儿童后发性白内障的手术治疗--后囊环形撕囊人工晶状体后囊夹持前段玻切

目的 评价后囊环形撕囊、人工晶状体光学部分夹持联合前段玻璃体切除治疗儿童后发障的疗效。方法 对9例儿童外伤性白内障注吸术后的后发障，行Ⅱ期后囊环形撕囊、人工晶状体光学部分后囊孔夹持联合前段玻璃体切除手术。结果 7例无后发障发生，2例撕囊孔后方纱幕样浑浊，经治疗好转。结论 后囊环形撕囊、人工晶状体光学部分撕囊孔夹持联合前段玻璃体切除是治疗儿童后发障的一种较好的手术方法，可以有效阻止后发障的再发生。     

后囊环形切除及其联合前段玻璃体切除术对后发性白内障影响的Meta分析

目的 系统评价白内障超声乳化吸除术中选择Ⅰ期后囊环形切除（PCCC）与选择Ⅰ期后囊环形切除联合前段玻璃体切除（PCCC＋AV）对患者后发性白内障的影响。设计 基于文献检索的Meta分析。研究对象 检索MEDLINE数据库、中国期刊网专题全文数据库、中文生物医学文献数据库、维普中文科技期刊数据库、中国医学学术会议论文、中国优秀硕博士论文数据库、超星数字图书馆、书生之家数字图书馆等；手工检索国内外相关教科书、会议论文等；并以所有检出文献的参考文献作为补充。方法 严格按照纳入、排除标准筛选文献，并对纳入文献进行质量评估，提取研究所需信息。数据分析选用Review Manager 4．2．2软件、SPSS10．0软件，检验异质性，根据检验结果选择相应的效应模型进行Meta分析，以优势比（OR）判定PCCC术式和PCCC＋AV术式对患者后发性白内障的影响，并改变选择的效应模型，计算失效安全数（Nfs）进行敏感性分析。主要指标 纳入研究的文献异质性，研究结果的敏感性，95％置信区间（CI）及Nfs。结果 6篇文献共计305例白内障患者。经异质性检验，纳入文献无异质性，选择固定效应模型计算OR值。后发性白内障PCCC组与PCCC＋AV组的合并OR值为0．13（95％CI：0．06～0．25），差异有统计学意义（P〈0．000）。改用随机效应模型计算OR值，进行敏感性分析，差异仍有统计学意义（P〈0．000），且Nfs=76．8，纳入文献稳定性好。结论 白内障超声乳化吸除术中选择Ⅰ期PCCC＋AV术式患者较术中单纯选择I期PCCC术式的患者更能有效抑制后发性白内障的发生。     

儿童先天性白内障手术治疗临床观察

目的:探讨和评价不同手术方式治疗儿童先天性白内障,预防后囊膜混浊的临床疗效。方法:对采取不同手术方式的50例(96眼)先天性白内障术后后发性白内障的发生及视功能的恢复情况进行回顾性分析。其中采用白内障囊外摘除术的18例34眼(EC-CE组);白内障超声乳化吸出及行后囊膜连续环形撕囊术的12例23眼(PCCC组);白内障超声乳化吸出、后囊膜连续环形撕囊联合前段玻璃体切割术的20例39眼(AV组)。≥2岁的患儿施行Ⅰ期人工晶状体植入。术后随访12～36mo,观察术后视力、并发症及眼部情况。结果:治疗后3组患儿视力均有提高,ECCE组、PCCC组与AV组后发性白内障的发生率分别为100%(34/34)、35%(8/23)和13%(5/39),3组比较,差异均有统计学意义(P<0.05)。结论:后囊膜连续环形撕囊术联合前段玻璃体切割术较囊外摘除术及后囊膜连续环形撕囊术能更有效减少儿童先天性白内障术后后发性白内障的发生。     

