先天性白内障的手术时机:单侧与双侧对比

Surgical Timing for Congenital Cataract:a Comparison Review between Unilateral and Bilateral Cases

文章整合国内外最新手术治疗进展,分析单、双侧先天性白内障手术的最佳治疗时机,认为单侧先天性白内障患儿出生后即存在视觉刺激的剥夺,导致患眼与健眼之间形成竞争性抑制,其预后较双侧先天性白内障差。单侧先天性白内障患儿在出生4~6周内、双侧先天性白内障则在出生8周内进行白内障摘除手术,预后较好。人工晶体植入手术,建议在患儿满2岁后进行,但2岁内也可能存在合适的手术时间窗口。单侧白内障患儿患眼有着较高的弱视风险,早期进行人工晶体植入可最大程度保证良好的视力预后;适当推迟双侧白内障患儿人工晶体的植入,可降低术后并发症的风险。手术年龄越小术后并发症的发生率越高,而早期植入人工晶体可以降低高度远视引发的弱视风险,故在选择手术时机时需权衡利弊。

This article reviews the latest domestic and international advancements in surgical treatment of congenital cataracts,analyzing optimal treatment timing for unilateral and bilateral cases.It is concluded that unilateral congenital cataracts generally have a worse prognosis compared to bilateral congenital cataracts.This is primarily due to the deprivation of visual stimulation in the affected eye shortly after birth,leading to competitive inhibition between the affected and healthy eyes.For children with unilateral congenital cataracts,cataract removal surgery should ideally be performed within 4 to 6 weeks of birth,whereas for bilateral congenital cataracts,surgery is recommended before 8 weeks of age for better outcomes.In terms of intraocular lens implantation,it is generally recommended to perform this surgery after the child reaches 2 years of age.However,there may be an appropriate surgical window before the age of 2 in some cases.For children with unilateral cataracts,the affected eye has a higher risk of amblyopia.Early intraocular lens implantation may help maximize the chances of a good visual prognosis.For children with bilateral cataracts,intraocular lens implantation can be delayed appropriately to reduce the risk of postoperative complications.The younger the age at the time of surgery,the higher the risk of postoperative complications.However,early intraocular lens implantation can reduce the risk of amblyopia caused by high hyperopia.Therefore,it is crucial to balance the pros and cons when determining the optimal timing for surgery.