儿童单眼外伤性白内障手术后弱视康复的研究

Study on amblyopia of children with monocular traumatic cataract surgery

目的探讨儿童单眼外伤性白内障手术后弱视的治疗方法、弱视治疗的时机和双眼视觉功能的康复的方法。方法单眼外伤性白内障的弱视儿童27例,其中男孩21例,女孩6例。年龄3.4～11.7岁,平均7.8岁。手术前视力为光感～0.05,角膜外伤均为非角膜光学区的穿孔伤和光学区内的角膜薄翳。手术方法:白内障的摘出人工晶状体植入,所有斜视者同时进行斜视矫正,手术中或手术后进行散瞳验光,术后3～4周矫正屈光不正,同时进行同视机脱抑制、光刷、光栅及图形刺激等弱视治疗,旁中心注视进行红光后像治疗。手术后1月开始治疗,共治疗6～12月,平均6.5月。结果远视力0.8以上8例,0.3～0.8者9例,0.3以上占62.96%;0.1～<0.3者5例,0.1以上占81.48%;0.1以下5例。结论儿童单眼外伤性白内障手术要一次解决白内障和其他导致弱视的因素,如斜视;手术后1月进行屈光矫正并开始系统的弱视训练和视觉康复,则大多数能取得较好的疗效。

Objective The children＇s monocular traumatic cataract often involve the monocular deprived amblyopia, and it is the important factor that has the side-effect on visual development, This research will investigate how to do surgery, how to treat the amblyopia and how to recover the binocular vision. Methods 27 children with monocular traumatic cataract had been collected from 2004, of 21boys and 6 girls, age from 3.4-11.7 years old, mean 7.8 years old, the penetrating of anterior segment located in the non-optometry area. Operation： Phaeo ＋ [OL transplantation, if had ocular deviation, corrected it at the mean time, the optometry examination will be performed in operation Or postoperatively, and optometry correction will be done within 3-4 weeks postoperatively. Amblyopia treatment including amblyocope, Heidinger brush, CAM, and pattern stimuli on the kids with center fixation, pleoptics on eccentric fixation. Results The time for treatment will start in 1 month postoperatively, duration time 6-12 months, means 6.5 months. Snellen table was used for testing the recovery of visual acuity （AC） , 8 cases above 0.8, 9 cases in 0.3-0.8,5 cases in 0.1-0.3,5 under 0.1. Conclusions All the operations including Phaco ＋ IOL and deviation correction will be finished in first time. Optometry correction should be performed within 1 month. All treatments on amblyopia will start in 1 month postoperatively, most of them will be recovered.