儿童白内障一期后囊截开及后房型人工晶状体植入术的探讨

目的 探讨一期后囊截开对儿童白内障后房人工晶状体植入术后后囊浑浊的预防作用。方法 对４４例（５２眼）儿童先天性和外伤性白内障采用一期后囊截开、部分切除或联合前段玻璃体切除术。术后随访３月以上。结果 出院时矫正视力≥０．５者达７２％,随访显示９０％术眼视轴区透明,眼底清晰可见。结论 后囊一期截开或部分切除可预防儿童白内障术后晶状体囊浑浊的发生。对于穿孔伤所致晶状体囊破孔较大者宜联合前段玻璃体切除术。     

儿童白内障一期后囊截开及后房型人工晶体植入术的探讨

目的：探讨不同方法一期后囊截开对儿童白内障后房型人工晶体植入术后晶体后囊膜混浊的预防作用。方法：对28例（31只眼）儿童先天性白内障和外伤性白内障分别采用一期后囊膜切开、部分切除或联合前部玻璃体切除及后房型人工晶体植入术。术后随访3个月以上。结果：出院时矫正视力≥0．5者达71％，随访显示80％术眼视轴区透明，眼底清晰可见。结论：一期切开或部分切除后囊在一定程度上预防儿童白内障术后晶体后囊膜混浊的发生。对于穿通伤所致晶体囊膜破孔较大者宜联合前部玻璃体切除术。     

儿童外伤性白内障手术两种方式的效果比较

目的比较20-G和25-G两种玻璃体切除系统在儿童外伤性白内障手术中行晶状体后囊切开联合前段玻璃体切除的效果及安全性。方法回顾性分析研究。儿童外伤性白内障81例（81只眼）全麻下行白内障吸出联合人工晶状体植入术,分别采用经角膜缘20．G玻璃体手术系统（44例）和经平坦部25-G玻璃体手术系统（37例）行晶状体后囊切开联合前段玻璃体切除。术后随访12—24个月,分别观察两组患儿术中并发症、术后视力及并发症的发生情况。结果最佳矫正视力（BCVA）20-G组与25-G组两组患儿术前（x^2=0．131,P〉0．05）、术后末次随访时差异均无统计学意义（x^2=0．246,P〉0．05）;术中20-G组有5例（11．36％）人工晶状体植入睫状沟内,25-G组人工晶状体均植入晶状体囊袋内,20-G组出现视网膜水肿、人工晶状体移位、后发性白内障等并发症的概率明显高于25-G组。结论对于儿童外伤性白内障,25-G系统经平坦部玻璃体切除术较20-G系统经角膜缘玻璃体切除术行晶状体后囊切开联合前段玻璃体切除更加安全有效。     

儿童外伤性白内障摘出联合前段玻璃体切除的临床观察

目的 观察儿童外伤性白内障摘出联合前段玻璃体切除术效果。方法 ５９例行白内障囊外摘出联合前段玻璃体切除和人工晶体囊袋内植入，术后平均随访２０要脱盲率为１００％，脱残率为８８．１４％，矫正视力〉０．５者占７１．１８％。２０．３３％有一定程度人工晶状体夹持，５．０８％发生后发障。结论本术式是安全的，显著减少了术中并发症，使妇数患儿建立了良好的视功能。     

儿童先天性和外伤性白内障的手术效果观察

目的 评价儿童先天性和外伤性白内障手术的效果。方法 对77例（101眼）儿童行白内障摘出手术,其中78眼植入人工晶状体,25眼后囊截开,16眼行前段玻璃体切除。对术后随访1月－2年的59眼进行并发症分析。其中先天性白内障31眼,外伤性白内障17眼进行视力变化分析。结果 术后脱盲率77．1％,脱残率50．0％。主要并发症为晶状体前渗出膜、后囊浑浊、人工晶状体夹持。结论 儿童白内障术后视力均有提高,但并发症明显高于成年人,因此对3岁以下儿童人工晶状体植入持慎重态度。对于先天性白内障,尤其是完全性、致密核性、单侧白内障应尽早手术。对于外伤性白内障在积极控制炎症情况下尽早手术。术后随访、抗弱视治疗至关重要。     

儿童白内障一期后囊截开及后记主型人工晶体植入术的探讨

目的：探讨不同方法一期后囊截开对儿童白内障后房型人工晶体植入术后晶体后囊膜混浊的预防作用。方法：对２８例儿童先天性白内障和外伤性白内障分别采用一期后囊膜切开、部分切除或联合前部玻璃体切除及后房型人工晶体植入术。术后随访３个月以上。结果：出院时矫正视力≥０．５者达７１％，随访显示８０％术眼视轴区透明，眼底清晰可见。结论：一期切开或部分切除后囊在一定程度上预防儿童白内主后晶体后囊膜混浊的发生。对于穿通     