先天性白内障手术中预防后发障的方法

目的　探讨小儿先天性白内障手术中预防后发障的方法。方法　对 46例 ( 4 6眼 )先天性白内障 ,以白内障超声乳化仪的注吸I/A系统吸净晶状体植入人工晶状体后 ,进行后囊连续环形撕囊及前段玻璃体切除联合手术 (A组 ) ,同期施行的3 2例 ( 3 2眼 )先天性白内障 ,以同样的方法行白内障摘出人工晶状体植入后 ,进行单纯后囊连续环形撕囊术 ,不做前段玻璃体切除 ,作为对照组 (B组 )。术后随访 2年以上。结果　后发障发生的情况 ,A组 2眼 ( 4 4% ) ,B组 7眼 ( 2 1 9% ) ,两组对比差异具有显著性意义 (P <0 0 5 )。两组均未发现眼底并发症。结论　先天性白内障术中行后囊连续环形撕囊联合前段玻璃体切除术 ,是预防后发性白内障的有效方法。     

后囊连续环形撕囊联合前段玻璃体切除术在儿童白内障手术中的应用

目的探讨后囊连续环形撕囊联合前段玻璃体切除术对儿童后发性白内障的预防作用。方法对32例32眼儿童白内障患者利用超声乳化技术摘除白内障时Ⅰ期进行后囊连续环形撕囊联合前段玻璃体切除术。结果全部术眼视轴区均透明，3眼后囊膜不规则撕裂，32眼均不影响IOL植入，无术中术后并发症。结论在利用超声乳化技术摘除白内障时Ⅰ期进行后囊连续环形撕囊联合前段玻璃体切除术，能使视轴区保持清亮，有效防止后发性白内障的发生。     

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。     

双连续环形撕囊联合前部玻璃体切除治疗儿童白内障的临床体会

目的 探求治疗儿童白内障最佳的手术方法,以避免后发障和多次重复手术。方法 儿童白内障65例（107只眼）,在局麻或全麻下,行上方巩膜隧道切口,前囊连续环形撕囊,白内障吸出后,行后囊连续环形撕囊及前部玻璃体切除。结果 随访观察12～18个月,矫正视力≥0．4者81只眼,占75．7％,后发障2只眼,占1．87％。结论 双连续环形撕囊＋前部玻璃体切除能有效地预防后发障的发生。     

白内障摘除联合后囊连续环形撕囊治疗先天性白内障

目的：观察先天性白内障摘除术中行后囊连续环形撕囊（PCCC）防治后发性白内障的疗效及可能出现的并发症。 方法：采用小切口先天性白内障单纯囊外摘除或联合人工晶状体植入术，对58例97眼先天性白内障患者进行后囊连续环形撕囊，使晶状体后囊中央形成约3～5mm的囊膜缺损区，行前部玻璃体切除术，以避免后发性白内障的发生。 结果：Ⅰ期植入人工晶状体50眼：术后1mo矫正视力≥0．6者18眼，0．5以下42眼；术后3mo矫正视力≥0．6者20眼，0．5以下46眼；术后6～12mo矫正视力≥0．6者21眼，0．5以下50眼。术后lmo第1次复查，无1眼发生后发性白内障，3mo周边部后囊膜浑浊40例，撕囊区清亮。6～12mo16眼发生新生膜，10眼少量玻璃体脱出于前房，玻璃体轻度浑浊，瞳孔不圆18眼，人工晶状体偏位10眼，无1眼发生视网膜脱离。 结论：后囊连续环形撕囊是一种经济、安全、高效的防止先天性白内障术后后发性白内障的手术方式，适用于不能配合激光治疗的儿童，但存在一定的复发率。     

后囊连续环形撕囊联合前段玻璃体切除术在先天性白内障手术中的应用

目的观察先天性白内障手术中联合后囊连续环形撕囊及前段玻璃体切除术的意义。方法 50例（79眼）年龄2月～8岁先天性白内障施行摘出手术（超过2岁者植入人工晶状体）。其中21例（31眼）联合后囊连续环形撕囊（Ⅰ组）,29例（48眼）联合后囊连续环形撕囊及前段玻璃体切除术（Ⅱ组）。随访6～36个月,观察并比较两组视力及后囊浑浊的情况。结果术后矫正视力≥0.5者,Ⅰ组11眼（35.48%）,Ⅱ组31眼（64.58%）;视力0.3～0.4者,Ⅰ组14眼（45.16%）,Ⅱ组14眼（29.17%）;视力≤0.2者,Ⅰ组6眼（19.35%）,Ⅱ组3眼（6.25%）;两组比较差异有统计学意义（χ^2=5.38,P〈0.05）。后发性白内障（后囊浑浊≥3级者）,Ⅰ组9眼（29.03%）,Ⅱ组2眼（4.17%）;两组比较差异有统计学意义（χ2=5.69,P〈0.05）。均未出现眼底并发症。结论后囊连续环形撕囊联合前段玻璃体切除术能明显降低儿童先天性白内障术后后发障的发生率。     

