先天性白内障人工晶状体植入术后屈光状态及程度改变

目的 分析不同年龄段先天性白内障患者人工晶状体植入术后近视漂移及眼轴增长情况。设计 回顾性病例系列。研究对象 31例（53眼）先天性白内障患儿，平均（3.21±1.56）岁时接受一期或二期人工晶状体植入术。方法 对以上患儿按手术年龄分为两组：Ⅰ组＜3岁（16例，27眼），Ⅱ组≥3岁（15例，26眼）；按每次随访年龄分为三组：A组＜4岁（11例，18眼），B组4~6岁（17例，30眼），C组＞6岁（9例，15眼）。术后随访（28.74±11.67）个月，检查患儿屈光状态及眼轴增长情况。主要指标 屈光变化及眼轴长度变化。 结果 术后近视漂移程度：A组平均（1.18±0.98） D/年，B组平均（0.80±0.81） D/年，C组平均（0.71±0.82） D/年（F=3.532，P=0.032）；但B组与C组差异无统计学意义（P=0.605）。眼轴长度增加：Ⅰ组平均（1.22±0.76） mm，Ⅱ组平均（0.82±0.46） mm（P=0.030）。目标屈光度误差：Ⅰ组平均（1.64±1.32） D，Ⅱ组平均（0.55±1.16） D（P=0.009）。同一随访时间内屈光变化量与眼轴变化量呈中度相关（r=0.596，P<0.001）。结论 先天性白内障人工晶状体植入术后近视漂移程度随年龄增加而减小，年龄越小则眼轴增长及近视漂移幅度越大，在一定程度上，眼轴长度增加的幅度会影响到近视漂移的程度。（眼科， 2014, 23： 80-85）

Refraction and its changes after intraocular lens implantation in congenital cataract

 Objective To investigate the myopic shift and axial length growth after cataract extraction and intraocular lens (IOL)implantation in children with congenital cataract. Design Retrospective case series. Participants Thrirty-one children (53 eyes) with congenital cataract accepted primary or secondary IOL implantation. Methods The clinic information of the participants were retrospectively reviewed. The time interval of cataract extraction with primary or secondary IOL implantation was（3.21±1.56）years. The follow-up period was 28.74±11.67 months postoperatively. The participants were divided into 2 groups according to the age at surgery, groupⅠ: ＜3 years old（16 cases, 27 eyes）, groupⅡ: ≥ 3 years old（15 cases, 26 eyes）. The participants were also divided into 3 groups according to the age at follow-up period, group A: ＜4 years old（11 cases, 18 eyes）, group B: 4~6 years old（17 cases, 30 eyes）, group C: ＞6 years old（9 cases, 15 eyes）. During the regular follow-up period, the changes of refractive status and axial length were recorded. Main Outcome Measures The changes of refractive status and axial length. Results The mean myopic shift power of group A, B and C  was 1.18±0.98 D/y, 0.80±0.81 D/y, and 0.71±0.82 D/y respectively (F=3.532，P=0.032), but the difference between group B and C was no statistics significant (P=0.605). The mean axial length growth of  group Ⅰ and Ⅱ was 1.22±0.76 mm and 0.82±0.46 mm respectively (P=0.030). The mean prediction error for the two groups was 1.64±1.32 D and 0.55±1.16 D respectively (P=0.009). During the same follow-up period, the changes of refractive status and axial length showed a moderate correlation (r=0.596，P<0.001). Conclusion The myopic shift power decrease with the age increasing after IOL implantation in children with congenital cataract, the myopic shift power and axial length growth of younger patients are more rapid than older patients. To some degree, the increasing of axial length will effect the myopic shift power. (Ophthalmol CHN, 2014, 23: 80-85)