CAJ | 학술논문

目的探讨23-G微创玻璃体手术系统治疗儿童外伤性白内障的安全性和有效性,评估短期的视觉效果和并发症.方法回顾性系列病例研究.2009年3月至2011年9月在复旦大学附属眼耳鼻喉科医院眼科诊治的儿童外伤性白内障连续病例32例(32眼),平均年龄(5.4±2.2)岁.所有病例使用23-G微创玻璃体手术系统经角巩膜缘切口穿刺进前房行前囊切开、晶状体切除、后囊切开、前段玻切及人工晶状体(IOL)植入术,术后1周即进行视功能干预.随访时间平均为(17.1±8.2)个月.采用Fisher确切概率法.结果所有病例手术顺利,术中无并发症.术后1周眼压为(12.9±2.4)mmHg,炎症反应轻,无前房纤维渗出等反应.5眼(16％)有轻度虹膜后粘连.4眼(12％)发生视轴区混浊并行YAG激光后囊切开,5眼(16％)发生IOL表面色素沉着.无青光眼、脉络膜脱离、视网膜脱离等并发症.平均logMAR最佳矫正视力(BCVA),术前为2.37±1.16,末次随访时为0.39±0.48,差异具有统计学意义(t=10.916,P＜0.01).金属致伤物、受伤后3个月内行白内障手术、弱视训练依从性好是术后BCVA≥20/40的预测指标(F=0.028、0.047、0.000,P＜0.05).结论 23-G微创玻璃体手术系统在儿童外伤性白内障手术中的应用安全有效,早期行视功能干预能显著改善视功能.
목적 탐토23-G미창파리체수술계통치료인동외상성백내장적안전성화유효성,평고단기적시각효과화병발증.방법 회고성계렬병례연구.2009년3월지2011년9월재복단대학부속안이비후과의원안과진치적인동외상성백내장련속병례32례(32안),평균년령(5.4±2.2)세.소유병례사용23-G미창파리체수술계통경각공막연절구천자진전방행전낭절개、정상체절제、후낭절개、전단파절급인공정상체(IOL)식입술,술후1주즉진행시공능간예.수방시간평균위(17.1±8.2)개월.채용Fisher학절개솔법.결과 소유병례수술순리,술중무병발증.술후1주안압위(12.9±2.4)mmHg,염증반응경,무전방섬유삼출등반응.5안(16％)유경도홍막후점련.4안(12％)발생시축구혼탁병행YAG격광후낭절개,5안(16％)발생IOL표면색소침착.무청광안、맥락막탈리、시망막탈리등병발증.평균logMAR최가교정시력(BCVA),술전위2.37±1.16,말차수방시위0.39±0.48,차이구유통계학의의(t=10.916,P＜0.01).금속치상물、수상후3개월내행백내장수술、약시훈련의종성호시술후BCVA≥20/40적예측지표(F=0.028、0.047、0.000,P＜0.05).결론 23-G미창파리체수술계통재인동외상성백내장수술중적응용안전유효,조기행시공능간예능현저개선시공능.
Objective To evaluate the safety and efficacy of a 23-gauge transconjunctival sutureless vitrectomy system for the management of traumatic cataract in children and to determine the short-term outcome and complications.Methods This retrospective study involved a consecutive series of 32 children (32 eyes) who suffered from traumatic cataract from March 2009 to September 2011.Each eye underwent anterior capsulotomy,lentectomy,posterior capsulotomy,and anterior vitrectomy through a superior limbal incision using a 23-gauge vitrectomy cutter.A limbal port incision was used to introduce an infusion micro cannula to maintain the anterior chamber with balance salt solution.The superior limbal incision was enlarged to 2.75 mm by a diamond knife.An intraocular lens (IOL) was implanted in the bag or sulcus.The enlarged incision was closed with one or two 10-0 nylon suture.Refraction correction with spectacles and amblyopic training began 1 week postoperatively.The mean follow-up period was 17.1±8.2 months.Results All the surgical procedures were successfully performed in all 32 eyes.No intraoperative complication was noted.The mean postoperative intraocular pressure (IOP) was 12.9±2.4 mmHg.Postoperative inflammation was mild.No fibrin reactions,vitreous escape or incarceration were noted in the anterior chamber.Neither significant aqueous flare nor aqueous cell was observed 1 week after surgery.Five eyes (15.6％) had mild posterior synechiae.All eyes had primary IOL implantation.IOL was implanted in the bag in 22 eyes (68.7％) and in the sulcus in 10 eyes (31.3％).The mean axial length of the 32 eyes was 22.36±1.03 mm at the time of operation and the mean IOL power was +22.97±1.89 D.Four eyes (12.5％) developed visual axis opacification (VAO) and required capsulotomy by YAG laser.IOL pigmentation was noted in 5 eyes (15.6％).No cases of ocular hypertension,glaucoma,choroidal detachment or retinal detachment were observed.The mean logMAR best corrected visual acuity (BCVA) was 2.37±1.16 preoperatively and 0.39±0.48 at the last follow-up,BCVA was significantly improved (t=10.916,P＜0.01).BCVA was improved in 29 eyes postoperatively.The predictors of good visual outcomes (BCVA≥20/40) included metal as the object causing injury,cataract operation within 3 month after injury and good amblyopic treatment (Fisher=O.028,0.047,0.000,respectively.P＜0.05).Conclusion Management of traumatic cataract in children via an anterior approach using the 23-gauge transconjunctival sutureless vitrectomy system appears safe and effective.Advantages include a more precise capsulotomy and more sufficient lensectomy and anterior vitrectomy,stable intraoperative IOP,and reduced surgical trauma and inflammation.