IOL睫状沟植入联合IOL光学部周边后囊孔嵌顿术对儿童外伤性白内障的疗效观察

The treatment effect of intraocular lens ciliary sulcus implantation combined with posterior capsular incarceration of intraocular lens on children with traumatic cataract

目的 比较外伤性白内障摘出术后不同人工晶状体（IOL）植入的临床疗效,寻找更优的儿童外伤性白内障的手术方式.方法 采用回顾性病例对照研究方法.收集2012年6月至2015年6月收治的60例60眼儿童外伤性白内障患者的病历资料,其中男44例,女16例;年龄1～14岁,平均（5.99±2.80）岁.60例患儿均在全身麻痹下行手术治疗,均由同一术者完成手术,均行外伤性白内障摘出＋IOL植入＋前段玻璃体切割术,根据后囊膜损伤情况将患者分为2个组,联合手术组患者30例30眼行IOL睫状沟植入联合IOL光学部周边后囊孔嵌顿手术,单纯手术组患者30例30眼行单纯IOL睫状沟植入手术,术后随访1～6个月,平均（4.3±1.2）个月.对比分析2个组手术前后最佳矫正视力BCVA、中央视轴区混浊程度、IOL偏斜度、术后并发症及手术操作时间.结果 联合手术组和单纯手术组术后不同BCVA患眼比例与术前比较,差异均有统计学意义（联合手术组：x2=7.548,P＜0.05;单纯手术组：x2=5.579,P＜0.05）.2个组患儿中央视轴区不同分级混浊患眼数量及不同BCVA患眼数量比较差异无统计学意义（x2=0.362,P＞0.05）.联合手术组中IOL偏斜度较大患眼数量少于单纯手术组,术后不同IOL偏斜度患眼数量比较差异有统计学意义（x2=9.858,P＜0.05）.联合手术组中并发症患眼数量少于单纯手术组,2个组不同并发症患眼数量比较,差异有统计学意义（x2=7.200,P＜0.05）.2个组不同手术操作时间患眼数量比较,差异无统计学意义（x2=0.658,P＞0.05）.结论 IOL睫状沟植入联合IOL光学部周边后囊孔嵌顿术对于治疗儿童外伤性白内障更为有效,并发症少,IOL偏斜度低.

Objective To compare the treatment effect of intraocular lens ciliary sulcus implantation combined with posterior capsular incarceration of intraocular lens and simple intraocular lens ciliary sulcus implantation.Methods We retrospectively analyzed 60 eyes of 60 children with traumatic cataract from June 2012 to June 2015 in the Second People＇s Hospital of Yunnan Province,including 44 males and 16 females and the average age ranged from 1 to 14 years.The patients were divided into two groups according to the situation of posterior capsular,30 eyes of 30 children for each group.The patients in combined surgery group were performed intraocular lens ciliary sulcus implantation combined with posterior capsular incarceration of intraocular lens,and the patients in simple surgery group were performed simple intraocular lens ciliary sulcus implantation.The follow-up time ranged from 1 month to 6 months.The best corrected visual acuity（BCVA）,grade of optic axis turbid,dislocation of intraocular lens,postoperative complications and surgical duration were compared between the two groups.Results The BCVA after surgery was significantly different from that before surgery in both groups （combined surgery group：x2 =7.548,P〈 0.05;simple surgery group：x2 =5.579,P〈0.05）.The postoperative turbidity of central axis area and BCVA were not significantly different between the 2 groups （x2 =0.362,P〉0.05）.The dislocation degree of intraocular lens and proportion of postoperative complications were lower in the combined surgery group than those in the simple surgery group （x2 =9.858,P〈0.05;x2 =7.200,P〈0.05）.The duration of surgery was not significantly different between the 2 groups （x2 =0.658,P 〉 0.05）.Conclusions Posterior capsular incarceration of intraocular lens has fewer complications,lower dislocation degree of intraocular lens and more effective for children with traumatic cataract than intraocular lens ciliary sulcus implantation.