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。

AIM:To evaluate the efficacy and safety of two different surgical techniques on congenital cataract on children.METHODS:Twenty-two children (1-3 years old) with congenital cataract were randomly divided into two groups (group A and group B).With group A (10 patients,20 eyes),we applied 23-gauge (23G) trans corneal limbus vitrectomy system to complete lens cortex gettering,posterior capsulotomy and anterior vitrectomy;With group B (12 patients,24 eyes),we used the phacoemulsification I/A to complete lens cortex gettering,and performed anterior vitrectomy with anterior vitreous cutting instrument.After that,the differences in intraoperative and postoperative complications between two groups were compared.RESULTS:In group A,the width of corneal limbal incision was 0.6mm,the incision was self-sealing,and the anterior chamber was stable and iris did not prolapse during the surgery.In group B,the width of corneal limbal incision was 3mm,anterior chamber was unstable and intraoperative iris prolapse occurred in 14 eyes (58%).And the incision need to be stitched up after surgery.In the postoperative follow-up of 6-24 months (an average of 14 months),we found that corneal neovascularization did not occur in group A,while in group B,corneal neovascularization occurred in four eyes (17%);Other complications,such as posterior capsular opacification,retinal detachment,glaucoma,hypotony or endophthalmitis did not occur in either group.CONCLUSION:The 23G trans corneal limbus vitrectomy system used in pediatric cataract surgery is safer and more effective than phacoemulsification I/A.It is promising in treatment of congenital cataract on children.

R779.6