儿童白内障摘除人工晶状体植入术后视功能的长期随访

目的　评价儿童白内障摘除后房型人工晶状体 (IOL)植入术后视力和双眼视功能的情况。方法　对年龄<13岁的儿童白内障患者 47例(68只眼 )行白内障摘除人工晶状体植入术,其中单眼外伤性白内障 12例,单眼先天性白内障 14例,双眼先天性白内障 21例。记录患者的术前情况,包括白内障类型、晶状体混浊程度、手术年龄及合并症情况,检查术后最佳矫正远视力 (BCDVA)、最佳矫正近视力 (BCNVA)及双眼视功能情况。平均随访时间 ( 41 3±12 3 )个月。结果　术后BCDVA≥0 5和BCNVA≥0 5均为 34只眼 ( 50 0% )。18例患者 ( 38 3% )术后获得良好双眼视功能。不同BCDVA术眼在手术年龄、晶状体混浊程度及合并症 (斜视和眼球震颤 )方面的差异有统计学意义(P<0 05 );术后获得不同双眼视功能者在手术年龄、合并症 (斜视和眼球震颤 )及双眼BCDVA方面的差异有统计学意义 (P<0 05)。结论　儿童白内障摘除后房型IOL植入术后患者可获得较好视力和一定双眼视功能,但手术效果与手术时机、晶状体混浊程度及合并症 (斜视和眼球震颤)等多种因素密切相关。     

Clinical characteristics and surgical outcomes of pediatric cataract in Taiwan

Purpose To report treatment of pediatric patients with cataract, and evaluate the efficiency of different surgical interventions. Method This study comprised a consecutive series of pediatric patients with congenital or developing cataract who received surgery between 1993 and 2002 at Chang Gung Memorial Hospital in Taiwan. Patients’ demographics, cataract type, presenting symptoms, surgical intervention, postoperative visual acuity, and follow-up refractive changes were recorded. Results Three hundred and ninety-nine eyes of 246 children were included; unilateral cataract was present 21.8% of the eyes. The age at surgery was ranged from 1 to 157 months. Eyes were grouped by surgical interventions performed: Group 1 included 98 eyes that had lensectomy. Group 2 included 89 eyes that had lensectomy and secondary intraocular lens implantation. Group 3 included 212 eyes that had lensectomy with primary intraocular implantation. The mean follow up time was 41.3 months. Finally, 23.1% group 1 patients, 42.1% group 2 patients, and 63.4% group 3 patients achieved visual acuity better than 20/60 (P=0.000). Upon analysis with multifactor regression, age at onset (P=0.011) was the only significant factor related to visual outcome. Complications such as after cataract and glaucoma occurred in 21.6% and 5.8% of all patients, respectively. Conclusions Intraocular lens implantation for children with congenital or developing cataract is an effective treatment for visual rehabilitation, even for those patients age 2 years and younger.     

Pyramidal anterior polar cataracts

OBJECTIVE: To document clinical features and subsequent management of pyramidal anterior polar cataracts in children. DESIGN: Retrospective, noncomparative case series and clinicopathologic correlation. PARTICIPANTS: Fifteen patients who presented to the pediatric ophthalmology clinic. INTERVENTION: All patients underwent measurement of visual acuity, assessment of ocular motility, examination of the anterior and posterior segments, and cycloplegic refraction. Amblyopia treatment was instituted when appropriate. When visual impairment occurred from cataract progression or amblyopia or both, cataract removal with or without lens implantation was performed. After surgery, correction of refractive error and treatment of amblyopia were instituted. Several pyramidal opacities were retrieved during cataract extraction and examined by light and electron microscopy. MAIN OUTCOME MEASURES: Visual acuity at initial presentation, size of lens opacity before surgery, amblyopia status, most recent visual acuity after cataract extraction, and histologic examination of lens opacity. RESULTS: Nine children had bilateral and six had unilateral pyramidal cataracts (24 eyes). There was no discernible inheritance pattern. Patients were followed for 27 months on average. Twenty of 24 eyes developed cortical opacification that extended significantly beyond the base of the pyramidal lesion. Nineteen eyes required cataract surgery: 10 eyes underwent lensectomy with anterior vitrectomy and 9 had extracapsular cataract extraction, 8 of which had insertion of a posterior chamber intraocular lens. Amblyopia was present or developed in all six patients with unilateral cataract and in eight of nine patients with bilateral cataract. Visual acuity in many eyes remained poor despite amblyopia therapy. The pyramidal opacities consisted of hyperplastic lens epithelium, which exhibited a loss of polarity and was surrounded by a collagenous matrix. CONCLUSIONS: Pyramidal anterior polar cataracts are present at birth and may represent a variant of anterior polar lens opacities. They may be unilateral or, if bilateral, they may be either symmetric or asymmetric. They consist of hyperplastic lens epithelium in a collagenous matrix. Patients with pyramidal cataracts are likely to develop amblyopia. This can result from either unilateral occurrence or asymmetry of bilateral opacities and is often worsened by surrounding cortical opacification. Many patients require cataract surgery. All infants and young children with anterior polar opacities showing this configuration should be followed for cataract progression and amblyopia.     

