儿童先天性白内障治疗及随访.docVIP

儿童先天性白内障治疗及随访 　 作者：曾广川，廖武，叶计芬，李瑜明，杨军 【摘要】 目的 评价儿童先天性白内障超声乳化吸除、人工晶体(intraocular lens，IOL)植入、后囊撕开联合前段玻璃体切割术的临床效果，以及术后弱视治疗的重要性。方法 对儿童先天性白内障患者58例72眼，均采用超声乳化吸除并植入后房型人工晶体后，后囊膜连续环形撕囊或囊膜切开，联合前段玻璃体切除。术后随访观察视力、眼压、屈光状态、后囊浑浊及双眼视功能。结果 术后矫正视力≥0.5的有18眼(25%)，视力在0.1～0.4的有29眼(40.3%)，视力lt;0.1的有10眼(13.9%)，欠合作的有15眼(20.8%)。经过弱视治疗1年以上，视力有提高的有28眼(38.9%)，有融合功能患儿22例(37.9%)。葡萄膜炎反应和视轴区混浊为术后主要并发症。结论 儿童先天性白内障超声乳化吸除、囊袋内人工晶体植入、后囊膜环形撕囊并行前段玻璃体切割术可有效预防后发性白内障的发生，术中术后并发症少，效果确切。术后及时的弱视治疗与白内障手术治疗同样重要。 【关键词】 白内障;儿童;人工晶体;手术;弱视治疗 　　[Abstract] Objective To assess the clinical effects of phacoemulsification,implantation of the posterior chamber intraocular lens,posterior lens capsule section and anterior segment vitrectomy in pediatric cataract and to assess the significance of the amblyopia therapy after operation.Methods Participants were 58 cases(72 eyes)with pediatric cataract.Phacoemulsification,implantation of the posterior chamber intraocular lens,posterior lens capsule section or continuous curvilinear capsulorhexis and anterior segment vitrectomy were performed.Main outcome measures preoperative and postoperative visual acuity,intraocular pressure，refractive status,posterior capsular opacification and binocular vision.Results The postoperative corrected vision:exceed 0.5 in 18 eyes(25%)，from 0.1 to 0.4 in 29 eyes(40.3%)，less than 0.1 in 10 eyes(13.9%)，uncooperative in 15 eyes(20.8%).After one year amblyopia therapy,vision improvement was in 28 eyes(38.9%),fusion function occurred in 22 patients(37.9%).The major complications of operation were uveitis and optic axis opaque.Conclusion Phacoemulsification,implantation of the posterior chamber intraocular lens,posterior lens capsule section or continuous curvilinear capsulorhexis and anterior segment vitrectomy are safe and effective in the treatment of pediatric cataract,especially in the prevention of posterior capsular opacification.The amblyopia therapies after operation are also important contrasted to operation. 　　[Key words] cataract;child;intrao