机构地区:[1]北京大学人民医院眼科视网膜脉络膜疾病诊治研究北京市重点实验室教育部视觉损伤与修复重点实验室,100044
出 处:《中华眼视光学与视觉科学杂志》2018年第1期26-29,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science
摘 要:目的:随访观察并比较足月和早产的双眼先天性白内障患儿于婴儿期行白内障手术治疗后的远期视功能和并发症。方法:前瞻性队列研究。对2002 年1 月至2012 年7 月在北京大学人民医院眼科收治的婴儿期双眼先天性白内障术后患儿进行跟踪随访。所有患儿均接受双眼同期白内障吸出、后囊切开及前部玻璃体切割术,术后进行屈光矫正、弱视训练并密切随访。按出生时胎龄将患儿分为早产儿组(胎龄≤36 周)和足月儿组(胎龄 〉 36 周),对末次随访时2 组患儿的单眼和双眼最佳矫正视力(BCVA,LogMAR),术后远期并发症和合并症进行比较,数据采用Student's t 检验和卡方检验进行分析。结果:15例(30眼)足月患儿和36例(72眼)早产患儿纳入本研究。2组患儿的初次手术时月龄、性别构成、最长随访时间和末次随访时二期人工晶状体植入比例等方面比较差异无统计学意义。末次随访时,足月儿组单眼BCVA为0.66±0.28,双眼BCVA为0.54±0.25;早产儿组单眼BCVA为0.52±0.27,双眼BCVA为0.42±0.24。2 组患儿单眼BCVA间差异存在统计学意义(t =-2.316,P =0.023)。末次随访时早产儿组单眼BCVA(Snellen)≥30/50为14 眼(14/72),而足月儿组则为0 眼,2组患儿单眼BCVA分布差异存在统计学意义(χ2=11.229,P =0.022),但双眼BCVA分布差异无统计学意义(χ2=7.174,P =0.140)。足月儿和早产儿白内障术后长期并发症和合并症包括斜视(3/15和8/36)、眼球震颤(4/15和14/36)、后发性白内障(3/15和3/36)和高眼压症(1/15和1/36)等,2组间发生率比较差异均无统计学意义。结论:在生命更早期阶段即对双眼先天性白内障患儿进行积极治疗和干预对远期视功能预后存在影响。早产的双眼先天性白内障患儿应在全身情况允许的情况下尽早手术治疗。Objective: To evaluate and compare long-term visual outcome and complications between premature and mature infants after bilateral cataract surgery during infancy. Methods: This prospective cohert study included children with bilateral congenital cataracts who were recruited between January 2002 and July 2012 at Peking University People's Hospital. All patients received simultaneous bilateral cataract extraction combined with primary capsulotomy and anterior vitrectomy. After the operation, all patientswore aphakic glasses during the follow-up periods. The children were divided into premature (gestational age equal or less than 36 weeks) and mature (more than 36 weeks) groups based on their gestational age. The unilateral and bilateral best corrected visual acuity (BCVA), unilateral and bilateral BCVA distribution, and postoperative complications at the last visit were evaluated and compared. The data were analyzed with student's t test and chi-square test. Results: Thirty-six premature and 15 mature infants with bilateral congenital cataracts were recruited. The age at surgery, gender composition, longest follow-up period, and the rate of secondary intraocular lens implantation at the last visit were similar between the mature and premature groups. At last visit, the unilateral BCVA (LogMAR) of mature and premature groups was 0.66±0.28 and 0.52±0.27 respectively (t=-2.316, P=0.023), while the bilateral BCVA was 0.54±0.25 and 0.42±0.24 (P〉0.05), respectively. The unilateral BCVA (Snellen) was ≥30/50 in 14 eyes (14/72) of the premature group, while the BCVAs of all children in the mature group were 〈30/50. The distribution of unilateral BCVA was significantly different between the two groups (χ2=11.229, P=0.022).However, the bilateral BCVA distribution was similar for the two groups (χ2=7.174, P=0.140). The long-term postoperative complications of the mature and premature children included strabismus (3/15 vs. 8/36),nystagmus (4/15 vs. 14/36�
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