【作者】 孙平；

【导师】 亢晓丽；

【作者基本信息】 上海交通大学 ， 眼科学（专业学位）， 2016， 硕士

【摘要】 目的探讨儿童先天性白内障术后视功能恢复效果及其主要影响因素,为先天性白内障的手术干预时机及术后光学矫正方式提供临床指导。方法本研究回顾分析了2003年1月~2015年6月期间在上海交通大学医学院附属新华医院确诊为先天性白内障并接受手术治疗的291例(485眼)患儿的临床资料。从单双眼、眼部异常发现年龄、晶状体切除手术年龄、IOL(intraocular lens,IOL)植入年龄、术后无晶状体眼光学矫正方式、术后并发症等方面分析了先天性白内障患儿的术后视力、注视稳定性及眼位等视功能评价指标的影响因素。结果采用SPSS19.0统计学软件进行分析处理。结果1.本研究共纳入291例患儿(485眼),男性178例,女性113例;单眼97例,双眼194例。末次随访时的平均年龄为54.4±35.8月。发现眼部异常的平均年龄为13.8±20.9月,单眼白内障发现眼部异常的年龄较双眼白内障晚。进行晶状体切除手术的平均年龄为22.1±26.6月。Ⅰ期植入IOL的平均年龄为50.0±26.7月,Ⅱ期植入IOL的平均年龄为60.7±22.1月。IOL植入术前无晶状体眼92.7%采用框架眼镜矫正,7.3%采用硬性透气性角膜接触镜(rigid gas permeable contact lens,RGPCL)矫正。术后并发症的发生率为12.0%。2.终末随访时,238眼采用标准对数视力表检查,最佳矫正视力平均为0.29±0.22;137眼采用LEA GRATINGS视力检查,最佳矫正视力平均为0.10±0.12。双眼患儿中,双眼视力均<0.3者占43.7%,双眼视力均<0.05者占1.1%。双眼发病、眼部异常发现年龄>12月龄、晶状体切除手术年龄<3月龄、单眼白内障24月龄前Ⅰ期植入IOL及IOL植入前无晶状体眼采用RGPCL矫正的患眼视力预后较好。3.白内障手术前眼球震颤发生率为68.5%,单眼患者与双眼患者发生率分别为42.3%和74.2%。晶状体切除手术年龄<3月龄者与≥3月龄者眼球震颤发生率分别为62.5%和84.1%。术前发生眼球震颤患眼视力明显低于未发生者。4.白内障手术前斜视发生率为27.6%,单眼患者与双眼患者发生率分别为54.5%和19.0%。晶状体切除手术年龄<6月龄者与≥6月龄者斜视发生率分别为21.0%和31.1%。术前发生斜视患眼视力明显低于未发生者。结论1.本研究患儿终末随访平均视力为0.29±0.22。双眼患儿中,双眼视力均<0.3者占43.7%,双眼视力均<0.05者占1.1%。单眼白内障、眼部异常发现年龄≤12月龄者、晶状体切除手术年龄≥3月龄者、单眼白内障24月龄前未Ⅰ期植入IOL及IOL植入前采用框架眼镜进行光学矫正者视力低于双眼白内障、发现年龄>12月龄、手术年龄<3月龄、单眼白内障24月龄前Ⅰ期植入IOL及RGPCL矫正者。2.晶状体切除手术前眼球震颤的发生率为68.5%。双眼患者眼球震颤发生率明显高于单眼患者,差异显著。晶状体切除手术年龄≥3月龄者眼球震颤发生率明显高于晶状体切除手术年龄<3月龄者,差异显著。术前发现眼球震颤患眼视力明显低于注视稳定者,差异显著。3.晶状体切除手术前斜视的发生率为27.6%。单眼白内障斜视发生率明显高于双眼白内障,差异显著。晶状体切除手术年龄≥6月龄者斜视发生率高于晶状体切除手术年龄<6月龄者,但差异不显著。术前发生斜视患眼视力明显低于正位者,差异显著。更多还原

【Abstract】 Objective To report visual outcome and evaluate its relative factors after congenital cataract surgery in children in the hope that it will provide references for the operation time and best optical correction regimen of infantile aphakia.Methods The records of 291 children(485eyes)opterated for congenital cataract at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between January 2003 and June 2015 were reviewed retrospectively.The visual acuity,fixation,eye alignment and their influence factors,including laterality,ocular anomalies discovery age,lensectomy age,intraocular lens(IOL)implantation age,postoperative optical corretion methods and postoperative complicatios were evaluated.The SPSS 19.0 statistical program was used to analyse the results.Results 1.This retrospective study comprised 291 congenital cataract cases(178 male and 113 female;97 unilateral and 194 bilateral).The mean age at last follow-up was 54.4±35.8 months.The mean age when the eye anomalies were first noticed was 13.8±20.9 months and the unilateral patients were discovered later than bilateral cases.The mean lensectomy age at was 22.1±26.6 months.The mean primary IOL implantation age was 50.0±26.7 months and the mean secondary IOL implantation age was 60.7±22.1 months.92.7% aphakic eyes were corrected with aphakic glasses and 7.3% with rigid gas permeable contact lenses(RGPCL).The incidence of postoperative complications was 12%.2.The mean best corrected visual acuity(BCVA)of 238 eyes measured with standard logarithmic visual acuity chart was 0.29±0.22 and 0.10±0.12 of 137 eyes measured with LEA GRATINGS.BCVA of both eyes of 43.7% bilateral patients were less than 0.3 and 1.1% bilateral patients were less than 0.05.Patiants with bilateral cataract,ocular anomalies discovery age older than 12-month-old,lesectomy age younger than 3-month-old,unilateral aphakia with primarily IOL implantation before 24-month-old and aphakia corrected with RGPCL have better visual prognosis.3.Preoperative incidence of nystagmus were 68.5%,42.3% and 74.2% in total,unilateral and bilateral patients,respectively.Nystagmus prevalence of cases whose lensectomy age yonger than 3 months and older then 3 months were 62.5% and 84.1%.BCVA of patients with preoperative nystagmus was worse than that of patients without.4.Preoperative incidence of strabismus were 27.6%,54.5% and 19.0% in total,unilateral and bilateral patients,respectively.Strabismus prevalence of cases whose lensectomy age yonger than 6 months and older then 6 months were 21.0 % and 31.1%.BCVA of patients with preoperative strabismus was worse than that of patients without.Conclusion 1.The mean visual acuity at last follow-up was 0.29±0.22.BCVA of both eyes of43.7% bilateral patients was less than 0.3 and 1.1% bilateral patients was less than 0.05.BCVA of unilateral cataract eyes,patients whose eye anomalies discovery age younger than 12-month-old,cataract operation age 3-month-old,unilateral aphakia without primarily IOL implantation before 24-month-old aphakia corrected with aphakic glasses was worse than bilateral ones,discovery age older than 12-month-old,operation age older than 3-month-old,unilateral aphakia with primarily IOL implantation before 24-month-old and aphakia corrected with RGPCL.2.Preoperative incidence of nystagmus were 68.5% in total.Bilateral cases had higher nystagmus incidence than unilateral ones.Nystagmus prevalence of cases whose lensectomy age yonger than 3 months was lower than that of those older than 3 months.BCVA of patients with preoperative nystagmus was worse than that of patients without.3.Preoperative incidence of strabismus were 27.6% in total.Unilateral cases had higher strabismus incidence than bilateral ones.Strabismus prevalence of cases whose lensectomy age yonger than 6 months was lower than that of those older then 6 months.BCVA of patients with preoperative strabismus was worse than that of patients without.更多还原