先天性白内障的治疗选择和疗效观察

发布时间：2018-03-12 19:39

本文选题：先天性白内障　切入点：人工晶体植入　出处：《广西医科大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的：观察比较2岁内先天性白内障患儿I期和II期植入人工晶体的结果。方法：回顾性观察38例(50眼)年龄小于2岁的先天性白内障患儿,其中A组16例(20眼)2个月到24个月的先天性白内障患儿行白内障抽吸+人工晶体I期后房植入+后囊膜环形撕囊(PCCC)+前段玻璃体切割术(AV)。B组22例(30眼)2个月到24个月的先天性白内障患儿行白内障抽吸+后囊膜环形撕囊(PCCC)+前段玻璃体切割术(AV),2岁后再行II期人工晶体后房植入术。根据出院复查门诊病历记录和电话随访比较观察两组术后并发症和视力恢复情况,时间均为术后12月到36个月。结果：A组患儿情况是：无明显并发症的有12眼,8眼合并有以下1-3种并发症：瞳孔不规则或后粘连共5眼；后发障的有3眼；人工晶体前膜的有2眼；外斜视的有3眼；人工晶体偏位或夹持的有1眼；眼球震颤出现或加重的有4眼：继发青光眼的有1眼。患儿3到4岁视力情况：有14眼视力大于0.1(占总眼数70%),有5眼视力小于0.1,1眼视力不配合。B组患儿情况是：无明显并发症的有8眼,22眼合并有以下1-3种并发症：瞳孔不规则或后粘连共22眼；后发障的有4眼；人工晶体前膜的有3眼；斜视加重的有4眼；人工晶体偏位或夹持的有12眼；眼球震颤出现或加重的有5眼；继发青光眼的有3眼。患儿3到4岁视力情况：有13眼视力大于0.1(占总眼数43%),有16眼视力小于0.1,1眼视力不配合。结果的统计学分析,瞳孔不规则或虹膜部分后粘连：A组有5眼,B组有22眼,x2=11.286,P=0.001两组间差异有统计学意义(P0.01),A组发生此并发症少于B组.两组患儿术后其他并发症差异均无统计学意义(P0.05)。3岁后视力改善统计值x2=3.884,P=0.049两组间差异有统计学意义(P0.05),A组视力好于B组。结论：通过两组患儿术后的临床观察对比,在治疗方案上,2个月到24个月的先天性白内障患儿行白内障抽吸+人工晶体I期后房植入+后囊膜环形撕囊(PCCC)+前段玻璃体切割术(AV),可有效恢复屈光间质透明,减少屈光不正的程度,术后并发症与II期人工晶体植入对比无明显增多,术后视力恢复更好,对远期视力情况还需要长时间观察。
[Abstract]:Objective: to observe and compare the results of intraocular lens implantation in stage I and II of children with congenital cataract within 2 years old. Methods: 38 cases (50 eyes) of congenital cataract, whose age was less than 2 years old, were retrospectively observed. Group A (16 cases, 20 eyes) with congenital cataract for 2 months to 24 months underwent posterior chamber implantation with posterior chamber implantation of posterior capsular annular capsulorhexis (PCCC) anterior segment vitrectomy for 2 to 24 months. Group B (22 cases, 30 eyes) received anterior vitrectomy for posterior capsular annular capsulorhexis (PCCC) for 2 months to 24 months. The anterior segment vitrectomy of posterior capsular annular capsulorhexis (PCCCC) was performed in children with congenital cataract after 2 years of age. Phase II IOL posterior chamber implantation was performed after 2 years of age. A comparative study was made according to the medical records of outpatient outpatient and telephone follow-up. The postoperative complications and visual acuity were observed in both groups. The time was from December to 36 months after operation. Results in group A, 12 eyes (8 eyes) without obvious complications were complicated with the following 1-3 complications: 5 eyes with irregular pupil or posterior adhesion, 3 eyes with posterior defect, 2 eyes with anterior membrane of intraocular lens, 3 eyes with exotropia, 3 eyes with posterior synechia, 3 eyes with posterior synechia, 3 eyes with posterior myopia, 3 eyes with posterior conglutination, 3 eyes with posterior conglutination, 3 eyes with intraocular lens membrane. Intraocular lens misalignment or clamping of 1 eye; There were 4 eyes with nystagmus or aggravation: 1 eye with secondary glaucoma. Visual acuity of children aged 3 to 4 years: 14 eyes with visual acuity greater than 0.1 (accounting for 70 eyes, 5 eyes with visual acuity less than 0.1%). 8 eyes (22 eyes) without obvious complications were complicated with the following 1-3 kinds of complications: 22 eyes had irregular pupil or posterior adhesions; There were 4 eyes with posterior impairment, 3 eyes with anterior membrane of intraocular lens, 4 eyes with aggravated strabismus, 12 eyes with IOL deviation or clamping, 5 eyes with nystagmus and 5 eyes with severe nystagmus. There were 3 eyes with secondary glaucoma. Visual acuity of children aged 3 to 4 years: 13 eyes with visual acuity greater than 0.1 (accounting for 43 eyes and 16 eyes with visual acuity less than 0.1%). There were 22 eyes with irregular pupil or iris posterior adhesion in group B, 22 eyes in group B had a significant difference between group A and group B. the complications in group A were less than those in group B. there was no significant difference in other complications between the two groups (P 0.05.3 years old). The visual acuity of group A was better than that of group B. There was a significant difference between the two groups in the statistical value of visual acuity improvement (x2) 3.884% P0. 049. The visual acuity of group A was better than that of group B. Conclusion: through the clinical observation and comparison of two groups of children after operation, In the treatment scheme, the anterior segment vitrectomy of posterior chamber implantation of posterior capsular annular capsulorhexis (PCCCCC) was performed in children with congenital cataract from 2 months to 24 months after cataract aspiration, which could effectively restore the transparency of refractive stroma. To reduce the degree of ametropia, the postoperative complications were not significantly increased compared with those of stage II IOL implantation, the postoperative visual acuity recovered better, and the long-term visual acuity still needed to be observed for a long time.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R776.1

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