儿童双眼先天性白内障人工晶状体植入术后眼轴长度和屈光状态的变化

目的　探讨儿童双眼先天性白内障摘除人工晶状体植入术后眼轴长度和屈光状态的变化情况。方法　对38例(76只眼)已行白内障摘除、前后环形撕囊、前段玻璃体切除、晶状体囊袋内人工晶状体植入术的双眼先天性白内障患儿进行回顾性研究。按手术年龄分为2 ~3岁(A组)、4~5岁(B组)、6~7岁(C组)、8~12岁(D组)4组,检测术前和术后5年术眼的眼轴长度和角膜屈光力、术后1个月和5年的屈光状态,分析视力预后与眼轴长度和屈光状态变化的关系。结果　4组平均屈光度数变化分别为-2. 06、-1 .81、-0 .56及-0. 25D,差异有统计学意义(P<0. 01);眼轴长度平均增长1. 21、1 .13、0. 47及0 .34mm,差异有统计学意义(P<0 .01)。各组手术前、后角膜屈光力比较,差异均无统计学意义(P>0. 05)。术后50只眼( 65. 8% )最佳矫正视力≥0 .5。术后最佳矫正视力与屈光度数变化和眼轴长度变化无相关性(P>0. 05)。结论　双眼白内障摘除、前段玻璃体切除、晶状体囊袋内人工晶状体植入术可安全、有效治疗儿童双眼先天性白内障;术后屈光状态出现向近视方向移动的趋势,眼轴长度接近同龄正常儿童,屈光度数和眼轴长度的变化随手术年龄的增大而趋于稳定。2~5岁患儿双眼人工晶状体度数的选择应以低度欠矫为宜。

Refractive change and axial growth after bilateral intraocular lens implantation in children with congenital cataract

Objective To observe refractive change and axial growth in children with bilateral congenital cataract after intraocular lens (IOL) implantation. Methods 38 patients (76 eyes) with congenital cataract, who undergone cataract extraction, posterior continuous curvilinear capsulorhexis, anterior vitrectomy and primary IOL implantation in the capsular bag, were included. Patients were divided into four groups based on their age at surgery: 2-3 years (group A), 4-5 years (group B), 6-7 years (group C) and 8-12 years (group D). The refraction, axial length and corneal curvature in the follow-up for five years were reviewed. The correlation between best corrected visual acuity (BCVA) and refractive or axial change was analyzed. Results The mean myopic shift was -2.06,-1.81,-0.56 and -0.25 D respectively in the four groups ( P <0.01). The axial elongation was 1.21,1.13,0.47 and 0.34 mm respectively ( P <0.01). There was no statistically significant difference among the four groups in corneal curvature preoperatively ( P >0.05) or postoperatively ( P >0.05). 50 eyes (65.8%) had a final BCVA of 0.5 or better. No statistically significant correlation was found between BCVA and refractive change ( P >0.05) or axial growth ( P >0.05). Conclusions Cataract extraction combined with primary anterior vitrectomy and bilateral IOL implantation is safe and effective for bilateral congenital cataract. There is a mild trend of myopic shift postoperatively, and the pattern of axial length is similar to normal eyes. Refractive change and axial growth tend to be stable in older patients. It is recommended to set the immediate postoperative refraction under correction slightly in patients with age 2-5 years.