Ⅰ期人工晶状体植入在7-24月先天性白内障患儿中应用的临床研究

发布时间：2018-05-11 01:39

本文选题：先天性白内障 + 人工晶状体　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:先天性白内障是导致儿童盲的重要因素之一,在我国儿童视力损伤原因中占第二位[1,2]。对具有手术指征的先天性白内障,手术治疗是最重要的治疗方法,也是获得治疗后视力进步的基本因素。目前对大于2岁的先天性白内障患儿行Ⅰ期人工晶状体(intraocular lens,IOL)植入逐渐成为常规[4,5]。虽然近年来越来越多的眼科医生倾向于对2岁以下先天性白内障患儿行Ⅰ期IOL植入[6],但是现有研究证据仍不能证明Ⅰ期IOL植入在7~24月先天性白内障患儿中应用的危险性及收益性。本文通过对2010~2016年在我院诊断先天性白内障并接受白内障吸除+后囊膜切开+前段玻璃体切割术+IOL植入术的7~24月患儿进行病例随访及既往资料收集分析,探讨在该术式在7~24月先天性白内障中应用的安全性及有效性,同时探寻我院眼科治疗该部分患儿与欧美研究组报道及国内发达地区治疗该类患儿疗效差异及其可能存在的原因。方法:收集2010年7月至2016年4月间因先天性白内障在我院行白内障吸除+后囊膜切开+前段玻璃体切割术+IOL植入术的20例31眼患儿病历资料,患儿接受手术的年龄均为7~24月龄。收集患儿术前、术中、出院前等资料。电话通知患儿回院进行随访,收集患儿术后随访资料,若有二次入院患者,收集二次住院资料。对前瞻性部分的病人进行术后1周、1月、3月、半年检查1次,如无不良事件发生,嘱患儿家属每3月~6月返院复查1次。每次随访检查包括最佳矫正视力(best corrected distance visual acuity,BCDVA)、眼压、眼前段检查、眼底检查、验光,调整斜弱视治疗方案,每半年行眼A/B超1次了解患儿眼轴发育情况及排除视网膜脱离等并发症,记录术后并发症情况。主要观察项目包括:1.术后最佳矫正视力;2.术后并发症;3.术后斜弱视;4.术后屈光状态与眼轴长度;5.随访情况。视力转变成最小分辨角的对数表达(logarithmoftheminimumangleofresolution,logmar)。应用spss17.0软件进行统计学检测。结果:1.视力:20例患儿中19例(30只眼)可以配合视力检查。17例26眼裸眼远视力(uncorrecteddistancevisualacuity,ucdva)中位数为1.0logmar(相当于国际标准视力表0.1)。19例30眼bcdva中位数为0.7logmar(相当于国际标准视力表0.2)。单侧发病患眼bcdva中位数为0.8logmar(相当于国际标准视力表0.15),双侧发病患眼平均bcdva中位数为0.7logmar(相当于国际标准视力表0.2)。两者比较差异有统计学意义(p=0.049)。2.术后并发症:20例31眼中术后5眼(16.13%)发生后发性白内障及视轴区混浊,其中4眼在全麻下行晶状体增殖皮质切除术联合前段玻璃体切除,1眼行yag激光后囊膜切开术;4眼(14.81%)瞳孔移位、变形,由于未遮挡视轴,未手术处理;未发现术后切口渗漏、青光眼相关不良事件、出血、眼内炎、视网膜脱离等并发症发生。3.术后斜弱视:20例31眼中有6例(22.5%)发生斜视,其中3例术前已存在斜视。23眼(74.2%)发生弱视,所有的单眼发病患儿(9例9眼)都发生弱视。4.术后屈光状态与眼轴长度:所有患眼术后平均等效球镜度数为+1.88±2.46d,最低为-2.50d,最高为+5.625d。20例患儿中14例(22只眼)能配合a超检查,术眼术后平均眼轴长度为21.73±1.29mm。5.随访情况:20例(31眼)患儿随访时间为8~80月,平均为36.45月,平均随访次数为5.65次,平均随访频率为8.05月/次。完成术后早期随访(3月)有18例(29眼),完成中期随访(1~3年)有16例(25眼),完成远期随访(3年以上)有8例(12眼)。结论:1.Ⅰ期人工晶状体植入在7~24月先天性白内障中的应用是安全、有效的,不良事件发生率较低。2.随访率低及未加强弱视治疗可能是术后视力欠佳的主要原因。
[Abstract]:Objective: congenital cataract is one of the important factors that cause blindness in children. It is second [1,2]. for congenital cataract with surgical indications in China. Surgical treatment is the most important method of treatment. It is also the basic factor for the improvement of visual acuity after treatment. At present, children with congenital cataract over 2 years of age are at present. The implantation of intraocular lens (IOL) has gradually become a conventional [4,5]., although more and more ophthalmologists in recent years tend to undergo stage I IOL implantation to [6] for children with congenital cataract under 2 years of age, but the current research evidence still cannot prove the risk of the application of stage I IOL implantation in children with 7~24 months of congenital cataract. In this paper, a case of 7~24 months of 7~24 months in the diagnosis of congenital cataract in our hospital and +IOL implantation with cataract extraction plus posterior capsule incision plus anterior vitrectomy and anterior vitrectomy was carried out to investigate the safety and effectiveness of the application of this operation in 7~24 month congenital white barrier. The difference and possible reasons for the treatment of this part of the Department of ophthalmology in our hospital and the European and American research group and the domestic developed areas in the treatment of this kind of children. Methods: to collect 20 cases of 31 eyes from July 2010 to April 2016 with cataract extraction, posterior capsule incision and anterior vitrectomy with +IOL implantation in our hospital. The age of the children's medical records was 7~24 months old. The children were collected before the operation, during the operation, and before discharge. The telephone informed the children to go back to the hospital and collect the follow-up data. If there were two hospitalized patients, two hospitalized data were collected. 