后囊膜切开大小对先天性白内障术后远期预后的影响  

Effect of posterior capsular incision size on long-term outcome after congenital cataract surgery

作　　者：张娅萍[1] 马波[1] 杜秀梅[1] 喻磊[1] 郭琳[1] 王伟伟[1] 王从毅[1] ZHANG Yaping;MA Bo;DU Xiumei;YU Lei;GUO Lin;WANG Weiwei;WANG Congyi(Department of Ophthalmology,Shaanxi Ophthalmology Hospital,Xi'an No.4 Hospital,Xi'an 710004,China)

机构地区：[1]陕西省眼科医院眼科陕西省西安市第四医院眼科

出　　处：《中国眼耳鼻喉科杂志》2019年第6期405-409,共5页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：西安市第四医院(2016B-11);国家自然科学基金(81500719)

摘　　要：目的评价不同后囊膜切开大小对先天性白内障摘除术后视力、视功能、视轴区混浊(VAO)的影响情况。方法前瞻性临床研究。对年龄<8岁的儿童白内障患者58例(107眼)行白内障摘除人工晶状体(IOL)植入术。记录患儿术前情况,包括视力、眼压、眼位、晶状体混浊程度、全身及眼部合并症、手术年龄。根据术中后囊膜切开直径的大小分成2组:A组为2~<4 mm,B组为4~<5.5 mm。术后定期随访。结果平均随访时间(61.3±12.3)个月,A组20例37眼(单眼3例),B组26例46眼(单眼6例),2组患者基线资料比较差异无统计学意义(P>0.05)。术后5年,A组最佳矫正视力(BCVA)为0.31±0.21,其中6眼BCVA≥0.5(16.2%),具有融合功能的6例,具有立体视功能的4例。19眼(51.4%)在术后7~24个月发生不同程度的VAO,其中6眼因严重的VAO再次手术切除,其余13眼给予YAG激光切开术。B组BCVA为0.48±0.26,其中24眼BCVA≥0.5(52.17%),具有融合功能的8例,具有立体视功能的8例。6眼(13.0%)发生不同程度VAO,其中2眼行YAG激光切开术治疗,且有2例随着术后双眼视功能的建立,眼球震颤减轻甚至消失。术后5年,A组平均眼轴长度较术前增长(2.30±2.06)mm,B组较前增长(2.13±1.53)mm,2组患者在BCVA、VAO发生方面差异有统计学意义(P=0.002,P<0.05;P值均<0.05),在眼轴增长长度、双眼融合功能及立体视功能方面差异无统计学意义(P=0.67,0.837,0.296;P值均>0.05)。结论儿童白内障摘除后房型IOL植入联合前部玻璃体切除术,术中后囊膜切开范围为4~<5.5 mm时不但可以安全植入IOL,便于术中前部玻璃体的有效切除,同时可以明显改善术后视觉质量并减少VAO的发生。Objective To evaluate the effect of different posterior capsular incision sizes on visual acuity, binocular function and visual axis opacity(VAO) after congenital cataract surgery. Methods Prospective clinical study. To compare the capsular outcomes with different primary capsulorhexis sizes, 58 eligible patients(107 eyes) under the age of 8 were assigned to two groups by posterior capsulorhexis diameter(Group A: 2~<4 mm;Group B: 4~<5.5 mm). The mean follow-up time is 61.3 ±12.3 months. Results Group A had 20 patients(37 eyes,3 of them are unilateral), group B had 26 patients(46 eyes,6 of them are unilateral). There was no significant difference in the baseline data between the two groups(P>0.05). After five years of surgery, the average of best corrected visual acuity(BCVA) was 0.31±0.21, 6 eyes(16.2%) had the BCVA≥0.5, 6 patients had fusion function, 4 patients had stereopsis functions. Nineteen eyes(51.4%) developed varying degrees of VAO 7~24 months after surgery. Six of them developed severe VAO and received surgical resection. In group B, the average BCVA was 0.48±0.26,24 eyes(52.17%) with BCVA≥0.5, 8 cases had fusion function, 8 cases had stereoscopic vision function. Six eyes developed VAO, 2 of them were treated with laser posterior capsulorotomy, and 2 cases who have nystagmus reduced or even disappeared with the establishment of postoperative binocular vision function after surgery. Compared with the preoperative data, 5 years after surgery, the average AL increased 2.30±2.06 mm in group A and 2.13±1.53 mm in group B. The differences of BCVA and VAO between the two groups were statistically significant(P=0.002, P<0.05;P all<0.05). There were no significant difference in AL, binocular fusion function and stereopsis function(P=0.67, 0.837, 0.296;P all>0.05).Conclusions Posterior capsule incision ranged from ≥4 mm to <5.5 mm during pediatric cataract extraction and intraocular lens implantation with anterior vitrectomy have a great significance to improve postoperative visual acuity, binocular

关 键 词：先天性白内障 儿童 人工晶状体 视功能 远期预后 

分 类 号：R47[医药卫生—护理学]