西藏地区儿童外伤性白内障手术临床分析

Ciinical analysis of pediatric traumatic cataract surgery in Tibet Autonomous Region

目的探讨西藏地区儿童外伤性白内障手术效果及影响因素。方法2006年1月至2011年8月收治的4—14岁外伤性白内障75例，行白内障摘出＋人工晶状体植入术，随访观察3个月。结果手术术后视力较术前视力提高（P〈0．001）。手术脱盲率为74．7％，脱残率为60．0％。外伤后≤3d进行手术者术后视力恢复高于〉3d至1周组，拉萨地区术后患者视力要优于其他地区患者（P=0．020）。未入学患者术前视力要比入学后患者视力差（P=0．008），并且术后恢复视力也低于入学后患者（P=0．027）。藏族和汉族患者术后视力差异无统计学意义（P=0．864）。术后早期主要并发症是角膜浑浊（88．0％）、虹膜粘连（28．0％）、前房积血（25．3％）、高眼压（9．3％）。晚期主要并发症是后囊浑浊（46．7％）和人工晶状体移位（4．0％）。结论西藏地区儿童外伤性白内障发生后，及时转诊和早期手术可以得到较好的视力康复，对于儿童，特别是未入学儿童，需要加强视力保护宣教。

Objective To investigate clinical effect and influencing factors of pediatric traumatic cataract in Tibet Region. Methods Retrospectively analyzed clinical data of 75 cases （75 eyes） with traumatic surgery cataract aged 4 to 14 years old who accepted cataract extraction and intraocular lens implantation from January, 2006 to August, 2008. These patients were followed up for 3 months after operation. Resuits The vision acuity after the operation was higher than preoperative vision （ P 〈 0. 001 ）. The rate of excluding blindness was 74.7% and excluding disability was 60%. When operation in less than 3 days after trauma, visual acuity recovery was better than that of the 5d to lwk group and postoperative vision in Lasa area was better than that in other areas （ P = 0. 020）. The preoperative and postoperative vision acuity of the children not in school were lower than those of the children in school （P = 0. 008 and P = 0. 027 respectively）. There was no statistical significance compared with the visual recovery of Tibetan and Hun nationality （ P = 0. 864）. The main postoperative complications included corneal opacity （ 88.0% ）, synechiae of iris （28.0%） , hyphema （25.3%） , high introcular pressure in early period, and posterior capsular opacification（46.7% ） and displacement of intraocular lens （4.0%） in later. Conclusion Timely referral and early surgery enhance postoperative visual recovery in pediatric traumatic cataract in Tibet area. The instruction and education on vision protection may be important to children, especially those not in schools.