1 weeks after the operation, in January, March, 1 times for half a year. No adverse events occurred, and the family members were asked to return to the hospital 1 times every March ~6 months. Each follow-up examination included the best corrected visual acuity (best corrected distance visual acuity, BCDVA), intraocular pressure, anterior examination, fundus examination, optometry, adjustment of the treatment scheme of oblique amblyopia, and 1 times of A/ B ultrasound every six months to understand the development of the eye axis and the retina The main observation items include: the best corrected visual acuity after 1. operation, 2. postoperative complications, 3. postoperative oblique amblyopia, 4. postoperative refraction and ocular axis length; 5. follow up. Visual transformation into the minimum resolution angle logarithmic expression (logarithmoftheminimumangleofresolution, LogMAR). Application of SPSS17.0 software Results: 1. visual acuity: 19 cases (30 eyes) in 20 children with visual acuity (30 eyes).17 26 eyes with 26 eyes (uncorrecteddistancevisualacuity, ucdva) median is 1.0logmar (equivalent to international standard visual acuity chart 0.1).19 case 30 eyes bcdva median is 0.7logmar (equivalent to international standard visual acuity chart 0.2). Unilateral onset The median of bcdva was 0.8logmar (equivalent to international standard visual acuity chart 0.15), and the median bcdva in bilateral onset was 0.7logmar (equivalent to international standard visual acuity chart 0.2). The difference was statistically significant (p=0.049).2. postoperative complications: 5 eyes (16.13%) in 20 cases (16.13%) after operation (5 eyes) and posterior axis opacity 4 eyes were combined with anterior vitrectomy and anterior vitrectomy under general anesthesia, 1 eyes underwent YAG laser posterior capsule incision, 4 eyes (14.81%) pupil displacement, deformation, unshielded visual axis, unoperated treatment, and no postoperative incision leakage, glaucoma related adverse events, bleeding, endophthalmitis, retinal detachment and other complications after the.3. operation. Oblique amblyopia: in 31 eyes of 20 cases, 6 cases (22.5%) had strabismus, of which 3 cases had strabismus.23 eyes (74.2%) with amblyopia. All the children with monocular disease (9 cases and 9 eyes) had the refractive state and axial length of amblyopia after.4. operation: the average equivalent spherical mirror degree was +1.88 + 2.46d after the operation of all eyes, the lowest was -2.50d, and the highest was +5.625d.20 case. In the 14 cases (22 eyes), the average axial length of the ocular axis was 21.73 + 1.29mm.5. follow-up after operation. The follow-up time of 20 cases (31 eyes) was 8~80 months, the average was 36.45 months, the average follow-up time was 5.65 times and the average follow-up frequency was 8.05 months. There were 18 cases (29 eyes) after the early follow-up (March), which completed the interim follow-up (1~3 year) of 16. For example (25 eyes), 8 cases (12 eyes) were completed for long term follow-up (over 3 years). Conclusion: the application of 1. stage intraocular lens implantation in 7~24 month congenital cataract is safe, effective, low incidence of adverse events and low.2. follow up rate and unstrengthened amblyopia may be the main cause of poor visual acuity after operation.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6

【参考文献】