儿童先天性白内障476例手术特点分析

Clinical characteristics of congenital cataract in 476 children

目的分析儿童先天性白内障手术方式、人工晶状体(intraocular lens,IOL)植入情况和术后并发症情况,以期为儿童先天性白内障的治疗提供参考。方法回顾分析2008年1月至2016年1月在我院行先天性白内障摘出的13岁以下儿童的临床资料。手术前后行裂隙灯显微镜、眼底、眼压、最佳矫正视力等常规检查。2岁及以下儿童行白内障超声乳化摘出+后囊连续环形撕囊(posterior continuous curvilinear capsulorhexis,PCCC)+前段玻璃体切割(anterior vitrectomy,AV)术,2岁后行二期IOL植入术;>2~4岁儿童行白内障超声乳化摘出+PCCC+AV+IOL植入术;>4~7岁儿童行白内障超声乳化摘出+PCCC+IOL植入术;>7岁儿童行白内障超声乳化摘出+IOL植入术。结果共476例(740眼)纳入本研究,年龄(33.59±37.14)个月,其中0~6个月166例(282眼,38.11%)。一期植入IOL 260眼,年龄(5.59±2.43)岁;二期植入IOL 480眼,年龄(4.06±2.12)岁。IOL植入术后残留屈光度(等效球镜度数):>2~4岁为(3.53±0.56)D,>4~6岁为(2.36±0.32)D,>6~8岁为(1.65±0.52)D,>8~13岁为(-0.25±0.32)D。术后并发症326眼,其中虹膜粘连115眼(35.28%),位于视轴上的后发性白内障97眼(29.75%),术后青光眼54眼(16.56%)。末次随访时单眼白内障术后最佳矫正视力为(0.56±0.41)LogMAR,双眼白内障术后最佳矫正视力为(0.42±0.27)LogMAR,两组相比差异有统计学意义(P=0.04)。结论儿童先天性白内障约三分之一在6个月内进行白内障超声乳化摘出术。双眼先天性白内障患儿视力预后优于单眼先天性白内障患儿。儿童先天性白内障患儿术后并发症较成人多,需谨慎处理。

Objective To analyze the operative methods,intraocular lens （IOL） implantation and postoperative complications in children with congenital cataract,and give the references for treating of congenital cataract.Methods From January 2008 to January 2016,children under the age of 13 years with congenital cataract were enrolled.Preoperative and posterior slit lamp microscope,fundus,intraocular pressure were examined.Children under 2 years old were treated with phacoemulsification （PHACO）,posterior continuous curvilinear capsulorrhexis （PCCC）,anterior-vitrectomy （AV）,and 〉2-4 years old with PHACO＋PCCC＋AV＋IOL implantation,〉4-7 years old children with PHACO＋PCCC＋IOL implantation,children 〉7 years with PHACO＋IOL implantation.Results A total of 476 patients （740 eyes） were enrolled in the study,the average age were （33.59±37.14） months,of which 0~6 months were 166 cases （282 eyes,38.11%）.260 eyes were implanted with IOL,aged （5.59±2.43） years,480 eyes were implanted in the second surgery,aged （4.06±2.12） years.Refaction diopter （equivalent spherical） after IOL implantation in children aged 〉2-4 years old was （3.53±0.56） D,〉4-6 years old was （2.36±0.32） D,〉6-8 years old was （1.65±0.52）D,〉8-13 years old was （-0.25±0.32） D.The postoperative complications occurred in 326 eyes,of which 115 eyes （35.28%） with iridotic adhesions,97 eyes （29.75%） with posterior cataract on the visual axis,and 54 eyes （16.56%） with glaucoma.At the last follow-up,the best corrected visual acuity were （0.56±0.41） LogMAR for monocular cataract surgery and （0.42±0.27） LogMAR for binocular cataract surgery,the difference was statistically significant （P=0.04）.Conclusion One-third of children with congenital cataract are treated with surgical treatment under 6 months old,about half of the children undergo IOL implantation at 2~3 years of age.The postoperative visual acuity in children with binocular cataract is better than children with monocular cataract.The complications in children are more complicated than adults,which should be paid more attention.