儿童外伤性白内障眼内炎患者人工晶状体植入时机的选择

Timing of intraocular lens implantation for children with traumatic cataract and endophthalmitis

目的:探讨儿童外伤性白内障眼内炎患者人工晶状体植入的手术时机。方法:本研究为前瞻性研究,入选病例为我院2003-06/2005-06收治的69例69眼儿童外伤性白内障眼内炎患者,术中观察玻璃体积脓不超过一个象限或仅累及前部玻璃体,视网膜状态完好者。将69例69眼患者随机分为两组,对两组患者采用不同手术方式进行治疗,A组34例34眼:进行玻璃体切除,同期植入人工晶状体;B组35例35眼:先进行玻璃体切除,术后3～6moII期植入人工晶状体。比较两种方法的治疗效果。结果:两组患者术后视力均明显提高。两组手术前后视力分别进行比较P=0.000,差别均有显著统计学意义;两组之间手术前后视力比较,术前P=0.978,差别无显著统计学意义;术后P=0.005,差别有显著统计学意义。A组患者术后视力明显好于B组。两组之间术后反应及并发症进行比较,差别无显著统计学意义。结论:在严格控制适应证的基础上,儿童外伤性白内障眼内炎患者,进行玻璃体切除同期植入人工晶状体,配合有效的术后处理,一般均能取得较好的治疗效果。

AIM： To explore the timing of intraocular lens （IOL） implantation for children with traumatic cataract and endophthalmitis. METHODS： This prospective study included 69 eyes of 69 consecutive patients with traumatic cataract and endophthalmitis, undergoing vitrectomy for eye trauma in our hospital from June 2003 to June 2005. The cases whose corneas and retinas are relatively normal, and whose vitreous empyema is within one quadrant or only involved anterior vitreous were selected. Two methods of treatment were performed for these patients. In group A, 34 cases （34 eyes） were given vitrectomy and IOL implantation at the same time; in group B, 35 cases （35 eyes） were given vitrectomy. With an interval of 3 to 6 months they were performed IOL implantation. The effects of treatment were analyzed with descriptive statistics. RESULTS： The postoperative visual acuity of patients in group A and group B was all improved compared with that before the operation, and there existed statistically significant differences （ P = 0. 000）. The postoperative visual acuity of group A was much better than that of group B and there was significant difference （ P = 0.005）. With respect to postoperative reactions and complications, there was no statistically significant difference between two groups （ P= 0. 990）. CONCLUSION： Our results suggest that if we can control the surgical indications strictly, and perform the vitrectomy and IOL implantation at the same period for children with traumatic cataract and endophthalmitis, combined with effective postoperative treatment, we could get better therapeutic outcomes generally.