婴儿白内障手术临床观察

Phacoemulcification combined with posterior continuous curvilinear capsulorhexis for infantile cataract

目的观察超声乳化吸出联合后囊膜连续环行撕囊,但不行前部玻璃体切割术治疗1岁以内婴儿先天性白内障的效果,以探讨一种婴儿白内障简便可行的手术方法。方法11例(19眼)先天性白内障患儿,手术年龄平均(6.91±3.05)月(2-11月)。3mm巩膜隧道切口,连续环行撕除晶体前囊膜5mm,超声乳化注吸器注吸出晶体皮质,连续环行撕除晶体后囊膜4mm,一期均未植入人工晶体,均未行前部玻璃体切割术。术后第4天、1月、3月、6月、1年均散瞳镇静后行角膜、前房、眼底及屈光状态检查。结果术后第4天所有眼角膜清,瞳孔圆,眼底清,19眼均未见后囊膜混浊。仅1例术后3月复查发现后囊膜混浊(1/195.26%),给予后囊膜切开联合前部玻璃体切割术,随访1年未发生后囊膜混浊。其余18眼末次随访均未发生后囊膜混浊。随访时间(12.64±6.93)月(6-30月)。结论超声乳化吸出联合后囊膜连续环行撕囊,后囊膜混浊发生率低,无需行前部玻璃体切割术,手术并发症少,可成功治疗婴儿白内障。

Objective To Observe the result of phacoemulcification combined with posterior continuous curvilinear capsulorhexis （PCCC） without primary anterior vitrectomy in infantile cataract surgery. Methods 11 babies （19 eyes） with congenital cataract were involved. Mean age of surgery was （6.91 ± 3.05） months （2-11 months）. 3mm sclera tunnel incision was done. Phacoemulcification was performed combined with 5mm anterior continuous curvilinear capsulorhexis and 4mm PCCC without primary IOL and anterior vitrectomy in 19 eyes. Follow-up was done postoperatively in the 4^th day, the 1st month, the 3rd month, 6th month and 1 year respectively. Results The corneas were clear and the pupils were round in all cases at 1st day postoperatively. Mean follow-up duration was （12.64 ± 6.93） months （range 6-30 months）. 18 eyes had a clear visual axis at the last follow-up examination. Posterior capsule opacification （PCO） （5.26%） was developed in one eye in which capsulotomy with anterior vitrectomy was performed at the post-operative 3 months. The eye did not developed PCO in 1 year after the second surgery. Conclusion Phacoemulcification combined with PCCC without primary anterior vitrectomy in pediatric cataract surgery was safe and effective, with a low reopacification rate.