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目的:评价两种不同术式治疗儿童先天性白内障的疗效。方法:将1 ～3岁儿童先天性白内障22例44眼,随机分为A,B两组。A组10例20眼应用23G玻璃体切割机(简称玻切)完成晶体皮质吸除及前节玻切,B组12例24眼应用常规超声乳化I/A头吸除晶体皮质后,应用前节玻切机切除前部玻璃体。所有手术均由同一医生进行。比较不同术式的术中切口闭合情况,虹膜脱出率,术后角膜新生血管及其他相关并发症的差异。结果:A组角膜缘透明切口宽0.6mm,手术及关闭切口时均能维持前房眼压稳定,B组角膜缘透明切口宽3mm,术中切口欠密闭,前房维持不佳,术后需缝合切口;A组术中未发生虹膜脱出现象,B组术中发生虹膜脱出14眼(58%);A组术中3眼(15%)出现低眼压,B组术中20眼(83%)出现低眼压。术后随访6 ～24(平均11)mo,A组术后角膜透明,未发生新生血管,B组术后4眼出现缝线处角膜新生血管,占17%;A组后发障发生率为10%(2眼),B组后发障发生率为8%(2眼);随访中其他并发症如:视网膜脱离、青光眼、低眼压、眼内炎等两组均未发生。结论:应用23G玻璃体切割机直接行儿童白内障晶体皮质吸除及前节玻切手术,术中能够维持前房稳定,降低术中虹膜脱出及术后缝线处角膜新生血管发生率,更安全,更有效,是一种值得推广的I期治疗儿童白内障手术方式。
Objective: To evaluate the efficacy of two different surgical procedures for the treatment of congenital cataract in children. Methods: A total of 44 eyes of 22 children with congenital cataract 1 ~ 3 years old were randomly divided into A and B groups. A group of 10 cases of 20 patients with 23G vitrectomy machine (referred to as vitrectomy) completed cortical aspiration and anterior vitrectomy, B group 12 cases of 24 patients with conventional phacoemulsification I / A head cortical aspiration, the application of the former section Glass-cutting machine to remove the anterior vitreous. All operations are performed by the same doctor. Comparison of different surgical procedures incision closure, iris prolapse rate, postoperative corneal neovascularization and other related complications. Results: The width of limbal clear incision was 0.6mm in group A, the intraocular pressure of anterior chamber was stable during operation and incision incision, the width of corneal incision was 3mm wide in group A, the incision was not closed and the anterior chamber was not maintained well. There was no iris prolapse occurred in group A during operation, and 14 eyes (58%) had iris prolapse during operation in group A. Low intraocular pressure (IOP) occurred in 3 eyes (15%) in group A and 20 eyes (83 eyes) in group B %) Ocular hypotension. The corneas were clear and no neovascularization occurred in group A after operation, and the corneal neovascularization occurred in 4 eyes after operation in group A (17%). The incidence of postoperative complications in group A was 10% (2 eyes), and 8% (2 eyes) after the B group. Other complications such as retinal detachment, glaucoma, hypotony and endophthalmitis did not occur in both groups. Conclusions: The 23G vitrectomy machine can directly remove cataract and cataract in children with cataract. It can keep the stability of the anterior chamber and reduce the rate of corneal neovascularization during operation. It is safer, More effective, is a worthy promotion of I treatment of cataract surgery in children.