Incidence and risk factors for glaucoma after pediatric cataract surgery with and without intraocular lens implantation.

PURPOSE: We sought to report the incidence of glaucoma in the eyes of children who underwent cataract surgery with and without intraocular lens implantation and to report the risk factors for developing glaucoma. METHODS: We undertook a retrospective review of pediatric cataract surgery charts, excluding traumatic cataract, aniridia and Lowe syndrome, steroid-induced cataract, lens subluxation, uveitis, retinoblastoma, radiation-induced cataract, retinopathy of prematurity, secondary IOL implantation, and patients with less than 1 month of postoperative follow-up. RESULTS: After pediatric cataract surgery, 10 (3.8%) of 266 eyes with primary intraocular lens implantation were diagnosed with glaucoma, whereas 8 (17.0%) of 47 aphakic eyes were diagnosed with glaucoma. During the initial analyses, we noted that all of the patients who developed glaucoma underwent cataract surgery when they were 4.5 months or younger. For all patients who underwent surgery during the first 4.5 months of their life, the glaucoma incidence was 24.4% (10/41) in children with pseudophakic eyes and 19.0% (8/42) in age-matched children with aphakic eyes (risk ratio=1.1, CI=0.7-1.9; P=.555). In patients who underwent surgery during the first 4.5 months of their life, the average age of the patients who developed glaucoma was not significantly different than those who did not develop glaucoma in pseudophakic eyes (2.0 months+/-1.4 vs. 1.9 months+/-1.0, P=.700) or aphakic eyes (2.6 months+/-1.5 vs. 1.4 months+/-0.9, P=.070). The corneal diameter of the eyes that developed glaucoma versus eyes that did not was not significantly different in patients with pseudophakic eyes (P=.860) or aphakic eyes (P=.254). Glaucoma was diagnosed in patients at an average of 8.6 months and 117.9 months after cataract surgery in those with pseudophakic eyes and aphakic eyes, respectively. CONCLUSIONS: Patients undergoing cataract surgery at an early age are at high risk for the development of glaucoma with or without an intraocular lens implant.     

不同玻璃体切割方式预防儿童晶状体植入术后视轴混浊的对比研究

目的 在儿童白内障术中应用两种不同的玻璃体切割系统行后囊切开联合前段玻璃体切除术,术中同期植入人工晶状体(IOL),比较术后视轴混浊的发生率.方法 回顾性病例研究.连续收集因先天性及发育性白内障收入山东省眼科研究所并行手术治疗的8岁及以下患儿,2003年6月至2006年6月及2006年7月至2008年6月间分别采用18-G及25-G玻璃体切割系统行后囊切开和前段玻璃体切除术,采用x2检验比较两种手术后视轴混浊的发生率.结果 共19例双眼患儿和16例单眼患儿应用18-G同轴玻璃体切割系统行后囊切开及前段玻璃体切除术,19例双眼和12例单眼患儿利用经睫状体扁平部的25-G玻璃体切割系统进行手术,术后视轴混浊的发生率分别为15％(8/54)和2％ (1/50),二者差异具有统计学意义(x2=5.393,P＜0.05).此外,应用18-G玻璃体切割系统的患儿,有3眼IOL术中植入睫状沟,14眼术后发生明显的虹膜后黏连;而应用25-G玻切系统的患儿,所有患眼IOL均同期稳定植入囊袋内,术后仅有2眼发生轻度的虹膜后黏连.结论 儿童白内障摘除联合IOL植入操作中行后囊膜切开联合前段玻璃体切除手术时,相较于18-G同轴玻璃体切割系统,经扁平部的25-G玻璃体切割系统不仅降低了术后视轴混浊的发生率,而且增加了手术的安全性.     