儿童白内障三种术式后发障形成的临床探讨

目的 探讨预防儿童后发性白内障的手术方式。方法 48例(57眼)儿童白内障，其中先天性白内障41眼，外伤性白内障16眼，年龄3—14岁。57眼随机分为3组，每组都行小切口、前囊连续环形撕囊，白内障吸出及折叠式人工晶状体植入。Ⅰ组行后囊抛光，保留完整后囊；Ⅱ组行后囊连续环形撕囊；Ⅲ组行后囊连续环形撕囊及前部玻璃体切除术。术后随访3—18月，平均12月，观察并记录各组后发性白内障发生情况及其它并发症。结果 后发障≥3级者发生率Ⅰ组为42％，Ⅱ组为21％，Ⅲ组为0。各组均无玻璃体癌、视网膜脱离或囊样黄斑水肿等并发症发生。术后矫正视力≥0．5者40眼(70％)，0．1—0．4者11眼(19％)。结论 白内障吸出及折叠式人工品状体植入术中，行后囊连续环形撕囊联合前部玻璃体切除术可有效地预防儿童后发性白内障的发生，远期效果需进一步观察。     

The Incidence of After Cataract Following Three Different Types of Cataract Surgery in Children: A Meta-Analysis

Via meta-analysis, we assessed the effect of pediatric cataract surgery with posterior continuous curvilinear capsulorhexis (PCCC) with or without anterior vitrectomy (AV) on the incidence of after cataract. Group 1 consisted of pediatric cataract surgery with or without PCCC. Group 2 consisted of pediatric cataract surgery with PCCC with or without AV. The pooled odds ratio of after cataract in Group 1 was 0.21; in Group 2 it was 0.13. Pediatric cataract surgery with PCCC is superior to single cataract surgery in preventing the incidence of after cataract. Drs. Jian, Xiaolei, and Rongdi are from the Third Military Medical University, Department of Ophthalmology, Daping Hospital, Chongqing, China, 400042. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices. Using meta-analysis, the authors assessed the effect of pediatric cataract surgery with posterior continuous curvilinear capsulorhexis with or without anterior vitrectomy on the incidence of after cataract.     

白内障术中后囊膜破裂行后囊膜连续曲线形撕囊术

目的：讨论白内障囊外摘除、超声乳化摘除及针吸摘除术中后囊膜破裂时行后囊膜连续曲线形撕囊术（ｐｏｓｔｅｒｉｏｒ ｃｏｎｔｉｎｕｏｕｓ ｃｕｒｖｉｌｉｎｅａｒ ｃａｐｓｕｌｏｒｈｅｘｉｓ,ＰＣＣＣ）的方法和作用。方法：利用撕囊镊对１０例（１０眼）白内障摘除术中后囊膜破裂眼行ＰＣＣＣ,５例联合行前段玻璃体切除术。结果：１０例后囊膜破裂后行ＰＣＣＣ眼９例成功完成ＰＣＣＣ,１ 均植入后房人工晶体。术后观察１月～３年（平均１６月）,９例行ＰＣＣＣ眼视轴均清晰,未发生视网脱离及后发性白内障,无明显的人工晶体光学部偏中心或人工晶体异位。结论：ＰＣＣＣ可有效避免后囊膜破孔进一步无限放射状撕裂,保持周边后囊膜的完整性。使人工晶体稳固于囊袋内。     

