婴幼儿先天性白内障术后视功能评价

目的 综合评价婴幼儿先天性白内障术后的视功能发育情况.方法 为回顾性系列病例研究.将先天性完全白内障患儿41例(62只眼)按年龄分为4组.A组:＜0.5岁,13例(20只眼);B组:≥0.5且＜1岁,11例(16只眼);C组:≥1岁且＜2岁,9例(15只眼);D组:≥2岁,8例(11只眼).均施行白内障吸除及双撕囊联合前段玻璃体切除手术,术后3 d使用Mini刺激器行闪光视觉诱发电位(F-VEP)检查,术后1周用维视顿视功能治疗和检查系统评价视力情况,随后配戴合适框架眼镜,遮盖健眼进行增视训练,12周后再次使用Mini刺激器行F-VEP检查以及视力检查.结果 4组患儿增视功能训练12周后的P100潜伏时分别为(90.28±1.59)、(111.30±1.59)、(125.28±1.97)、(147.87±1.46)ms,与术后3 d[(144.61±2.25)、(150.05±1.92)、(153.89±1.12)、(164.15±1.48)ms]比较明显缩短(t=43.75,32.77,31.61,65.04;P＜0.01).4组患儿增视功能训练12周后P100振幅分别为(12.65±0.25)、(10.56±0.05)、(9.06±0.40)、(8.71±0.02)Μv,与术后3 d[(3.41±0.06)、(4.60 ±0.10)、(4.70±0.27)、(5.00±0.01)Μv]比较明显增加(t=-376.05,-91.64,-507.77,-399.41;P＜0.01).视力检查亦显示,增视功能训练12周后视力(0.471 ±0.021、0.462 ±0.033、0.410±0.027、0.390 ±0.033)较术后1周(0.112±0.0127、0.107 ±0.013、0.117 ±0.014、0.120±0.014)明显提高(t=20.983,10.607,15.036,7.488;P＜0.05),且年龄段越小其视功能恢复越好,以A组患儿视功能恢复情况最好.结论 先天性白内障患者应尽早行手术治疗,术后配戴合适眼镜以及合适的增视功能训练,对于患者视功能的发育及重建具有重要意义.

Evaluation of visual function after congenital cataract extraction

OBJECTIVE: To evaluate visual development after extraction of congenital cataract in young patients. METHODS: This was a retrospective clinical study. Forty one congenital cataract patients (62 eyes) at 0-3 years old were divided into 4 groups: <0.5 year old, > or =0.5 and <1 year old, > or =1 and <2 years old and > or =2 years old. Capsulectomy and cataract aspiration combined with anterior vitrectomy were performed in all cases. After the operation, patients were treated with optical correction by spectacles and visual training with occlusion therapy. Flash visual evoked potential (F-VEP)was examined by using Mini stimulator 3 days and 12 weeks after surgery. VISTON visual plasticity system was used to assess visual acuity 1 week and 12 weeks after surgery. RESULTS: VEP examination revealed that P100 latent time was reduced by visual training 3 months after surgery as compared with that of 3 days after surgery. Both P100 amplitude and visual acuity were increased. The younger patients obtained the better improvement. The group for lower than 0. 5 year old recovered best. CONCLUSION: Congenital cataract patients should be operated as early as possible and wear suitable spectacles for optical correction and undertake visual training after surgery, these procedures play a significant role for visual development and improvement in these patients.