摘要
目的 评价二种不同术式对儿童先天性白内障的疗效.方法 将1～3岁儿童先天性白内障22例（44只眼）,随机分为A、B二组.A组10例（20只眼）应用23G玻璃体切割（简称玻切,下同）机完成晶状体皮质吸除及前节玻切,B组12例（24只眼）应用常规超声乳化I/A头吸除晶体皮质后,应用前节玻璃体切割机切除前部玻璃体.所有手术均由同一医生进行.对比研究不同术式术中切口闭合情况,虹膜脱出率,术后角膜新生血管及其他相关并发症的差异. 结果 A组透明角膜缘切口宽0.6mm,手术及关闭切口时均能维持前房眼压稳定,B组透明角膜缘切口宽2.8mm,术中切口欠密闭,前房维持不佳,术后需缝合切口;A组术中未发生虹膜脱出现象,B组术中发生虹膜脱出14只眼（占58.3%）;A组术中出现低眼压为3只眼（占15%）,B组术中为20只眼（占83.3%）.术后随访6~24个月,平均11个月,A组术后术眼角膜透明,均未发生新生血管,B组术后缝线处术眼角膜发生新生血管为4眼（占16.6%）;A组后发障发生率为2眼（占10%）,B组后发障发生率为2眼（占8.3%）;随访中其他并发症如：视网膜脱离、青光眼、低眼压、眼内炎等二组均未发生.结论 应用23G玻璃体切割机直接行儿童白内障晶体皮质吸除及前节玻切手术,术中能够维持前房稳定,降低虹膜脱出率及术后缝线处角膜新生血管发生率,是一种更安全有效的I期治疗儿童白内障手术方式.
Objective To evaluate the effects of congenital cataract surgery with two different methods. Methods Twenty two cases （44 eyes） of children with cataracts, 1-3 years old, were divided into two groups in random. In Group A, both lens materials and anterior vitreous were performed with 23-gauge vitrectomy in 20 eyes of 10 children with cataracts; while in Group B, the lens materials was aspirated by irrigation/aspiration （I/A）, but the anterior vitreous was cut by anterior vitrectomy in 24 eyes of 12 children with cataracts. All the surgeries were done by one surgeon. To investigate the condition of incision, the rate of iris prolapse, cornea neovascularization and other complications between two groups. Results The incision diameter in group A was just 0.6mm, it maintained stable IOP （intro ocular pressure） during vitrectomy and closure. While in group B, the incision diameter was 2.8mm, it was difficult to maintain stable IOP during surgery, and sutures were needed when surgery finished. In group A, iris prolapse didn＇t occur when operation, while it occurred in 14 eyes （58.3%） in group B. The average follow-up period was eleven months （range, 6 to 24）. Cornea neovascularization didn＇t happen in group A, while in group B it occurred in 4 eyes （16.6%）. The rate of posterior capsular opacification was 10% in group A, and it was 8.3% in group B. Other complications, such as retinal detachment, glaucoma, low pressure and endophthalmitis did not occur. Conclusions The 23-gauge vitrectomy used directly in lensectomy and vitrectomy in pediatric cataract surgery can maintains stable IOP, reduce the rates of iris prolapse and cornea neovascularization, which is much safer and more effective. It is promising to be a regular way in first stage of congenital cataract surgery.
出处
《中国实用眼科杂志》
CSCD
北大核心
2010年第8期891-893,共3页
Chinese Journal of Practical Ophthalmology
