先天性白内障手术治疗例临床分析.docxVIP

先天性白内障手术治疗30例临床分析【摘要】 目的 探讨先天性白内障手术时机及方法选择。方法 对30例50眼先天性白内障进行手术治疗，lt;3岁为白内障摘除和后囊膜环形撕囊，部分二期植入人工晶体；≥3岁采用小切口超声乳化、后囊膜环形撕囊或合并前段玻璃体切割联合一期人工晶体植入。进行5～12个月随访，分析判断手术时机、手术方法、术后并发症、术后弱视训练对巩固疗效的重要性。结果 经治疗后所有患者视力有改善征象，表现为明显追光、视物清晰、视力提高。出现后囊膜混浊是先天性白内障常见的术后并发症，经激光治疗取得一定疗效。结论 先天性白内障手术干预是一种有效方法。宜早发现、早诊断、早治疗，以便把握手术时机。3岁以下婴幼儿进行白内障吸出、后囊膜环形撕囊或并行前段玻璃体切割术，术后及时视光学检查配镜，日后二期植入人工晶体。3～6岁患者行白内障吸出、后囊膜环形撕囊或并行前段玻璃体切割联合一期人工晶体植入以欠矫10%~20%为宜，7岁后给足人工晶体度数，后囊膜环形撕囊或并行前段玻璃体切割术，是预防婴幼儿白内障手术后囊膜混浊最有效的方法。后囊膜混浊仍和年龄相关明显，年龄越大发病率越低。 【关键词】 先天性白内障；人工晶体植入；近视飘移 【Abstract】 Objective To evaluate efficacy of surgical time and method of congenital cataract.Methods A retrospective analysis of 50 eyes of 30 children were referred after phacoemulsification with I (≥ 3 years) or Ⅱphase(lt;3 years) intraocular lens (IOL) implantation was performed. Posterior continuous curvilinear capsulorhexis and anterior vitrectomy were used in some cases. Surgical time and procedure， complications and treatment of amblyopia were discussed after operation with 5～12 months follow-up.Results Vision acuity was improved in all cases after treatment. Efficacy of using Nd ：YAG laser to treat posterior capsular opacification that was the main postoperative complication was proved.Conclusion Surgery management is an effective procedure for congenital cataract. The time of finding， diagnosis and treatment was very crucial for the prognosis of congenital cataract. Earlier operated and better vision acuity could be achieved. Power of IOLs is calculated using SRK-Ⅱ formula and choose according to children’s age. Posterior continuous curvilinear capsulorhexis with or without anterior vitrectomy was the most effective way to prevent posterior capsular opacificaton after operation which is related with age. 【Key words】 congenital cataract； intraocular implantation； myopia shift 先天性白内障是严重影响患儿视力发育的疾病，是胎儿发育过程中形成的不同程度、不同形式的晶状体混浊，多数出生前即已存在，少数在出生后逐渐形成或明显加重。先天性白内障治疗是以保存视力、预防弱视和促进融合功能发育为原则。现将30例先天性白内障手术治疗的结果报告如下。 1 资料与方法 1.1 一般资料 选取30例50眼先天性白内