發(fā)布時(shí)間：2018-05-11 01:39

  本文選題：先天性白內(nèi)障 + 人工晶狀體��； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:先天性白內(nèi)障是導(dǎo)致兒童盲的重要因素之一,在我國兒童視力損傷原因中占第二位[1,2]。對具有手術(shù)指征的先天性白內(nèi)障,手術(shù)治療是最重要的治療方法,也是獲得治療后視力進(jìn)步的基本因素。目前對大于2歲的先天性白內(nèi)障患兒行Ⅰ期人工晶狀體(intraocular lens,IOL)植入逐漸成為常規(guī)[4,5]。雖然近年來越來越多的眼科醫(yī)生傾向于對2歲以下先天性白內(nèi)障患兒行Ⅰ期IOL植入[6],但是現(xiàn)有研究證據(jù)仍不能證明Ⅰ期IOL植入在7~24月先天性白內(nèi)障患兒中應(yīng)用的危險(xiǎn)性及收益性。本文通過對2010~2016年在我院診斷先天性白內(nèi)障并接受白內(nèi)障吸除+后囊膜切開+前段玻璃體切割術(shù)+IOL植入術(shù)的7~24月患兒進(jìn)行病例隨訪及既往資料收集分析,探討在該術(shù)式在7~24月先天性白內(nèi)障中應(yīng)用的安全性及有效性,同時(shí)探尋我院眼科治療該部分患兒與歐美研究組報(bào)道及國內(nèi)發(fā)達(dá)地區(qū)治療該類患兒療效差異及其可能存在的原因。方法:收集2010年7月至2016年4月間因先天性白內(nèi)障在我院行白內(nèi)障吸除+后囊膜切開+前段玻璃體切割術(shù)+IOL植入術(shù)的20例31眼患兒病歷資料,患兒接受手術(shù)的年齡均為7~24月齡。收集患兒術(shù)前、術(shù)中、出院前等資料。電話通知患兒回院進(jìn)行隨訪,收集患兒術(shù)后隨訪資料,若有二次入院患者,收集二次住院資料。對前瞻性部分的病人進(jìn)行術(shù)后1周、1月、3月、半年檢查1次,如無不良事件發(fā)生,囑患兒家屬每3月~6月返院復(fù)查1次。每次隨訪檢查包括最佳矯正視力(best corrected distance visual acuity,BCDVA)、眼壓、眼前段檢查、眼底檢查、驗(yàn)光,調(diào)整斜弱視治療方案,每半年行眼A/B超1次了解患兒眼軸發(fā)育情況及排除視網(wǎng)膜脫離等并發(fā)癥,記錄術(shù)后并發(fā)癥情況。主要觀察項(xiàng)目包括:1.術(shù)后最佳矯正視力;2.術(shù)后并發(fā)癥;3.術(shù)后斜弱視;4.術(shù)后屈光狀態(tài)與眼軸長度;5.隨訪情況。視力轉(zhuǎn)變成最小分辨角的對數(shù)表達(dá)(logarithmoftheminimumangleofresolution,logmar)。應(yīng)用spss17.0軟件進(jìn)行統(tǒng)計(jì)學(xué)檢測。結(jié)果:1.視力:20例患兒中19例(30只眼)可以配合視力檢查。17例26眼裸眼遠(yuǎn)視力(uncorrecteddistancevisualacuity,ucdva)中位數(shù)為1.0logmar(相當(dāng)于國際標(biāo)準(zhǔn)視力表0.1)。19例30眼bcdva中位數(shù)為0.7logmar(相當(dāng)于國際標(biāo)準(zhǔn)視力表0.2)。單側(cè)發(fā)病患眼bcdva中位數(shù)為0.8logmar(相當(dāng)于國際標(biāo)準(zhǔn)視力表0.15),雙側(cè)發(fā)病患眼平均bcdva中位數(shù)為0.7logmar(相當(dāng)于國際標(biāo)準(zhǔn)視力表0.2)。兩者比較差異有統(tǒng)計(jì)學(xué)意義(p=0.049)。2.術(shù)后并發(fā)癥:20例31眼中術(shù)后5眼(16.13%)發(fā)生后發(fā)性白內(nèi)障及視軸區(qū)混濁,其中4眼在全麻下行晶狀體增殖皮質(zhì)切除術(shù)聯(lián)合前段玻璃體切除,1眼行yag激光后囊膜切開術(shù);4眼(14.81%)瞳孔移位、變形,由于未遮擋視軸,未手術(shù)處理;未發(fā)現(xiàn)術(shù)后切口滲漏、青光眼相關(guān)不良事件、出血、眼內(nèi)炎、視網(wǎng)膜脫離等并發(fā)癥發(fā)生。3.術(shù)后斜弱視:20例31眼中有6例(22.5%)發(fā)生斜視,其中3例術(shù)前已存在斜視。23眼(74.2%)發(fā)生弱視,所有的單眼發(fā)病患兒(9例9眼)都發(fā)生弱視。4.術(shù)后屈光狀態(tài)與眼軸長度:所有患眼術(shù)后平均等效球鏡度數(shù)為+1.88±2.46d,最低為-2.50d,最高為+5.625d。20例患兒中14例(22只眼)能配合a超檢查,術(shù)眼術(shù)后平均眼軸長度為21.73±1.29mm。5.隨訪情況:20例(31眼)患兒隨訪時(shí)間為8~80月,平均為36.45月,平均隨訪次數(shù)為5.65次,平均隨訪頻率為8.05月/次。完成術(shù)后早期隨訪(3月)有18例(29眼),完成中期隨訪(1~3年)有16例(25眼),完成遠(yuǎn)期隨訪(3年以上)有8例(12眼)。結(jié)論:1.Ⅰ期人工晶狀體植入在7~24月先天性白內(nèi)障中的應(yīng)用是安全、有效的,不良事件發(fā)生率較低。2.隨訪率低及未加強(qiáng)弱視治療可能是術(shù)后視力欠佳的主要原因。
[Abstract]:Objective: congenital cataract is one of the important factors that cause blindness in children. It is second [1,2]. for congenital cataract with surgical indications in China. Surgical treatment is the most important method of treatment. It is also the basic factor for the improvement of visual acuity after treatment. At present, children with congenital cataract over 2 years of age are at present. The implantation of intraocular lens (IOL) has gradually become a conventional [4,5]., although more and more ophthalmologists in recent years tend to undergo stage I IOL implantation to [6] for children with congenital cataract under 2 years of age, but the current research evidence still cannot prove the risk of the application of stage I IOL implantation in children with 7~24 months of congenital cataract. In this paper, a case of 7~24 months of 7~24 months in the diagnosis of congenital cataract in our hospital and +IOL implantation with cataract extraction plus posterior capsule incision plus anterior vitrectomy and anterior vitrectomy was carried out to investigate the safety and effectiveness of the application of this operation in 7~24 month congenital white barrier. The difference and possible reasons for the treatment of this part of the Department of ophthalmology in our hospital and the European and American research group and the domestic developed areas in the treatment of this kind of children. Methods: to collect 20 cases of 31 eyes from July 2010 to April 2016 with cataract extraction, posterior capsule incision and anterior vitrectomy with +IOL implantation in our hospital. The age of the children's medical records was 7~24 months old. The children were collected before the operation, during the operation, and before discharge. The telephone informed the children to go back to the hospital and collect the follow-up data. If there were two hospitalized patients, two hospitalized data were collected. 