白内障摘除联合人工晶状体植入术对儿童屈光状态的影响

Refraction shift after intraocular lens implantation in children

目的 探讨儿童白内障摘除联合后房型人工晶状体 (intraocularlens,IOL)植入术对术眼远期屈光状态的影响 ,为术前选择合适的IOL屈光度数提供依据。方法 对 5～ 12岁单眼白内障摘除联合后房型IOL植入术患儿 6 5例 (6 5只眼 )进行 5～ 10年随访 ,以对侧健眼为对照 ,记录术后视力、角膜曲率、眼轴长度和屈光度数的变化情况。结果 术前术眼和健眼平均眼轴长度分别为 (2 2 48± 0 44 )mm和 (2 2 43± 0 41)mm ;术后 10年术眼和健眼平均眼轴长度分别为 (2 3 45± 0 5 3)mm和(2 3 41± 0 5 0 )mm ,两者差异无显著性 (F =0 983,P >0 0 5 )。术后 10年术眼和健眼的屈光状态均向近视侧偏移 ,向近视变化的均值术眼为 3 2 9D ,健眼为 1 75D ,两者差异有显著性 (F =2 318,P <0 0 5 )。结论 儿童白内障摘除联合后房型IOL植入术不影响儿童眼轴的正常发育 ;以保证术眼术后的屈光度数接近儿童屈光平均生理值为原则为儿童白内障患者选择IOL的屈光度数 ,对防止患儿成年后双眼出现高度数屈光参差 ,防治儿童白内障眼弱视的发生和发展具有重要意义。

Objective To evaluate the refraction shift after posterior chamber intraocular lens (PC IOL) implantation in children. Methods A long term retrospective study involved 65 eyes of 65 patients aged from 5 to 12 years who underwent PC IOL implantation between December 1988 and December 1994. The mean follow up was 7 1 years (range 5 to 10 years). Refraction shift, keratometric readings and axial length were periodically measured. Sixty five healthy eyes were in the control group. Results The mean preoperative axial length of the surgical group was (22 48±0 44) mm, and of the control group, (22 43±0 41) mm. There was no statistically significant difference in axial length after 10 years in both groups, (23 45±0 53) mm in surgical group and (23 41±0 50) mm in control group. All the eyes showed a myopic drift with 3 29 D in surgical group and 1 75 D in control group ( F =2 318, P <0 05). Conclusion The ocular growth of children is found to be unaffected by the PC IOL implantation, the choice of IOL power should be retained in physiological hyperopia in pseudophakic children.