CAJ | 학술논문

目的探讨婴儿先天性白内障摘除术后虹膜黏连发生的特点和影响因素.方法回顾性系列病例研究.对我院2005年1月至2008年12月收治的先天性白内障全白型患儿33例(62眼).按手术年龄分为≤6个月和6～12个月2组,均施行前后环形撕囊、白内障摘除及前段玻璃体切除术,术后给予激素及散瞳药治疗.收集临床资料,包括虹膜黏连发生时间、部位、范围和发生率,分析其影响因素.结果婴儿先天性白内障术后虹膜黏连发生率为50%(31/62),2个年龄组发生率分别为60.0%(24,40)和31.8%(7/22),差异有统计学意义(χ2=4.509,P<0.05).11眼(35.5%)的虹膜黏连发生于术后2周内,22眼(71.0%)发生于术后1个月内;25眼(80.6%)发生于上方手术切口区:25眼(80.6%)黏连范围小于1个象限,以虹膜黏连的钟点数作为指标,2个年龄组黏连程度分别为(2.35±3.21)和(0.77±1.41)钟点,差异有统计学意义(t=2.187,P<0.05).在二期人工晶状体植入术中、术后并发症方面.虹膜黏连病例有7眼发生明显瞳孔移位而行瞳孔成型术,术后8眼发生纤维性渗出,6眼虹膜发生再次黏连,无黏连病例则无类似并发症,两者比较差异有统计学意义(P<0.05).结论虹膜黏连是先天性白内障术后常见并发症之一,手术年龄、手术损伤和术后药物治疗是虹膜黏连发生的明显影响因素.
목적 탐토영인선천성백내장적제술후홍막점련발생적특점화영향인소.방법 회고성계렬병례연구.대아원2005년1월지2008년12월수치적선천성백내장전백형환인33례(62안).안수술년령분위≤6개월화6～12개월2조,균시행전후배형시낭、백내장적제급전단파리체절제술,술후급여격소급산동약치료.수집림상자료,포괄홍막점련발생시간、부위、범위화발생솔,분석기영향인소.결과 영인선천성백내장술후홍막점련발생솔위50%(31/62),2개년령조발생솔분별위60.0%(24,40)화31.8%(7/22),차이유통계학의의(χ2=4.509,P<0.05).11안(35.5%)적홍막점련발생우술후2주내,22안(71.0%)발생우술후1개월내;25안(80.6%)발생우상방수술절구구:25안(80.6%)점련범위소우1개상한,이홍막점련적종점수작위지표,2개년령조점련정도분별위(2.35±3.21)화(0.77±1.41)종점,차이유통계학의의(t=2.187,P<0.05).재이기인공정상체식입술중、술후병발증방면.홍막점련병례유7안발생명현동공이위이행동공성형술,술후8안발생섬유성삼출,6안홍막발생재차점련,무점련병례칙무유사병발증,량자비교차이유통계학의의(P<0.05).결론 홍막점련시선천성백내장술후상견병발증지일,수술년령、수술손상화술후약물치료시홍막점련발생적명현영향인소.
Objective To investigate the general clinical features of iris synechia formation after extraction of congenital cataract in the first year of life; to determine its relationship to the risk factors. Methods This was a retrospective clinical study. Sixty -two eyes of 33 patients with congenital cataract were evaluated retrospectively between January 2005 and December 2008 based on clinical records. The patients were divided into two groups according to their age at the time of surgery: group A ≤6 months old and group B >6 months old (≤12 months). All operations were performed under general anesthesia. A scleral tunnel approach was used with bimanual lens aspiration. Posterior capsulorhexis and anterior vitrectomy was performed on all infants without intraocular lens implantation. The incidence, time of appearance, location and scope of iris synechia formation were observed. Results Of the 62 eyes, iris synechia formation occurred in 31 eyes after surgery, with a 50% incidence rate. The incidence of iris synechia formation for groups A and B was 60.0%(24/40) and 31.8%(7/22), respectively, after infantile congenital cataract surgery. There was a statistically significant difference in the incidence between the two groups (χ2 =4.509, P<0.05). Synechiae occurred in 11 eyes (35.5%) within 2 weeks,and in 22 eyes (71.0%) within 1 month. Twenty-five eyes (80.6%) developed iris synechia in the superior part of the iris. The adhesion scope of 25 eyes (80.6%) was smaller than a quadrant, and when the severity of iris synechiae was measured in hour units, there was a statistically significant difference between the severity of the two groups [group A, (2.35 ±3.21)hours; group B, (0.77 ± 1.41 )hours; t =2.187, P<0.05]. Regarding complications, 7 eyes required pupilloplasty in the secondary IOL implant operation, 8 eyes had fibrin exudation postoperatively, and there was a recurrence of iris synechiae in 6 eyes. However, there was no similar complication in the non -synechiae eyes. The difference was statistically significant (P<0.05). Conclusion Iris synechia formation is one of the postoperative complications after intraocular surgery in infantile cataract. It mainly occurred within 1 month after cataract extraction. There is a higher incidence of iris synechia formation in the first 6 months life. Age at the time of surgery, injury to the iris and drug administration were the most serious risk factors.