1 weeks after the operation, in January, March, 1 times for half a year. No adverse events occurred, and the family members were asked to return to the hospital 1 times every March ~6 months. Each follow-up examination included the best corrected visual acuity (best corrected distance visual acuity, BCDVA), intraocular pressure, anterior examination, fundus examination, optometry, adjustment of the treatment scheme of oblique amblyopia, and 1 times of A/ B ultrasound every six months to understand the development of the eye axis and the retina The main observation items include: the best corrected visual acuity after 1. operation, 2. postoperative complications, 3. postoperative oblique amblyopia, 4. postoperative refraction and ocular axis length; 5. follow up. Visual transformation into the minimum resolution angle logarithmic expression (logarithmoftheminimumangleofresolution, LogMAR). Application of SPSS17.0 software Results: 1. visual acuity: 19 cases (30 eyes) in 20 children with visual acuity (30 eyes).17 26 eyes with 26 eyes (uncorrecteddistancevisualacuity, ucdva) median is 1.0logmar (equivalent to international standard visual acuity chart 0.1).19 case 30 eyes bcdva median is 0.7logmar (equivalent to international standard visual acuity chart 0.2). Unilateral onset The median of bcdva was 0.8logmar (equivalent to international standard visual acuity chart 0.15), and the median bcdva in bilateral onset was 0.7logmar (equivalent to international standard visual acuity chart 0.2). The difference was statistically significant (p=0.049).2. postoperative complications: 5 eyes (16.13%) in 20 cases (16.13%) after operation (5 eyes) and posterior axis opacity 4 eyes were combined with anterior vitrectomy and anterior vitrectomy under general anesthesia, 1 eyes underwent YAG laser posterior capsule incision, 4 eyes (14.81%) pupil displacement, deformation, unshielded visual axis, unoperated treatment, and no postoperative incision leakage, glaucoma related adverse events, bleeding, endophthalmitis, retinal detachment and other complications after the.3. operation. Oblique amblyopia: in 31 eyes of 20 cases, 6 cases (22.5%) had strabismus, of which 3 cases had strabismus.23 eyes (74.2%) with amblyopia. All the children with monocular disease (9 cases and 9 eyes) had the refractive state and axial length of amblyopia after.4. operation: the average equivalent spherical mirror degree was +1.88 + 2.46d after the operation of all eyes, the lowest was -2.50d, and the highest was +5.625d.20 case. In the 14 cases (22 eyes), the average axial length of the ocular axis was 21.73 + 1.29mm.5. follow-up after operation. The follow-up time of 20 cases (31 eyes) was 8~80 months, the average was 36.45 months, the average follow-up time was 5.65 times and the average follow-up frequency was 8.05 months. There were 18 cases (29 eyes) after the early follow-up (March), which completed the interim follow-up (1~3 year) of 16. For example (25 eyes), 8 cases (12 eyes) were completed for long term follow-up (over 3 years). Conclusion: the application of 1. stage intraocular lens implantation in 7~24 month congenital cataract is safe, effective, low incidence of adverse events and low.2. follow up rate and unstrengthened amblyopia may be the main cause of poor visual acuity after operation.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R779.6

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