婴幼儿先天性白内障术后继发性青光眼的临床分析  

Clinical analysis of the occurrence of secondary glaucoma after pediatric congenital cataract surgery in the first 36 months of life

作　　者：张辉[1] 谢立信[1] 

机构地区：[1]山东省医学科学院山东省眼科研究所,青岛266071

出　　处：《中华眼科杂志》2013年第2期134-138,共5页Chinese Journal of Ophthalmology

摘　　要：目的探讨婴幼儿先天性白内障手术及其二期人工晶状体（IOL）植入术后继发性青光眼的发生。方法回顾性系列病例研究。1995年7月至2005年7月于山东省眼科研究所行先天性白内障手术的≤3周岁的儿童被纳人统计分析，排除术前与青光眼发生有关联的病例。详细记录手术年龄、白内障类型以及术后继发性青光眼的发生等相关信息。结果115例患儿（204只眼）被纳入研究对象，平均手术年龄（12．5±9．2）个月，术后平均随访（83．7±43．8）个月。双眼先天性白内障术后的11例15只眼（7．4％）发生继发性青光眼，其中6例6只眼（6／15）术后早期继发，5例9只眼（9／15）平均于术后（54．9±34．3）个月发生晚期青光眼。发生青光眼者13只眼（13／15）手术年龄≤9个月，12只眼（12／15）为核性或全白内障，继发性青光眼发生眼均无同期IOL植入。此外，二期睫状沟植入IOL的86只眼中，13只眼（15．1％）发生继发性青光眼，其中6只眼（6／13）有二次手术病史。结论婴幼儿双眼先天性白内障术后有一定的继发性青光眼发生率。晚期的继发性青光眼多在术后数年出现，且二期IOL植入术后亦有一定的继发性青光眼发生率，因此术后长期随访非常重要。Objective To observe the rate of secondary glaucoma after pediatric congenital cataract surgery in the first 36 months of life. Methods Retrospective case series. The records of children who underwent surgery for congenital cataract within the first 36 months of life between July 1995 and July 2005 at Qingdao Eye Hospital were reviewed. Children with preoperative conditions associated with glaucoma were excluded. Age at surgery, unilateral or bilateral cataract, type of congenital cataract, primary intraocular lens （IOL） insertion, duration of follow-up, postoperative best corrected visual acuity, development of aphakic glaucoma, and development of glaucoma after secondary IOL implantation were evaluated. Results A total of 115 patients （204 eyes） with an average surgery age of （12. 5 ±9. 2） months were included; the mean follow-up time was （ 83.7 ± 43.8 ） months. 15 eyes （ 11 patients ） （ 7.4% ） had subsequent development of glaucoma, 7 of which （4 patients ） developed late-onset open-angle glaucoma. Of the 15 eyes, 13 eyes had surgery within 9 months, and 12 eyes developed nuclear or total cataract. None of the primarily pseudophakia eyes developed glaucoma in our study. Of 86 eyes that received implantation of secondary intraoeular lens in the ciliary sulcus, 13 eyes （15.1%） developed pseudophakia glaucoma. Conclusions Secondary glaucoma occurred after pediatric bilateral cataract surgery. As late-onset glaucoma usually occurred several years after primary surgery, long-time follow-up after pediatric cataract surgery needs to be emphasized.

关 键 词：白内障 手术后并发症 青光眼 儿童 

分 类 号：R779.6[医药卫生—眼科]