儿童白内障摘除联合人工晶状体植入和后囊撕除术的临床观察

目的观察儿童白内障应用超声乳化吸除联合后房型人工晶状体植入术，且对≤6岁患儿行后囊撕除联合前段玻璃体切除术的临床效果。方法对31例（34眼）儿童白内障行超声乳化吸除术，对≤6岁患儿同时行后囊撕囊联合前段玻璃体切除术，观察术中术后并发症及术后视力情况。随访7-32个月。结果术后视力≥4．9者6眼（18．75％），4．6-4．8者19眼（59-38％），4．0-4．5者5眼（15．63％）。主要并发症为术中后囊不规则撕裂、术后虹膜炎性反应和后囊混浊。结论儿童白内障手术操作难度较成人大．需掌握手术技巧。对6岁以上和以下患儿的后囊区别对待．可有效控制不良反应．减少并发症．使术后视力达到较为理想的效果。     

前部玻璃体切除在先天性白内障手术中的作用

目的探讨存先天性白内障手术中前部玻璃体切除对术后视轴区后囊浑浊的预防作用。方法对61例（122眼）2～8岁的儿童双眼先天性白内障施行晶状体超声乳化联合人工晶状体植入。右眼为对照组（61眼）联合后囊连续环形撕囊;左眼为研究组（61眼）联合后囊连续环形撕囊及前部玻璃体切除。随访6～66月,平均31．6月观察记录两组视轴区浑浊情况和其它并发症.结果视轴区浑浊发生率,对照组为36．07％,研究组为8．20％,研究组明显低于对照组（P〈0．01）。在能够进行视力检查的48例（96眼）中,术后最佳矫正视力≥0．3者,对照组为30只眼（62．50％）;研究组为39只眼（81．25％）,研究组高于对照组,差异有统计学意义（P〈0．05）。结论对于（2～8岁）儿童先天性白内障,在施行晶状体超声乳化联合人工晶状体植入的同时,联合后囊连续环形撕囊及前部玻璃体切除,可安全有效的减低术后视轴区浑浊的发生率。     

后囊膜截开联合前段玻璃体切割术在先天性白内障手术中的应用

目的 :探讨后囊膜截开联合前段玻璃体切割术 (PCCC +AV )在先天性白内障手术中的应用效果。方法 :对先天性白内障患儿者 5 5例 ( 88眼 )进行回顾性研究。行晶状体吸除术 42眼 ,其中 3 8眼联合PCCC +AV术。行晶状体吸除联合人工晶体植入术 44眼 ,其中联合PCCC +AV术 15眼。随访半年到 3年 ,观察视轴混浊、前房纤维渗出、虹膜膜后粘连、人工晶体夹持、黄斑囊样水肿和视网膜脱离等发生情况 ,并进行统计学分析。结果 :术中行PCCC +AV的患儿视轴混浊发生率明显低于未行PCCC +AV的患儿 ,两者有显著性差异 (P <0 0 1)。而前房纤维渗出、虹膜膜后粘连、人工晶体夹持的发生率无显著性差异 (P >0 0 5 )。各组均无一例发生黄斑囊样水肿和视网膜脱离。结论 :在先天性白内障手术中运用后囊膜截开联合前段玻璃体切割术 ,安全易掌握 ,可有效预防后发障 ,主要用于 0～ 5岁的患儿。     

