婴儿期双眼先天性白内障患儿二期人工晶状体植入的时机及视功能改变  

Timing and visual changes of secondary intraocular lens implantation in infants with congenital cataract

作　　者：苗恒[1] 侯宪如[1] 鲍永珍[1] 

机构地区：[1]北京大学人民医院眼科视觉损伤与修复教育部重点实验室视网膜脉络膜疾病诊治研究北京市重点实验室,100044

出　　处：《中华实验眼科杂志》2017年第3期259-262,共4页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景 婴儿期双眼先天性白内障严重危害患儿的视觉发育，已行双眼白内障摘出术的患儿行人工晶状体（IOL）植入是理想的屈光矫正方式，但其植入时机目前尚存争议。 目的 分析婴儿期双眼先天性白内障患儿二期IOL植入前后最佳矫正视力（BCVA）的变化和影响因素，探讨二期IOL的植入时机。方法 对2012年1月至2014年12月在北京大学人民医院接受白内障摘除－屈光矫正和弱视训练－二期IOL植入的患儿29例58眼的临床资料进行回顾性分析。所有患儿于出生1年内接受双眼白内障摘出术及后囊切开联合前部玻璃体切割术，行配戴框架眼镜屈光矫正和弱视训练后于2岁之后接受双眼同期二期IOL植入术。IOL植入术前1周及术后3个月时行双眼扩瞳验光并记录BVCA（LogMAR），比较二期IOL植入前后单眼BCVA的差异、分布变化及相关关系。结果 本研究中患儿接受白内障摘出术的平均年龄为（3.26±2.07）个月，二期IOL植入时平均年龄为（4.79±1.38）岁，2次手术间隔时间平均为（4.28±1.33）年。二期IOL植入术前1周患儿单眼BCVA（LogMAR）为0.790±0.422，术后3个月为0.570±0.307，差异有统计学意义（t＝3.223，P〈0.001）。二期IOL植入术后单眼BCVA≥0.5的眼数明显多于术前，差异有统计学意义（χ2＝53.931，P〈0.001）。二期IOL植入术前1周与术后3个月间单眼BCVA呈正相关（R2＝0.232，F＝17.037，P〈0.001）。结论 先天性白内障患儿在保证生命安全的前提下尽早实施白内障摘除－屈光矫正和弱视训练－二期IOL植入的系统性治疗，有利于BCVA的改善和弱视治疗，屈光矫正和弱视训练依从性差和效果欠佳的患儿应及时行二期IOL植入术。Background Bilateral congenital cataract is one of the vision-threating diseases during infant age.Intraocular lens （IOL） implantation is an ideal refraction correction method for children who have already received bilateral cataract extraction.However, the timing and effectiveness of secondary IOL implantation are still under debate.Objective This study was to analyze the visual changes and affecting factors before and after secondary IOL implantation and explore the operative timing.Methods The clinical data of 58 eyes of 29 patients who received bilateral cataract extraction-refractive correction and vision training-secondary IOL implantation in Peking University People＇s Hospital from January 2012 to December 2014 were retrospectively analyzed.All the patients received bilateral cataract extraction and posterior capsulotomy with anterior vitrectomy during their first year of life firstly, followed by the wearing of refractive spectacles or visual training, and secondary IOL implantation was simultaneously performed until 〉2 years old.Best corrected visual acurity （BCVA） （LogMAR） was examined at 1 week before and 3 months after secondary surgery under the mydriasis.Changes, distribution alternation of BCVA and the relationship of visual prognosis with preoperative visual acuity were evaluated.Results The average age at surgery of the patients was （3.26±2.07） months and that at secondary IOL implantation was （4.79±1.38） years, with the operative interval of （4.28±1.33） years.The BCVA before and after secondary IOL implantation was 0.790±0.422 and 0.570±0.307 respectively, showing a significant difference between them （t=3.223, P〈0.001）. The number of eyes with BCVA ≥0.5 after surgery was significantly more than that before surgery （χ2=53.931, P〈0.001）. A positive correlation in unilateral BCVA was seen between before and after secondary IOL implantation （R2=0.232, F=17.037, P〈0.001）.Conclusions A systemic management of bilateral cataract extraction-refractiv

关 键 词：先天性白内障 白内障摘出术 白内障摘出术后无晶状体眼/手术疗法 人工晶状体植入/方法 视力预后 婴儿 儿童 回顾性研究 

分 类 号：R779.6[医药卫生—眼科]