先天性白内障临床特点与术后视力的关系

目的:探讨先天性白内障患者的临床表现特点,是否合并眼球震颤,与白内障手术术后视力预后的关系.方法:分析1999至2000年"健康快车"在贵州、广西接诊的先天性白内障患者共81例84只眼(78例为单眼,3例为双眼),其中合并眼球震颤者13只眼,未合并眼球震颤者71只眼;男性50例,女性31例,年龄5～38岁.对于除外智力障碍及其他眼部先天异常和眼外伤史,能够进行视力检查,具有手术适应证者,行白内障摘除联合人工晶体植入术,并对术前、术后的最佳矫正视力进行比较.结果:合并眼球震颤眼中,术后最佳矫正视力O.05以下有3只眼(23%,3/13),0.05～0.3有9只眼(69%,9/13),0.3以上只有一只眼(8%,1/13).Fisher精确概率法统计显示,合并眼球震颤组术后视力较术前差异有统计学意义(P=0.04).无眼球震颤组术后视力较术前差异有统计学意义,其中术后最佳矫正视力0.05以下有6只眼(8%,6/71),0.05到0.3之间有24只眼(34%,24/71),0.3以上41只眼(58%,41/71).无眼球震颤组与合并眼球震颤组的术后视力改善比较,两组差异有统计学意义.结论:无眼球震颤的先天性白内障患者行白内障手术后视力预后较好,明显优于合并眼球震颤的患者,但后者应考虑多因素手术的必要性.

Preoperative clinical features and surgical results of congenital cataract

Objective: To evaluate the relationship between preoperative nystagmus and visual outcome of congenital cataract surgery. Methods: Retrospective review of 81 patients (84 eyes) who underwent surgery for cataract was conducted,in which 7 cases of unilateral cataract and 3 of bilateral cataract were associated with preoperative nystagmus. All patients lacked other structural ocular defects or neurologic abnormalities and were old enough to cooperate with recognition visual acuity testing. Outcome parameters studied were best-corrected postoperative visual acuity of the eyes. Results: Best corrected postoperative visual acuity of the nystagmus eyes was 0.05 or worse in 3(23%,3/13), between 0.05 and 0.3 in 9(69%,9/13),and 0.3 or better in 1(8%,1/13).Best corrected visual acuity of the eyes without nystagmus was 0.05 or worse in 6(8%),between 0.05 and 0.3 in 24(34%),and 0.3 or better in 41 ((58%).) There was a statistical significance of preoperative visual acuity compared to postoperative visual acuity in cataract with(P=0.04) or without nystagmus. The great statistical significance was shown in the improvement of visual acuity between the patients with nystagmus and without nystagmus. Conclusion: Preoperative nystagmus in children with cataract does not preclude visual improvement, but may predict a poorer visual acuity outcome after cataract surgery. In these patients a decision must be made as to whether or not surgical intervention for the cataract would be worthwhile at this stage.