Functional outcomes of acrylic intraocular lenses in pediatric cataract surgery

PURPOSE: To evaluate the functional outcomes of in-the-bag implantation of acrylic intraocular lenses (IOLs) with posterior continuous curvilinear capsulorhexis (PCCC), without PCCC, with PCCC and anterior vitrectomy, and with PCCC and optic capture in pediatric cataract surgery. SETTING: Pediatric Ophthalmology Service, Guru Nanak Eye Centre, New Delhi, India. METHODS: Forty-two eyes of 25 children were included in this prospective study. All eyes had in-the-bag implantation of an AcrySof IOL (Alcon). Twenty-five eyes had had an anterior continuous curvilinear capsulorhexis (ACCC) (Group A). Seventeen eyes had PCCC along with ACCC (Group B), 4 had anterior vitrectomy combined with PCCC (Group C), and 6 had PCCC with IOL optic capture through the PCCC (Group D). Secondary opacification of the visual axis, visual acuity, and possible complications were observed and analyzed. RESULTS: The mean age of the patients was 78 months (range 36 to 144 months). The mean follow-up was 13 months (range 6 to 18 months). Four eyes (16%) in Group A developed visually significant posterior capsule opacification (PCO) involving the central visual axis and required secondary capsulotomy. All eyes in Groups B, C, and D had a clear visual axis at the last follow-up and did not require a secondary procedure. Minimal postoperative inflammation (ie, aqueous flare and IOL deposits ) was seen in all groups. The mean preoperative decimal best corrected visual acuity (BCVA) in Groups A, B, C, and D was 0.095, 0.055, 0.174, and 0.039, respectively. Postoperatively, the BCVA was 0.54, 0.66, 0.66, and 0.66, respectively. CONCLUSIONS: An optimal-sized ACCC followed by in-the-bag implantation of a foldable acrylic IOL helped maintain a clear visual axis by delaying the onset of PCO and leading to milder PCO. The benefits of a foldable acrylic IOL in pediatric cataract surgery can be increased by combining it with PCCC, with or without anterior vitrectomy, or with optic capture of the IOL.     

Completion rate of primary posterior continuous curvilinear capsulorhexis and vitreous disturbance during congenital cataract surgery.

PURPOSE: We sought to document the completion rate of primary posterior continuous curvilinear capsulorhexis during congenital cataract surgery and determine the incidence of disruption of vitreous face during this procedure. METHODS: One hundred six consecutive eyes of patients undergoing posterior continuous curvilinear capsulorhexis (PCCC) during congenital cataract surgery were evaluated prospectively for completion of PCCC and disruption of vitreous face. PCCC was performed under high-viscosity sodium hyaluronate (Healon GV 1.4%) initiated with 26 g of cystotome and later completed with Kraff-Uttrata forceps by frequent grasping and regrasping of the flap. Completion of PCCC and disruption of vitreous face during the procedure was noted. Even in cases of disrupted vitreous face, PCCC was performed and completed with forceps and, later, disruption of vitreous face was managed with 2-port automated limbal anterior vitrectomy. The size of PCCC was measured. An Alcon AcrySof SA30AL was implanted in-the-bag if the PCCC was 4 mm or smaller and in the sulcus when the PCCC was larger than 4 mm. RESULTS: The mean age of the 106 pediatric patients was 17 +/- 26 months (median, 6 months; range, 1 month to 8 years). PCCC was completed in all the eyes. Disruption of vitreous face during PCCC was noted in 5 of 106 (4.7%) eyes. The mean size of PCCC was 3.6 +/- 0.7 mm. A total of 98 (92.5%) had in-the-bag, and 8 (7.5%) eyes had sulcus implantation of IOL. CONCLUSION: PCCC was completed in all eyes with minimal disruption of vitreous face in a well-controlled manner under high-viscosity viscoelastics.     

Anterior and posterior capsulorhexis in pediatric cataract surgery with or without trypan blue dye: randomized prospective clinical study

PURPOSE: To evaluate the clinical efficacy of trypan blue 0.1% dye (Blurhex) in creating a complete anterior and posterior capsulorhexis during pediatric cataract surgery. SETTING: Tertiary eyecare center, Postgraduate Institute of Medical Education and Research, Chandigarh, India. METHODS: In a prospective randomized study, an anterior (ACCC) and posterior (PCCC) continuous curvilinear capsulorhexis were performed in pediatric patients. In Group 1 (n = 19), the ACCC and PCCC were created without use of trypan blue dye. In Group 2 (n = 23), intracameral trypan blue dye was used to stain the anterior and posterior capsules. RESULTS: In Group 1, 14 eyes (73.6%) had a complete ACCC and 10 (52.6%) had a complete PCCC. In Group 2, 21 eyes (91.3%) had a complete ACCC and 19 (82.6%) had a complete PCCC. CONCLUSION: In cases of pediatric cataract, staining the anterior and posterior capsules with trypan blue 0.1% allowed recognition of capsule flaps and facilitated the creation of complete ACCCs and PCCCs.