后发性白内障后囊切除术

目的探讨外伤性和并发性白内障后囊混浊的治疗方法。方法后发性白内障30例（33眼），经平坦部施行后囊切除及前段中轴玻璃体切除术。结果术后随访3－32月，32眼后囊中央形成直径3mm圆孔，切囊成功率达97％，矫正视≥0．5者占84．8％；未发现瞳孔区玻璃体疝、囊样黄斑水肿或视网膜脱离等并发症。结论该手术是一种安全可靠的后发性白内障治疗方法，特别适用于外伤性和并发性白内障，尤其是儿童人工晶体前膜形成者。     

儿童白内障摘除及人工晶体植入术

目的探讨儿童白内障摘除联合前段玻璃体切割及人工晶体植入的临床疗效.方法41例(59只眼)儿童先天性白内障及外伤性白内障施行现代囊外摘除联合前段玻璃体切割,对3岁以上儿童38例(53只眼)同期成功植入后房型人工晶体.结果3岁以上儿童术后裸眼视力≥0.3者先天性白内障25只眼(69.4%),外伤性白内障14只眼(82.4%).术后,先天性白内障1只眼发生后囊混浊;外伤性白内障3只眼轻度瞳孔上移,1只眼轻度晶体偏位.影响术后视力提高的主要原因是先天性白内障的重度弱视和外伤性白内障的角膜瘢痕.结论儿童白内障后囊膜切开联合前段玻璃体切割是防止术后并发障的有效方法.     

儿童白内障后囊撕囊联合前玻璃体切除预防后囊浑浊

目的探讨后囊撕囊联合前段玻璃体切除术对小儿白内障术后后发障的预防。方法对58例（62眼）儿童白内障采用超声乳化后行后囊撕囊联合前段玻璃体切除,再行人工晶状体植入,术后随访2a以上。结果术后矫正视力〉0.3者59眼（95.16%）。随访显示56眼（90.32%）视轴区透明。结论后囊撕囊联合前玻璃体切除可预防儿童白内障术后后囊浑浊的发生。     

Ⅰ期后囊环形切除联合前段玻璃体切除在白内障超声乳化术中的应用

目的　探讨采用 期后囊环形切除联合前段玻璃体切除术预防性治疗白内障超声乳化术后后囊混浊的临床疗效。方法　对 15 3例 (197只眼 )行白内障超声乳化吸除联合人工晶状体植入术 ,且在术中应用玻切头对后囊行 期环形切除加前段玻璃体切除术 ,随访一年以上 ,评价其手术疗效。结果　最佳矫正视力 :1.0以上者 73只眼 (37.1%) ,0 .5～ 0 .9者 81只眼 (41.1%) ,0 .1～ 0 .4者 40只眼 (2 0 .3%) ,小于 0 .1者 3只眼 (1.5 %)。手术主要并发症为出现新生膜性混浊。结论　 期行后囊环形切除联合前段玻璃体切除术是处理和预防白内障超声乳化术后后囊混浊的有效方法 ,方法简便 ,安全有效 ,对无明显视网膜脱离高危因素者 ,疗效可靠 ,值得推广。     

儿童角巩膜穿通伤合并外伤性白内障手术治疗53例分析

目的：探讨儿童角巩膜穿通伤合并白内障手术治疗效果。方法回顾性分析53例（53眼）儿童角巩膜穿通伤合并白内障手术治疗情况。采用显微镜下角、巩膜穿通伤缝合联合白内障超声乳化或囊外摘除及Ⅰ期后房型人工晶体植入、后囊切开前段玻璃体切除手术治疗,术后随访6~12月。结果视力恢复至0.8者26例（49.06%）,0.7~0.3者25例（47.17%）,0.3者2例（3.87%）;术前、术后视力差异有显著性,P〈0.001。行Ⅰ后囊切开前段玻璃体切除手术可明显降低视轴区后囊混浊发生率。结论儿童角巩膜穿通伤合并白内障行角、巩膜穿通伤缝合联合白内障超声乳化或囊外摘除及Ⅰ期后房型人工晶体植入、后囊切开前段玻璃体切除手术治疗可使患儿获得良好视功能,避免二次手术。     

前部玻璃体切除术在儿童外伤性白内障的应用

目的：探讨前部玻璃体切除术在儿童外伤性白内障手术中的应用。方法：儿童外伤性白内障21例21眼行白内障摘除联合人工晶状体植入术,术中进行前部玻璃体切除术。结果：术后随访6mo～2a,21眼视力均有不同程度的提高,视力〈0.12者4例（19.0%）,0.15～0.3者9例（42.9%）,≥0.5者6例（28.6%）,视力检查不合作2例（9.5%）。结论：前部玻璃体切除术能显著减少儿童外伤性白内障术后并发症,提高视力。     

