先天性核性白内障手术疗效分析

Surgical treatment of congenital nuclear cataract

目的 评价不同年龄段先天性核性白内障的特征及囊外白内障摘除术或联合后房型人工晶状体植入术的临床疗效。方法 对 38例 (76只眼 )先天性核性白内障患者按年龄段以不同术式进行白内障手术 ,术中手术显微镜直视下观察后囊膜下混浊的特征 ;术后平均随访 6个月 ,对手术并发症及视力变化情况进行分析。结果 术中发现后囊膜下混浊随年龄呈进行性发展 ,混浊面积与晶状体混浊核相当 ;各年龄段术后矫正视力分布差异有显著性 (χ2 =2 7 84,P <0 0 0 5 ) ;术后后囊膜混浊的发生率与患者年龄呈负相关性 (r =- 0 96 92 ,P <0 0 5 ) ;在年龄 3～ 12岁患者中 ,2只眼术后发生人工晶状体瞳孔夹持。结论 先天性核性白内障可伴发后囊膜下型白内障 ,发病机制尚待进一步研究 ;同类型先天性核性白内障手术的疗效主要取决于患者手术的年龄 ;儿童白内障术后并发症应及早诊治。

Objective To study the characteristics of congenital nuclear cataract and evaluate the therapeutic effects of extracapsular cataract extraction (ECCE) with or without intraocular lens (IOL) implantation in different age groups. Method ECCE with or without IOL implantation was performed on 76 eyes of 38 cases with congenital nuclear cataract in different age groups. Under operative microscope, the characteristics of the opacity of the posterior capsule were described. The visual acuity and possible complications were followed up for a mean period of 6 months. Results The opacity of the posterior capsule was progressively developing, its diameter was similar to that of the opaque nucleus. The difference of the post operative corrected visual acuity in different age groups was significant (χ 2=27 84, P <0 005). The rates of the secondary cataract were negatively correlated to the age groups ( r =-0 969 2, P <0 05). In 2 eyes, slight iris capture occurred in 3 12 year group. Conclusions Congenital nuclear cataract can combine with posterior capsular cataract. The etiology remains to be studied. The therapeutic effects of the congenital nuclear cataract mainly depend on the time of operation. The early treatment of post operative complications in children is of primary importance.