Randomized,clinical trial of multiquadrant hydrodissection in pediatric cataract surgery

PURPOSE: Evaluate efficacy of multiquadrant cortical-cleaving hydrodissection in pediatric cataract surgery. DESIGN: Randomized multicenter clinical trial. METHODS: Surgery performed at Iladevi Cataract & IOL Research Center (57 eyes, 42 patients) and Postgraduate Institute of Medical Education and Research (23 eyes, 17 patients). Study population comprised 59 consecutive patients (80 eyes) 12 years old and younger undergoing cataract aspiration. The intervention procedure involving envelope randomization was used to assign patients to multiquadrant cortical-cleaving hydrodissection (HY) (40 eyes), or no hydrodissection (HN) (40 eyes). The main outcome measures were as follows: (1) lens-substance removal time and volume of fluid used and (2) ease of lens substance removal. Presence or absence of residual fibers on the posterior capsule was recorded. RESULTS: The mean +/- standard deviation lens substance removal time was significantly less in the HY group (156.1 +/- 86.8 seconds) than in HN group (210.7 +/- 73.8 seconds; P =.003). Fluid used for lens substance removal was significantly less in the HY (91.0 +/- 47.5 ml) than in the HN group (156.9 +/- 87.2 ml; P <.001). In the HY group, lens substance removal was ranked as easy in 36 eyes (90.0%), average in 2 eyes (5.0%), and difficult in 2 eyes (5.0%). In the HN group, removal was easy in 19 eyes (47.5%), average in 12 eyes (30.0%), difficult in 5 eyes (12.5%), and very difficult in 4 (10.0%) eyes (P =.0005). Residual cortical fibers on the posterior capsule were noted in 12.5% of the HY group and 22.5% of HN group, but the difference was not statistically significant (P =.2). CONCLUSIONS: Multiquadrant cortical-cleaving hydrodissection decreases lens substance removal time, lessens fluid volume used for lens substance removal, and facilitates lens substance removal in pediatric cataract surgery.     

先天性白内障摘除人工晶体植入术后屈光状态的观察

目的探讨先天性白内障摘除人工晶体植入的临床疗效。方法对3~14岁先天性白内障摘除联合人工晶体植入108例(175眼),随访3~5年,观察视力、角膜曲率、眼轴长度和屈光度的变化。结果术后5年,单眼患者术眼和健眼平均眼轴长度之间无显著性差异(P>0.05);双眼患者平均眼轴长度与单眼患者健眼之间也无显著性差异(P>0.05)。单眼患者术眼和健眼术后5年屈光状态均向近视漂移,二者之间差异有显著性(P<0.01)。结论儿童先天性白内障摘除人工晶体植入不影响患儿眼球的正常发育,人工晶体的选择原则应结合患儿年龄术后形成屈光欠矫。     

Clinical Analysis of the Incidence and the Treatment of Pediatric Cataract Patients with Optic-nerve Maldevelopment

 Purpose: To interpret the incidence of optic-nerve maldevelopment in postoperative pediatric cataract patients, and evaluate the clinical efficacy of administration of murine nerve growth factor (mNGF) in such patients. Method: Pattern visual evoked potential (P-VEP) was used to measure the visual pathway function in 28 cases (56 eyes) with bilateral congenital cataract and 13 cases (13 eyes) with unilateral congenital cataract who underwent cataract extraction and intraocular lens implantation surgeries. The results were compared with 25 age-sex-matched healthy children (50 eyes). We administered mNGF in 13 cases (23 eyes) who had visual pathway disorder. The efficacy of mNGF injection was observed. P100 latencies, which were used as a main parameter in P-VEP measurement, were analyzed statistically. Result: When compared with normal children, the P100 latency was significantly prolonged in the congenital cataract group (P<0.05). A significant improvement was noted in the visual pathway of subjects treated with mNGF (P<0.05). Conclusion: Compared with normal children, the congenital cataract patients are more vulnerable to optic-nerve maldevelopment. Murine NGF likely plays a protective and nutritive role in the development of optic nerve in cases of optic-nerve maldevelopment followed by congenital cataract surgery.     

