儿童先天性白内障手术及术后弱视的防治

Congenital cataract operation and preventive treatment of postoperative amblyopia

目的 探讨儿童先天性白内障手术治疗的临床疗效及术后防治弱视的重要性。方法 对我院 6年来共收治先天性白内障患儿 5 2例 ( 74眼 ) ,分别行白内障囊外摘除 (ECCE组 ) 2 5例 ( 3 4眼 )、及白内障囊外摘除人工晶体植入术联合后囊切开及视轴中央前段玻璃体切除术 (ECCE +VAC组 ) 2 7例 ( 3 6眼 )。对术后随访 2～ 5年的远期视力及影响远期视力的原因等进行了回顾性分析。统计学处理采用 χ2 检验。结果 手术后脱盲率为 73 .3 %、脱残率为 5 0 .7%,经弱视治疗后提高为 86.7%和 76.8%。单眼病例在术后效果及弱视治疗后疗效均较双眼病例差 ,两者比较差异有显著性 ,P <0 .0 5。两种手术方式比较也有非常显著性差异 ,P <0 .0 1。结论 提倡儿童先天性白内障早期诊断、早期手术。采用白内障囊外摘除并植入人工晶体同时行Ⅰ期后囊切开联合前段玻璃体切除术为有效的治疗方法。 3岁左右儿童植入人工晶体可获得良好视力 ,重建视功能。强调术后随访 ,治疗弱视是保持和巩固远期视力的关键。

Objective To evaluate the effects and treatment of amblyopia in congenital cataract after operation. Methods Operation was performed on 74 eyes of 52 children with congenital cataract, The results were retrospectively within 6 years after operation. 25 cases (34 eyes) underwent cataract extraction (ECCE), and 27 cases (36 eyes) underwent cataract extraction with anterior vitrectomy (ECCE+VAC). The long term vision recovery was assessed two to five years after the operation. Results 73.3% patients were relieved from blindness and 50.7% relieved from disability On treatment of the amblyopia, these rose to 86.7% and 76.8%, respectively. The efficiency in cases with involvement of both eyes was much better than that in cases with single eye involvement, there were significant differences in the effects of postoperative and amblyopia between the two groups, ( P <0.05), and so weve the two surgical modalities, ( P <0.01).Conclusion Early diagnosis and early operation are important, cataract extraction with anterior vitrectomy and IOL implantation is effective for padiatric patients. Most patients have marked improvement in visual acuity and visual function with IOL implantation at the age of three. Follow up study after operation should be emphasized and is cruicial in maintainance of long term good eye vision. and treatment of amblyopia is essential. (Shanghai Med J, 2000,23∶160 162)