婴幼儿先天性白内障再次手术的临床分析  

Clinical analysis of reoperation of infants with congenital cataract

作　　者：纪丽君 金海鹰[2] 孙景莹 赵培泉[2] 

机构地区：[1]徐汇区大华医院眼科,上海200237 [2]上海交通大学医学院附属新华医院眼科,200092

出　　处：《中国实用眼科杂志》2015年第9期1038-1041,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的 探讨先天性白内障摘除术后再次手术的原因和术式,为先天性白内障病例有更优的手术治疗策略提供参考依据.方法 采用回顾性系列病例研究.对2012年10月至2013年8月于上海交通大学医学院附属新华医院眼科行先天性白内障手术后再次手术患儿51例（69只眼）,详细记录手术年龄、首次手术方式、随访时间、再次手术的时间间隔、再次手术方式、术后半年最佳矫正视力及眼压等,分析其再次手术的原因及术后效果.结果 婴幼儿先天性白内障再次手术：无晶状体眼55.1％（38/69）,后囊膜混浊30.5％ （21/69）,眼内炎4.3％ （3/69）,继发性青光眼4.3％ （3/69）,瞳孔膜闭2.9％ （2/69）和人工晶状体（IOL）脱位2.9％ （2/69）.无晶状体眼患儿行Ⅱ期IOL植入术,后囊膜混浊行后囊膜切除术,眼内炎行IOL取出＋玻璃体切除＋硅油充填术,继发性青光眼行青光眼引流阀植入术,瞳孔膜闭行瞳孔成形术,IOL脱位患儿行原IOL取出＋玻璃体切除＋IOL悬吊术.随访半年后最佳矫正视力＞0.3者26只眼,＞0.1者14只眼,＜0.1者12只眼.另有10例（17只眼）患儿不能配合视力检查,术后追光或注视目标较术前有明显提高.随访半年所有患儿采用手持式回弹icare眼压计检测眼压均在正常范围.结论 无晶状体眼及后囊膜混浊等是婴幼儿先天性白内障再次手术的主要原因,分析再次手术原因并针对性选择相应术式是较好的先天性白内障患儿的手术治疗策略之一。Objective To explore the causes of congenital cataract operation again after resection, the cases for clinical provide the basis for better treatment strategies.Methods A retrospective case series study.From October 2012 to August 2013 in Department of Ophthalmology, Xinhua Hospital affiliated to Shanghai Jiaotong University for congenital cataract operation again after operation in 51 cases （69 eyes）, the detailed record of operation, operation mode for the first time, age, distance of cataract operation were again operation interval.Postoperative half year best corrected visual acuity and intraocular pressure, etc.The causes of reoperation and postoperative effects were analyzed.Results The reoperation of infant congenital cataract, aphakic eye 55.1% （38/69）, 30.5% posterior capsule opacification （21/69）, endophthalmitis in 4.3% （3/69）, secondary glaucoma in 4.3% （3/69）, occlusion of pupil 2.9% （2/69） and IOL dislocation in 2.9% （2/69）.Aphakic patients with stage two IOL implantation, posterior capsule opacification underwent posterior capsulectomy, endophthalmitis underwent vitrectomy with silicone oil removal of IOL, secondary glaucoma underwent glaucoma valve implantation, occlusion of pupil children pupilloplasty, IOL dislocation patients for removal of IOL, vitrectomy, IOL suspension.Follow up for half a year after the best corrected visual acuity〉 0.3 in 26 eyes and 〉0.1 14 eyes, 〈0.1 12 eyes.Another 10 cases （17 eyes） of infants can not meet visual inspection, after light or looking at the target significantly increased compared with the preoperative.Six months after all treated with icare tonometer intraocular pressure in the normal range detection.Conclusions Aphakic eye and posterior capsule opacification is the main cause of infant congenital cataract operation again.

关 键 词：婴幼儿先天性白内障 再次手术 

分 类 号：R776.1[医药卫生—眼科]