摘要
目的观察双眼先天性白内障儿童行白内障摘出联合人工晶状体(IOL)植入术后疗效的5年随访结果。方法采用系列病例观察研究,对2007年1月至2012年1月在郑州大学第一附属医院行超声乳化白内障摘出联合后囊膜切除、前段玻璃体切割及IOL植入术的2~7岁双眼先天性白内障患儿72例144眼进行连续5年的随访观察,所有患儿均于第二眼术后2周行双眼屈光矫正和弱视训练。患儿根据手术时年龄不同分为2~3岁组32例64眼、4~5岁组24例48眼和6~7岁组16例32眼。对术眼术前、术后最佳矫正视力(BCVA)、屈光度变化、眼轴增长值、角膜曲率、视功能及手术并发症等结果进行系统观察,并分析手术时年龄与末次随访单眼BCVA的关系。结果 2~3岁组、4~5岁组和6~7岁组术眼平均屈光度数变化值分别为-2.10(-2.90,-1.90)、-1.73(-2.50,-2.10)和-0.52(-2.00,-0.28)D,总体比较差异有统计学意义(H=19.85,P<0.01);3个组眼轴长度分别平均增长(1.41±0.32)、(0.96±0.51)和(0.52±0.26)mm,总体比较差异有统计学意义(F=13.24,P<0.05);3个组手术前后角膜曲率比较,差异均无统计学意义(均P>0.05);3个组术眼术后BCVA较术前均明显提高,且获得一定的立体视觉,2~3岁组术眼BCVA优于4~5岁组和6~7岁组,差异均有统计学意义(均P<0.05)。术眼术后BCVA≥0.3者占80.56%(116/144),BCVA>0.8者占19.44%(28/144)。对患儿手术时年龄与术后BCVA进行回归分析,回归方程为术后BCVA=0.959-0.104×手术年龄,患儿手术的年龄越小,术后单眼BCVA越好(R^(2)=0.539,P<0.01)。结论儿童双眼先天性白内障患儿术后视功能的恢复与手术年龄有关,手术年龄越小,视功能恢复越好。术后及时、系统、规范的屈光矫正、弱视治疗和双眼视功能训练有助于视功能的发育和重建。
Objective To observe the 5-year outcomes and complications after cataract extraction combined with intraocular lens implantation in children with bilateral congenital cataract.Methods An observational case series study was performed.A total of 72 children(144 eyes),aged 2 to 7 years,who received intraocular lens(IOL)implantation combined with posterior continuous curvilinear capsulorhexies and anterior vitrectomy after cataract extraction for bilateral congenital cataract in The First Affiliated Hospital of Zhengzhou University from January 2007 to January 2012 were enrolled.All the patients underwent refractive correction and amblyopia training two weeks after the second operative eye underwent surgery.The patients were divided into 2-3 years old group(64 eyes),4-5 years old group(48 eyes)and 6-7 years old group(32 eyes)according to their age at surgery.The preoperative and postoperative best corrected visual acuity(BCVA),refraction,axial length,corneal curvature,binocular visual function and postoperative complications were observed during the 5-year follow-up period.The influence of age at surgery on postoperative BCVA in one eye at the final follow-up visit was analyzed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of The Affiliated First Hospital of Zhengzhou University(No.2020-KY-219),and written informed consent was obtained from guardians of the subjects before treatment.Results The mean myopic shift was-2.10(-2.90,-1.90),-1.73(-2.50,-2.10)and-0.52(-2.00,-0.28)D in the 2-3 years old group,4-5 years old group and 6-7 years old group,respectively,and the axial elongation in the three groups was(1.41±0.32),(0.96±0.51),and(0.52±0.26)mm,respectively,and the differences among the three groups were statistically significant(H=19.85,P<0.01;F=13.24,P<0.05).There was no statistically significant difference in preoperative and postoperative corneal curvature among the three groups(all at P>0.05).The BCVA was significantly improved in all the eyes after operation,and a certain binocular visual function was obtained,and the visual function in the 2-3 years old group was better than that of 4-5 years old group and 6-7 years old group(all at P<0.05).The BCVA at the end of following-up was 0.3 or better in 116 eyes(80.56%),and was better than 0.8 in 28 eyes(19.44%).The regression analysis results showed that children younger at surgery had better visual outcome(postoperative BCVA=0.959-0.104 operative age of patient;R^(2)=0.539,P<0.01).Conclusions The recovery of visual function in children with binocular congenital cataract is related to the age at operation.The younger the age at operation is,the better the recovery of visual function will be.Timely,systematic and standardized refractive correction,amblyopia treatment and binocular visual function training after operation are helpful to the development and reconstruction of visual function.
作者
谭楠
郑广瑛
Tan Nan;Zheng Guangying(Department of Ophthalmology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华实验眼科杂志》
CAS
CSCD
北大核心
2021年第4期305-312,共8页
Chinese Journal Of Experimental Ophthalmology
基金
国家自然科学基金项目(82000875)
河南省高等学校重点科研项目(16B320022)。
关键词
先天性白内障/手术
远期疗效
眼轴
角膜曲率
视功能
儿童
Cataract,congenital/surgery
Long-term outcome
Axis
Corneal curvature
Visual function
Children