Results of cataract extraction with IOL implantation in children aged 17 months to 8 years old

PURPOSE: To evaluate anatomical and functional results of cataract extraction and IOL implantation, together with posterior capsulectomy and anterior vitrectomy in children. MATERIALS AND METHODS: Cataract extraction and IOL implantation with posterior capsulectomy and anterior vitrectomy was performed in 32 eyes of children between 17 months and 8 years old. Patients were followed up for a mean period 36 months (from 6 months to 5.5 years). RESULTS: Good anatomical results were achieved in all, except 2 cases. One eye required removal of opacifications located posterior to the IOL In the second eye membrane from the anterior surface of the lens were excised. Final postoperative visual acuity in eyes with bilateral cataract was 0.59, whereas in unilateral cataract 0.25. Half of the children with bilateral cataract has significantly worse BCVA in one eye. CONCLUSIONS: Cataract extraction and IOL implantation with posterior capsulectomy and anterior vitrectomy in young children gives good anatomical results. Functional results are better in bilateral congenital cataract, comparing to unilateral cases. To achieve good functional results, visual rehabilitation is necessary.     

儿童先天性白内障摘除和人工晶体植入

目的 评价儿童白内障摘除联合人工晶体植入术后的临床疗效。方法 对64例（104只眼）1．5-14岁儿童先天性白内障患儿行白内障囊外摘除联合局限性前段玻璃体切除和人工晶体垂袋内植入术。对术后平均随访22个月的并发症、视力变化等进行分析。结果 术后脱盲率为86．4％．脱残率为62．7％。41．8％的眼获得了双眼视，30．6％的患儿有立体视。3只眼发生后发性白内障．5只眼有一定程度的人工晶体夹持。结论 白内障摘除联合前段玻璃体切除和人工晶体植入治疗儿童白内障，术中和术后并发症少，绝大多数患儿术后视力能够显著提高并建立了良好的视功能。影响术后视功能的因素应进一步研究。     

Comparison of epilenticular IOL implantation vs technique of anterior and primary posterior capsulorhexis with anterior vitrectomy in paediatric cataract surgery

PURPOSE: To compare the functional outcome of epilenticular intraocular lens (IOL) implantation vs the technique of anterior continuous curvilinear capsulorhexis (ACCC), posterior continuous curvilinear capsulorhexis (PCCC) with vitrectomy and in-the-bag IOL implantation in paediatric cataract surgery. METHODS: Forty eyes of 33 children with developmental or traumatic cataract, whose mean age was 2-12 years, were randomly divided into two groups A and B. Group A patients underwent epilenticular IOL implantation while in group B patients, ACCC, PCCC with anterior vitrectomy with in-the-bag IOL implantation was performed. Equal number of eyes (10 each) with developmental cataracts (subgroups A1 and B1) and traumatic cataracts (subgroups A2 and B2) were allotted to both the groups. Postoperative visual acuity, opacification of the visual axis, and possible complications were observed and analysed. RESULTS: Four eyes in subgroup B2 had fibrous or ruptured capsules, and were managed by epilenticular IOL implantation technique. One eye in subgroup B2 developed central posterior capsular opacification and hence required a secondary capsulotomy. All cases in group A maintained a clear visual axis at the last follow-up. Minimal postoperative inflammation was noticed in all groups, which subsided with anti-inflammatory medication. At the last follow-up, all eyes in group A gained visual acuity >/=6/18. Whereas in group B, visual acuity >/=6/18 was obtained in 85.7% cases with the epilenticular IOL implantation technique and in 83.3% cases with ACCC and PCCC with anterior vitrectomy technique. CONCLUSION: Epilenticular IOL implantation offers a safe and effective alternative for management of paediatric cataract. In selected cases of traumatic cataract, it is the preferred treatment modality.     

