儿童白内障手术及术后视力康复

Pediatric cataract operation and rehabilitation of postoperative visual function

目的 探讨儿童白内障手术疗效及术后视力康复.方法 观察2005年7月至2009年11月手术的45例（76只眼）儿童白内障患儿,行白内障摘除术＋后囊膜环形撕囊术（PCCC）＋前部玻璃体切除术33例（64只眼）,双眼白内障患儿同时手术,其中28例（58只眼）2岁以后再次行Ⅱ期人工晶状体植入术,;行白内障摘除术＋后囊膜环形撕囊术（PCCC）＋前部玻璃体切除术＋人工晶状体植入术9例（9只眼）;行白内障摘除术＋人工晶状体植入术3例（3只眼）.对手术年龄、手术方式、术后并发症及术后远期视力等进行回顾性分析,随访4～55个月,平均34.5月.结果 33例矫正视力在0.3以上,手术脱残率73.3%,5例矫正视力在0.05～0.3,手术脱肓率84.4%,2例矫正视力在0.05以下.5例患儿因年龄小不能合作检查视力,但能追随光亮或注视目标.后发障发生率为6.58%,双眼同时手术与同期单眼手术术后并发症差异无统计学意义（P＞0.05）.结论 白内障摘除术＋后囊膜环形撕囊术（PCCC）＋前部玻璃体切除术联合人工晶状体植入术是治疗儿童白内障安全有效的措施,儿童白内障双眼同时手术是安全的.坚持弱视训练是儿童白内障术后获得良好视力,重建视功能的关键.

Objective To evaluate the effects of pediatric cataract operation and rehabilitation of postoperative visual function. Methods Operation was performed on 45 cases （76 eyes） of pediatric cataract from July 2005 to November 2009. Of 33cases （64eyes） underwent posterior continuous curvilinear capsulorhexic （PCCC） and anterior vitrectomy after cataract extraction, and operation was performed simultaneously on bilateral pediatric cataract, 28cases （58eyes） underwent secondary intraocular lens （IOL） implantation at the age of above 2,9 cases （9eyes） underwent PCCC, anterior vitrectomy and IOL implantation after cataract extraction; 3 cases （3eyes） underwent IOL implantation after cataract extraction. Retrospective analysis was performed about the operation age, the operation methods and the postoperative complication, and the long-term vision recovery was recorded throughout the 34.5-month mean follow-up （range 4-55months）. Results The postoperative best-corrected visual acuity was better than 0.3 in 33 cases, among 0.05 to 0.3 in 5 and below 0.05 in 2. Five eyes in much younger children who could not receive visual acuity examination had better capability of light following and visual fixation after operation. 73.3% patients were relieved from disability and 84.4% patients were relieved from blindness on treatment of the amblyopia. The incidence of posterior capsular opacification was 6.58%. Between the simultaneous bilateral group and the single eye group, there was no significant difference in the postoperation complications （P 〉0.05）. Conclusions IOL implantation with posterior continuous curvilinear capsulorhexic （PCCC） and anterior vitrectomy after cataract extraction is a safe and effective operation for the treatment of pediatric cataract. Operation is safe on bilateral pediatric cataract. The amblyopia treatment after operation is the key to obtaining good visual acuity and building visual function.