Management of infantile cataracts: surgical technics and choices in lens implantation

Management of congenital or infantile cataracts benefited from progresses realized in adult surgery. It stays however specific to children's eyes and is incorporated in a global therapeutic strategy. It must be guided by a pediatric ophthalmogical team used to this kind of treatment. We report here, function of the type of cataract, uni or bilateral, congenital or infantile, the choice of the timing of surgery, of the therapeutic strategy, parental information, and preoperative evaluation. The actual standard of surgery is bimanual phacoaspiration with posterior capsulorhexis and anterior vitrectomy. It is described step by step. Indication of lens implantation, choice of the type and power of IOL function of age of the child is described, be it for initial or secondary lens implantation.     

晶状体及前部玻璃体切割术治疗先天性白内障

目的通过观察应用晶状体及前部玻璃体切割术治疗先天性白内障,评价该术式临床效果。方法对26例（46眼）2岁以内的先天性白内障患儿一期行晶状体及前部玻璃体切割术,随访观察其术后眼部情况及二期行人工晶状体植入术时眼部的情况及其并发症。结果采用该手术方式治疗的先天性白内障,术后患儿眼部反应轻微,无明显纤维素样渗出,并发症少,对后期行人工晶状体植入术影响较小。结论先天性白内障行晶状体及前部玻璃体切割术效果良好,该手术方式操作较简单,具有良好的临床应用效果,值得临床推广。     

Effect of Cataract Surgery on Ocular Axial Length Elongation in Young Children

Purpose: To evaluate the influence of cataract surgery on eyes of children between 1-5 years old.Materials and Methods : Forty- seven cases of pediatric cataract, including 31 cases of bilateral congenital cataract and 16 cases of unilateral posttraumatic cataract, were retrospected. Of the 31 cases of congenital cataract, 19 cases (group l) had undergone cataract extraction with intraocular lens(IOL) implantation, 12 (group 2) had undergone cataract extraction without IOL implantation. Each of them had their two eyes operated seperately at an interval of 1 year or longer. Of the 16 cases of posttraumatic catatract,6 (group 3) had undergone cataract extraction with IOL implantation and 10 (group 4) had undergone cataract extraction without IOL implantation. Mean age at the time of interested surgery was 2.9 years ( range from 1.1 to 5.1 years) . Ocular axial length of both eyes measured by A-scan ultrasonography before and after the surgery of the earlier operated eye in the congenital groups and the op     

儿童白内障手术治疗的临床观察

目的观察白内障摘出联合人工晶状体植入术治疗儿童白内障的临床疗效并探讨术后并发症的防御措施。方法对45例(60眼)儿童白内障,其中先天性白内障38眼,外伤性白内障22眼,分别采用不同术式联合不同类型的人工晶状体植入,术后随访12个月,对术后视力、术中及术后并发症等进行分析。结果术后脱盲率为91.3%,脱残率为81.0%.术中并发症为后囊破裂和玻璃体脱出,术后主要的并发症为后囊膜混浊、葡萄膜炎、人工晶状体夹持、弱视和斜视、继发青光眼。结论儿童先天性白内障及外伤性白内障行晶状体摘出联合人工晶状体植入,可以有效提高患眼的视功能,而术后的屈光矫正及弱视训练对于患儿视功能重建具有重要作用。     

儿童白内障摘除人工晶状体植入疗效观察

目的:评价儿童白内障摘除人工晶状体植入疗效,探讨并发症防治措施。方法:对78例93眼儿童行白内障摘除时作后囊截囊或撕囊前玻璃体切除、联合人工晶状体植入术,术后随访时间平均为24mo。结果:术后矫正视力普遍提高,除2例合并黄斑病变、1例单眼先天性白内障、1例双眼先天性白内障外,视力>0.05占94.3%,>0.2占75.0%,>0.5占44.3%。结论:儿童白内障摘除人工晶状体植入1期行后囊撕囊联合前玻璃体切除,绝大多数儿童视力显著提高,并建立良好的视功能。     

先天性白内障人工晶状体植入术临床观察

目的探讨先天性白内障手术时机及术后并发症处理。方法对35例47眼先天性白内障用超声乳化的注吸系统进行吸出手术并植入人工晶状体，应用SRK三元回归公式计算人工晶状体屈光度，且植入人工晶状体度数低于所得度数2D，并进行后囊环行撕囊。术后随访10．26月。结果检查合作者21例30眼，视力〉0．7者4眼（13．33％）；〉0．3者20眼（66．67％）；脱盲率为90％，脱残率67％。术后并发症后囊浑浊17眼；瞳孔夹持4眼。人工晶状体前膜5眼。结论先天性白内障致盲原因主要是形觉剥夺，应尽早施行手术，并及时处理术后并发症和进行弱视训练。     

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.     