儿童白内障手术及术后视力康复

目的 探讨儿童白内障手术疗效及术后视力康复.方法 观察2005年7月至2009年11月手术的45例(76只眼)儿童白内障患儿,行白内障摘除术+后囊膜环形撕囊术(PCCC)+前部玻璃体切除术33例(64只眼),双眼白内障患儿同时手术,其中28例(58只眼)2岁以后再次行Ⅱ期人工晶状体植入术,;行白内障摘除术+后囊膜环形撕囊术(PCCC)+前部玻璃体切除术+人工晶状体植入术9例(9只眼);行白内障摘除术+人工晶状体植入术3例(3只眼).对手术年龄、手术方式、术后并发症及术后远期视力等进行回顾性分析,随访4～55个月,平均34.5月.结果 33例矫正视力在0.3以上,手术脱残率73.3%,5例矫正视力在0.05～0.3,手术脱肓率84.4%,2例矫正视力在0.05以下.5例患儿因年龄小不能合作检查视力,但能追随光亮或注视目标.后发障发生率为6.58%,双眼同时手术与同期单眼手术术后并发症差异无统计学意义(P＞0.05).结论 白内障摘除术+后囊膜环形撕囊术(PCCC)+前部玻璃体切除术联合人工晶状体植入术是治疗儿童白内障安全有效的措施,儿童白内障双眼同时手术是安全的.坚持弱视训练是儿童白内障术后获得良好视力,重建视功能的关键.     

折叠式人工晶状体治疗儿童白内障的初步报告

目的　评价小切口白内障吸除及折叠式人工晶状体囊袋内植入术中采用撕除后囊、切除前段玻璃体技术治疗儿童白内障的临床效果。方法　对 2 8例 (37只眼 )儿童白内障患者行小切口白内障吸除、前后联合撕囊、前段玻璃体皮质切除及折叠式人工晶状体囊袋内植入术 ,其中先天性白内障 2 7只眼 ,外伤性白内障 10只眼。术后随访 3～ 15个月 ,平均 10个月。观察记录并发症发生情况、视力及角膜曲率的变化。结果　先天性白内障患者术后矫正视力均≥ 0 1,16只眼 (5 9 3% )矫正视力≥ 0 5 ;外伤性白内障患者术后矫正视力均≥ 0 3,8只眼 (80 % )矫正视力≥ 0 5。术后 1周 ,1个月和 3个月的手术源性角膜散光度数分别为 (1 18± 0 6 5 )、(0 6 7± 0 5 9)及 (0 6 0± 0 39)D。术后 1个月时 ,手术源性角膜散光度数趋于稳定。随诊中有 5只眼 (13 5 % )出现晶状体后囊膜切开区混浊 ,无其他并发症。结论　小切口白内障吸除及折叠式人工晶状体囊袋内植入术中撕除后囊、切除前段玻璃体治疗儿童白内障具有术后角膜散光小 ,视力恢复快 ,炎性反应轻 ,手术并发症少的优点     

前房维持器在合并外伤性白内障的眼内异物伤玻璃体手术中的应用

目的评价前房维持器灌注在对选择的病例行外伤性白内障摘出联合眼内异物摘出的玻璃体手术中的应用效果。方法36例（36眼）眼球穿孔伤合并白内障及眼内异物,排除术前已诊断合并视网膜脱离、外伤性眼内炎者。白内障摘出术中在前房维持器液体灌注下行白内障皮质清除,然后继续应用前房维持器行眼内液体灌注,联合20G玻璃体手术摘出眼后段异物,人工晶状体植入。术中始终应用前房维持器行眼内液体灌注。结果36例眼内异物均成功摘出。术后视力提高者36例,其中视力达0．1以上者34例（94％）。无大泡性角膜病变发生。1例视网膜脱离,经巩膜扣带术视网膜复位。结论经前房维持器灌注可代替经巩膜切口灌注应用于外伤性白内障摘出联合眼内异物摘出的玻璃体手术中,提供了另一种眼内液体灌注方式,可减少并发症。     

Preventing recurrent opacification of the visual pathway after pediatric cataract surgery

PURPOSE: To determine the rate of secondary opacification of the visual pathway following pediatric cataract surgery in children between the ages of 10 months and 7 years. METHODS: The medical records of children less than 7 years old who underwent lens aspiration, posterior chamber intraocular lens (IOL) implantation, primary pars plana posterior capsulectomy, and anterior vitrectomy were reviewed retrospectively. Twenty-six eyes in 19 children were included in the study. All procedures were performed by an anterior segment surgeon and a vitreoretinal surgeon. Main outcome measures were the prevalence of re-opacification of the visual pathway and of early postoperative complications. RESULTS: The visual pathway remained clear in 25 of 26 eyes (96%) after pediatric cataract surgery combined with primary pars plana posterior capsulectomy and anterior vitrectomy. The mean age at surgery was 46 +/- 23 months (+/-SD). Secondary opacification of the visual pathway occurred in one eye (4%), requiring another surgical procedure. At last follow-up (mean, 26 months; range, 6 to 79 months), the visual pathway was clear in all 26 eyes (100%). No cases of clinically significant IOL displacement or of retinal detachment were noted. CONCLUSIONS: For children undergoing pediatric cataract surgery between the ages of 10 months and 7 years, IOL implantation combined with primary pars plana posterior capsulectomy and anterior vitrectomy is effective in preventing re-opacification of the visual pathway.