摘 要：目的 评价过去3a内我们所做儿童人工晶状体植入术的结果。方法 所有研究施行IOL植入术儿童的年龄为2～14a。随访6～30mo，平均12mo。分析术后视力和可能发生的并发症。结果 77%为外伤性白内障，23%为先天性白内障。术后视力0.3或0.3以上者在外伤性白内障与先天性白内障患眼分别为62.85%和15.38%，差异有显著性(P＜0.01)。9眼 (10%)术后前房有纤维素形成，37眼(41.1%)有后囊混浊，无其他严重并发症发生。结论 2a以上儿童IOL植入术后短期疗效良好，很少发生较重的并发症。
Pediatric intraocular lens implantation
LIN Min,YANG Yu-Guang
(Department of Ophthalmology,Economic Technical and Developmental Zone Hospital of Dalian)
CHEN Ya-Jing
(Dalian TGM Hospital)
HUANG Hong-Shen
(The Third Hospital of Dalian,Dalian 116600,Liaoning Province,China)
Abstract：Objective To evaluate the results of pediatric intraocular lens implantation performed in the past 3 years.Method All children who under went IOL implantation at age of 2 to14 were studied.Follow-up period was 6 to 30 months with an averge of 12 months.Postoperative visual and possible complications were analysed.Results Seventy-seven percent of the cataracts were caused by trauma,and 23% were congenital cataracts.Postoperative visual acuity of 0.3 or better were attained in 62.85% of eyes with trauma,and in15.38% of congenital ,respectively.The difference was significant(P＜0.01).Postoperative complications were observed fibrin formation in nine eyes(10%)and posterior capsule opacified in 37 eyes(41.1%).There were no other severe complications.Conclusions Short-term result of IOLs implant in children older than 2 yeas old were favourable.Major complications were rare.
Key words：cataract;intraocular lens implantation;child▲
随着白内障手术方法和器械的改进，儿童人工晶状体植入(IOL)以成为一种安全可行的手术。自1995年至今我们施行了儿童(IOL)植入术80例96眼，获得了较好的疗效，现报告如下。
1 对象和方法
1.1 对象 本组80例中，男64例，女16例。年龄2～4a者10只眼(12.5%)，5～7a者32只眼(40.0%)，8～10a者27只眼(33.8%)，11～14a者11只眼(13.7%)。单眼IOL植入者80眼，双眼先后手术16眼。其中外伤性白内障(穿通伤62眼，钝挫伤8眼)70眼(77%)，先天性白内障(包括发育性白内障12眼)26眼(23%)。术前视力测量不合作24眼(26.6%)。视力低于0.05者56眼(62.2%)，0.05～0.2者10眼(11.2%)。术后随访6～30mo，平均12mo。
1.2 方法 术前10g·L-1米多林滴眼4次充分散瞳，并用欧可芬和抗生素液滴眼。对不和作幼儿均在全麻下施行手术。在角巩膜上缘作遂道切口，前房注入viscoat,连续环形撕囊或开罐式截囊，截除前囊膜直径6mm。抽吸净晶状体皮质，再注入viscoat，扩大切口至5.5mm，植入后房IOL于囊袋内或睫状沟。术前用A超测量眼轴长度，计算植入J或C襻PMMA～体型IOL度数为18～25D，平均21.4D。术后静脉注射青霉素600万单位和地塞米松5mg 3～5d，局部点必舒眼液滴眼，前房炎症反应明显者用10g·L-1米多林滴眼。
2 结果
2.1 术后视力 最终视力20眼检查不和作，76眼均较术前视力有明显进步，尤以外伤性白内障较先天性白内障视力恢复更明显。术后视力在0.3或0.3以上者，外伤性白内障占62.85%，先天性白内障占15.38%，差异具显著性(P＜0.01)(见表1)。
表1 儿童IOL植入术后的视力
Table 1 Visuaity after pediatric IOL implantation
| Visual acuity |
(Traumatic Cataracts
n=70 (%) |
congenital catarats
n=26 (%) |
| Uncooperation with examination |
6 |
8.57 |
14 |
53.85 |
| ＜0.05 |
8 |
11.43 |
2 |
7.69 |
| 0.05～0.2 |
12 |
17.14 |
6 |
23.08 |
| 0.3～0.4 |
26 |
37.14 |
2 |
7.69 |
| ＞0.5 |
18 |
25.71 |
2 |
7.69 |
2.2 术后并发症(1)前房纤维素渗出。本组有9眼(10%)在术后早期发现，约1wk后逐渐吸收；(2)后囊混浊。本组有37眼(41.1%)，能影响视力，治疗较困难；(3)其他严重并发症如眼压增高、虹摸夹持或IOL偏位等，本组尚未碰见。
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