婴儿先天性全白内障手术中应用23G玻璃体切割头的临床效果

Clinical effects of 23G vitrectomy head on infant with congenital full cataract surgery

目的探讨23G玻璃体切割头应用于婴儿先天性全白内障手术中的临床疗效。方法选取先天性全白内障患儿90例(124眼)作为囊膜环切组,采用23G玻璃体切割头进行前后囊膜环形切除,联合前部玻璃体切割。同期选取先天性全白内障患儿96例(136眼)采用传统的使用撕囊镊环形撕除前后囊膜,联合前部玻璃体切割的方法作为传统组。术后随访5～12个月,观察患儿视力、切口情况、虹膜粘连情况、并发症情况等。结果术后两组患儿能追光和能追物的例数较术前均有显著提高,差异有统计学意义(传统组χ2=1.561,P=0.000,囊膜环切组χ2=1.452,P=0.000);术后两组患儿追光和追物改善情况相比较,差异无统计学意义(χ2=0.181,P=0.670)。术后所有病例切口闭合良好,无浅前房及渗漏现象。传统组术中前囊向赤道部撕裂6眼,撕囊偏大或明显偏中心9眼;囊膜环切组术中无前囊撕裂向赤道部情况发生,均形成居中且直径约5mm的边缘较整齐的前后囊孔,无偏心及囊膜撕裂发生。传统组出现虹膜后粘连10眼,囊膜环切组出现部分瞳孔缘后粘连1眼,两组比较差异有统计学意义(χ2=6.861,P=0.009);传统组出现3级后发性白内障5眼,囊膜环切组无后发性白内障发生,两组比较差异有统计学意义(P=0.038);传统组的不良反应发生率显著高于囊膜环切组。结论婴儿先天性全白内障术中应用23G玻璃体切割头进行前后囊膜切除联合前部玻璃体切割术,可有效避免囊膜撕裂、虹膜粘连等并发症的发生,值得在临床推广应用。

Objective To evaluate the clinical effects of 23G vitrectomy head on infant with congenital full cataract. Methods A total of 90 children （ 124 eyes） with congenital full cataract were selected as the capsulorhexis circumcision group, and were treated with the back and forth enveloped loop excision by 23G vitrectomy head combined with anterior vitrectomy. Another 96 children （ 135 eyes） with congenital full cataract in the same period were selected as the traditional group, and were treated with back and forth tear curvilinear capsulorhexis forceps capsulotomy combined with anterior vitrectomy. They were followed up for 5 to 12 months,and the situations of vision, the incision, iris adhesions and complications were observed. Results Light perception and object perception in the two groups after surgery were significantly improved compared to preoperation, and the difference was statistically significant （traditionalgroup ：χ2 = I. 561, P = 0.000 ; envelope circumcision group ：χ2 = 1. 452, P = 0. 000 ） ; however, the light perception and object perception between the two groups after surgery was no statistical difference （χ2 = 0. 181 ,P = 0. 670 ）. The incisions all closed without shallow anterior chamber and leakage. There were 6 eyes of anterior capsule tear to the equator and 9 eyes of capsulorhexis obviously eccentric in traditional group;there was no anterior capsule tear to the equator, the formed capsule hole was centered with neat edges and the diameter was approximately 5 mm without eccentric and capsular tear. There were 10 eyes with posterior synechia in traditional group, 1 eye with posterior synechia in envelope circumcision group, and the difference was statistically significant（χ2= 6. 861 ,P = 0.009 ） ;there were 5 eyes with III phase posterior capsule opacification（PCO） in traditional group, no eye with III phase posterior capsule opacification（PCO） in envelope circumcision group, and the difference was statistically significant（P = 0.038 ） ;the incidence of adverse reactions in traditional group was significantly higher than that in the envelope circumcision group. Conclusion 23G vitrectomy head before and after capsular resection combined with anterior vitrectomy for the treatment of infant with congenital cataract, could effectively avoid complications, such as the tearing of capsular fihn and iris adhesions, so it is worthy of clinical application.