婴儿单眼先天性白内障术后无晶状体眼屈光矫正分析

Optical correction of aphakia following unilateral congenital cataract removal in infant

目的探讨Ⅰ期人工晶状体植入和压贴球镜矫正单眼先天性自内障术后无晶状体眼的疗效。方法临床病例对照研究。对2009年8月至2012年6月在济南市第二人民医院就诊的46例单眼先天性白内障患者（年龄6～18月），采用随机数字表法随机分为人工晶状体植入组（A组）和压贴球镜组（B组），随访1年，观察视力变化及术眼情况。结果二组术后1年视力较术后1周均f珥显提高，差异有统计学意义（tA=43．02，P〈0．01，95％可信区间：0．302～0．332；tB=25．62，P〈0．01，95％可信区间：0．158～0．186），二组术后1年与术后1周视力差值为0．317±0．023和0．172±0．019，A组较B组视力提高更明显，差异有统计学意义（t=23．31，P〈0．01，95％可信区间：0．132～0．158）。炎性反应重者A组10例（43．48％）、B组3例（13．04％），差异有统计学意义（X2=3．86，P=0．049）；视轴区出现致密纤维增殖膜A组6例（26．09％）、B组7例（30．43％），差异无统计学意义（X2=0．107，P=0．743）；二组均未见其它眼部并发症。结论对6～18个月单眼先天性白内障患者应在条件允许的情况下尽早Ⅰ期植入人工晶状体，未植入人工晶状体患者可用压贴球镜行屈光矫正。

Objective To evaluate the therapeutic effects of primary intraocular lens implantation and press-on spherical lens for optical correction of aphakia following unilateral congenital cataract removal in infant. Methods Forty-six patients with the age from 6 months to 18 months were di- vided into 2 groups randomly. Group A was with intraocular lens implantation, while group B with press-on spherical lens. The visual acuity and possible complications were followed up for 1 year. Results The visual acuity of both groups was significantly better 1 year than 1 week after surgery （tA=43.02, P 〈0.0001, 95% confidence interval： 0.302-0.332; tB=25.62, P 〈0.0001, 95% confidence in- terval： 0.158-0.186）. The visual acuity difference between 1 year and 1 week after surgery was high- er in the group A （0.317±0.023） than in the group dence interval： 0.132±0.158）. Serious inflammatory B （0.172±0.019） （t =23.31, P 〈0.0001, 95% confi- reactions occurred significantly more often in the group A than in the group B （X2=3.86, P =0.049）. Visual axis opacity occurred in 6 eyes （26.09%） in group A and 7 eyes （30.43%） in group B. The differences were not significant （X2=0.107, P = 0.743）. No other complications were found in two groups. Conclusions The patients suffering from unilateral congenital cataract, with the age from 6 months to 18 months, should be implanted intraoc- ular lens as soon as possible under permissive conditions. The patients who were not suitable for pri- mary intraocular lens implantation can be treated with press-on spherical lens for optical correction.