene mutation (Optigen, Ithaka, NY). Ten eyes of eight patients did not undergo an ERG, all of which demonstrated tapetal hyper-reflectivity, attenuated retinal vessels on funduscopy, and all of these patients were nyctalopic.
75/85（88.2%）只进行了ERG检查。所有ERG均显示视网膜功能减退，所有眼睛的ERG b波振幅中位数为10 mV（最小值为0 mV，

max 40 mV

）。30只（40%）手术眼的ERG轨迹平坦。一只狗的prcd基因突变检测呈阳性（Optigen，Ithaka，NY）。八名患者的十只眼睛没有进行ERG检查，所有这些眼睛都表现出视网膜反射过强，眼底检查显示视网膜血管变细，而且所有这些患者都有夜盲症。

A concurrent diagnosis of diabetes mellitus was not reported in any dog. Eight dogs had been diagnosed with keratoconjunctivitis sicca (KCS, 14.8%) at the time of the first examination.
没有任何一只狗同时被诊断患有糖尿病。首次检查时，有八只狗被诊断患有角结膜炎（KCS，14.8%）。

Cataracts were described as incipient (

1 / 85, 1.2 %

), immature (

40 / 85, 47.1 %

), mature (

38, 44.7 %

), and hypermature (

6 / 85, 7.1 %

). The cataract stage was significantly associated
白内障分为初期（

1 / 85, 1.2 %

）、未成熟（

40 / 85, 47.1 %

）、成熟（

38, 44.7 %

）和超成熟（

6 / 85, 7.1 %

）。白内障阶段与
with blindness before the surgery

(P = 0.004)

. Following the surgery, there was no association between previous cataract grade and visual outcome. There were statistically significant associations at P4

(P = 0.003)

and P5

(P = 0.029)

. However, these were considered questionable, due to the loss to follow up, as there were only 1 and 3 blind patients that presented for each period. A higher number of re-examined patients would be required to avoid bias. Gonioscopy was performed in 27 (25%) of 108 eyes in total with 16 (59.2%) abnormal findings of the iridocorneal angle (ICA). There were descriptions of seven narrow ICAs (7/27, 25.9%), six eyes with narrow ICAs alongside pectinate ligament dysplasia (PLD) (6/27, 22.2%), three eyes with PLD only (3/27, 11.1%), and 11 normal findings (

11 / 27, 40.7 %

). An abnormal finding on gonioscopy did not affect the visual outcome of operated eyes in this study statistically, and none of these cases developed glaucoma following surgery

(P < 0.001)

. Ocular ultrasound was performed in

93 (86.1 %)

of 108 eyes and abnormalities were reported in

24 (22.2 %)

eyes. The most frequent finding was vitreal degeneration (

n = 22, 20.3 %

). There was a single case of lenticonus and one suspected persistent tunica vasculosa lentis, which was not confirmed following surgery. There were no cases of retinal detachment.

(P = 0.004)

。手术后，先前的白内障等级与视力结果之间没有关联。在P4

(P = 0.003)

和P5

(P = 0.029)

阶段，两者之间存在统计学意义上的显著关联。然而，由于每个阶段仅有1名和3名失明患者接受了随访，这些关联被认为是值得怀疑的。为避免偏差，需要对更多患者进行复查。在 108 只眼睛中，有 27 只（25%）进行了眼底镜检查，其中有 16 只（59.2%）发现虹膜角膜（ICA）异常。其中有 7 只眼睛的虹膜角膜狭窄（7/27，25.9%），6 只眼睛的虹膜角膜狭窄同时伴有栉状韧带发育不良（PLD）（6/27，22.2%），3 只眼睛的栉状韧带发育不良（PLD）（3/27，11.1%），11 只眼睛的检查结果正常（

11 / 27, 40.7 %

）。据统计，在本研究中，眼底镜检查的异常发现并不影响手术眼的视力结果，这些病例中没有一例在术后发展为青光眼

(P < 0.001)

。108只眼睛中的

93 (86.1 %)

只进行了眼部超声波检查，

24 (22.2 %)

只报告了异常情况。最常见的发现是玻璃体变性（

n = 22, 20.3 %

）。有一例光斑和一例疑似持续性静脉曲张光斑，但手术后未得到证实。没有视网膜脱离病例。

Before surgery, 19 (22.4%) of the operated eyes demonstrated a positive menace response and 66 (77.6%) eyes had a negative response. However, significantly more eyes had a positive menace response post operatively from re-examination period P1 until and including P5 (

P \leq 0.003

), compared to the menace response before surgery. See Table 2/Figures 1 and 2.
手术前，19 只眼睛（22.4%）的威胁反应为阳性，66 只眼睛（77.6%）的威胁反应为阴性。然而，与手术前的威胁反应相比，手术后从复查期 P1 开始到 P5（包括 P5）期间（

P \leq 0.003

）出现阳性威胁反应的眼睛明显更多。见表 2/图 1 和 2。

Thirty eyes (40%) undergoing cataract surgery demonstrated a flat trace on ERG. Before surgery, five (16.7%) of these eyes had a positive menace response and 25 eyes (83.3%) had a negative menace response. Of the five eyes with flat trace readings and positive menace responses, two ERGs were measured consciously, and three ERGs were measured under general anesthesia. Despite the flat ERG traces in
接受白内障手术的 30 只眼睛（40%）在 ERG 上显示出平坦的轨迹。手术前，其中 5 只眼睛（16.7%）的威胁反应为阳性，25 只眼睛（83.3%）的威胁反应为阴性。在这五只读数平坦且威胁反应呈阳性的眼睛中，有两只眼睛的ERG是在有意识的情况下测量的，有三只眼睛的ERG是在全身麻醉的情况下测量的。尽管

TABLE 2 Summary of visual outcome per eye before and after surgery and significance of visual improvement compared to before surgery
表 2 手术前后每只眼睛的视力结果摘要以及与手术前相比视力改善的意义

Time 时间	All eyes 所有的眼睛						$\frac{McNemar}{P}$
Time 时间	n	Visual 视觉	Percent (%) 百分比	Blind 盲人	Percent (%) 百分比	Missing 失踪	$\frac{McNemar}{P}$
Before surgery 手术前	85	19	22.4	66	77.6
P1*	85	75	88.2	10	11.8		0.000
P2*	63	58	92.1	5	7.9	22	0.000
P3*	46	44	96.7	2	4.3	39	0.000
P4*	32	31	96.9	1	3.1	53	0.000
P5*	19	16	84.2	3	15.8	66	0.003
P6	15	9	60.0	6	40.0	70	0.289
P7	10	6	60.0	4	40.0	75	0.453

P , time period;

P =

significance level.
P ，时间段；

P =

显著性水平。

30 eyes, there was significant improvement of vision from P1 to P4 (

P \leq 0.031

). See Table 3/Figure 3.
30只眼睛的视力从P1到P4都有明显改善（

P \leq 0.031

）。见表 3/图 3。

There were increased odds for vision if an eye underwent phacoemulsification compared to eyes not undergoing surgery at

P 1 (P < 0.001, OR = 12.89, CI = 4.33, 38.8)

P 2 (P < 0.001, OR = 23.70, CI = 5.18, 108.39)

Correspondence 通信

Abstract 摘要

KEYWORDS 关键词

1 | INTRODUCTION 1 简介

2 | MATERIALS AND METHODS2 材料和方法

3 | RESULTS 3 结果

2 | MATERIALS AND METHODS
2 材料和方法