Pseudophakia and intraocular pressure

We studied the change in intraocular pressure in 373 consecutive eyes undergoing cataract extraction with intraocular lens implantation between Jan. 1, 1981, and May 31, 1982. There was a mean increase in intraocular pressure of 0.1 mm Hg following this surgery. This increase, however, was not statistically significant (P greater than .5). There was a mean rise in pressure of 0.8 mm Hg in the eyes undergoing intracapsular surgery and a mean fall in pressure of 0.6 mm Hg in the eyes undergoing extracapsular surgery (P less than .05). The change in pressure was unrelated to age, surgeon, or lens type. The results of a separate analysis of 16 eyes with a preoperative diagnosis of glaucoma and eight eyes with ocular hypertension were similar.     

Sterile corneal ulceration after cataract extraction in patients with collagen vascular disease

We report the occurrence of sterile corneal ulceration in 11 eyes of eight patients with collagen vascular diseases and dry eyes after cataract extraction with intraocular lens implantation. Keratolysis occurred after both extracapsular and intracapsular cataract extraction and appeared unrelated to the type of intraocular lens. Despite aggressive lubrication and other medical treatment, including systemic immunosuppressive agents, penetrating keratoplasty was often required. Although all eyes were saved, visual outcome was usually poor. The histopathologic finding of polymorphonuclear leukocytes localized near the areas of corneal dissolution provides evidence for the role of polymorphonuclear leukocyte-derived collagenase as a contributing factor in the pathogenesis of sterile corneal ulceration in these patients.     

Comparing the efficacy and safety of phacoemulsification in white mature and other types of senile cataracts

Aim: To compare the intraoperative difficulty and postoperative outcome in patients who have white mature cataract in one eye and other types of senile cataract in the other eye undergoing clear corneal phacoemulsification and foldable intraocular lens implantation. METHODS: 82 patients who had white mature cataract in one eye, posterior subcapsular, cortical, nuclear, or mixed type cataract in the other eye were enrolled in this prospective study. Postoperative outcomes, intraoperative difficulties related to capsulorhexis, and phacoemulsification were analysed between the two groups of eyes. Postoperative examinations were done at 1 day, 1 week, 1 and 3 months. RESULTS: Postoperative visual acuity, central corneal thickness, intraocular pressure, and rate of posterior capsule rupture were not significantly different between the two group of eyes (p>0.05). Mean effective phaco time, frequency of postoperative corneal oedema and posterior capsular plaque were found to be significantly higher in the mature cataract group (p<0.05). CONCLUSIONS: A one stage, 5 mm continuous capsulorhexis was achieved using trypan blue and generous amounts of retentive viscoelastic agent in eyes with white mature cataract. Intraoperative difficulties and postoperative outcome of clear corneal incision phacoemulsification surgery and foldable intraocular lens implantation were similar in white mature and other types of senile cataract. Topical anaesthesia in phacoemulsification of eyes with white mature cataract is safe and well tolerated.     

Visual acuity and binocular vision in children with pseudophakia

PURPOSE: To evaluate the results of cataract surgery in children with IOL implantation. MATERIALS AND METHODS: Our research involved 106 children (156 eyes) with congenital and traumatic cataract, in age from 18 months to 18 years, who underwent cataract surgery with intraocular lens implantation. We evaluated visual acuity for far vision and binocular vision after surgery. RESULTS: Visual acuity over 0.5 in unilateral congenital cataract was found in 27.25%, in traumatic cataract in 73%, whereas in bilateral congenital cataract visual acuity over 0.5 we received in 75% of operated children. Full binocular vision was obtained in children with good visual acuity (0.5 and more), with appropriate alignment of the eyes: 13.1% in unilateral congenital cataract, 45.4% in traumatic cataract and 55% in congenital bilateral cataract. CONCLUSIONS: Cataract surgery with intraocular lens implantation results in increase of visual acuity and in achievement binocular vision, if surgery is carried out in the early period, after it had been diagnosed.     

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。