预防儿童后发性白内障手术方式的探讨

Study of different surgical methods in preventing the occurrence of after-cataract in children

目的 探讨预防儿童后发性白内障的手术方式。方法 先天性白内障患者27例（34眼），年龄7～22月，分为2组：A组16例（19眼）行白内障吸出及后囊连续环形撕囊术；B组11例（15眼）行白内障吸出、后囊切除联合前部玻璃体切割术。术后随访7～36月，平均17月，观察2组后发性白内障发生情况以及其他并发症。结果 术中后囊膜撕裂发生率：A组为52．63％，B组为0％，2组比较差异有显著性（P＜0．005）；后发性白内障发生率：A组为42．11％，B组为0％，2组比较差异有显著性（P＜0．005）；2组术后其他并发症发生率无显著差异（P＞0．05），均未发生视网膜脱离和黄斑囊样水肿等并发症。结论 儿童先天性白内障摘出时一期行后囊连续环形撕囊在一定程度上可减少后发性白内障形成；一期行后囊合前部玻璃体切割术能有效预防后发性白内障的发生，该方法简便、安全，远期影响有待进一步观察。

Objective To investigate the appropriate surgical method which can reduce the occurrence of after-cataract on congenital cataract in children. Methods Twenty-seven cases （34 eyes） with congenital cataract, aged 7～22 months were randomly divided into 2 groups according to the different ways of operation. Nineteen eyes in group A were performed cataract suction combined with posterior continuous curvilinear capsulorhexis （PCCC）; 15 eyes in group B were conducted cataract suction combined with excision of posterior lens capsule and anterior vitrectomy. Occurrences of postoperative aftercataract and other complications were observed during follow-up for 17 months （ range 7～36 months） in these eyes. Results The rupture of posterior lens capsule during operation was 52. 63% in group A and 090 in the group B, which showed statistical difference between the two groups （P〈0. 005） ; The rate of occurrence of after-cataract was 42.11% in group A and 090 in the group B, which also showed statistical difference（P 〈0.005） ; There were no statistically significant differences in other complications between two groups（P〉0.05）. No case was found with serious complications such as retinal detachment, cystoid macular edema. Conclusion Early cataract suction combined with PCCC can reduce development of after-cataract to a certain degree. But early cataract suction combined with excision of posterior lens capsule and anterior vitrectomy is a safe, easy and efficient method for preventing after-cataract in children.