【摘要】 目的 探讨超声乳化吸除联合连续环形后囊撕除和一期人工晶体植入术治疗先天性白内障对后发障的预防作用。方法 对61例(68眼)先天性白内障患者施行超声乳化吸除术，其中55眼术中连续环形撕除后囊，52眼联合植入人工晶体。所有患者术后随访6个月以上。结果 61例(68眼)术后1周矫正视力≥0.5者41眼(70.7%)与术后1个月矫正视力≥0.5者42眼(72.4%)比较，差异无显著性(P>0.05)；术后3个月和6个月，未行连续环形后囊撕除组的13眼中分别有5眼和8眼发生了后发障(分别为46.2%和61.5%)，而连续环形后囊撕除组分别为1眼和4眼发生后发障(分别为1.82%和7.3%)，两组间差异具有非常显著性(P均<0.01)；术中未能一期植入人工晶体组和一期人工晶体植入组分别有8眼和4眼发生后发障(分别为50.0%和7.7%)，差异亦具有非常显著性(P<0.01)。结论 白内障超声乳化联合连续环形后囊撕除和一期人工晶体植入术治疗先天性白内障，可有效减低术后后发障的发生率。

    【关键词】 后囊连续环形撕囊；白内障；儿童；后发性白内障

    Phacoemulsification and posterior continuous curvilinear capsulorhexis for congenital cataract

    SUN Chu-xiong,XI Xing-hua,JIANG Sheng-gang.

    Department of Ophthalmology,Yueyang Rehabilitation Hospital,Yueyang 414000,China

    【Abstract】 Objective To approach the role of phacoemulsification combined with posterior continuous curvilinear capsulorhexis(PCCC)and primary intraocular lens implantation for congenital cataract in prevention after-cataract.Methods The phacoemulsification was performed in 68 eyes of 61 patients with congenital cataract,of which 55 eyes performed PCCC,and 52 eyes performed PCCC combined with the implantation of intraocular lens.All the patients could be included in a postoperative follow-up examination more than 6 months.Results In the 61 cases(68 eyes),comparing the eyes which best corrected visual acuity were 0.5 or better,there were no significant difference between the eyes one week postoperatively(41 eyes,70.7%)and the eyes one month postoperatively(42 eyes,72.4%)(P>0.05).Among 13 eyes not performed PCCC,posterior capsule opacification (PCO) was occurred in 5 eyes (46.2%) and in 8 eyes(61.5%)respectively three months and six months postoperatively.Among 55 eyes performed PCCC,PCO was occurred in 1 eye(1.82%) and in 4 eyes(7.3%) respectively three months and six months postoperatively.The difference was extremely significant between the two groups(P<0.01).PCO was occurred in 8 eyes(50%)and in 4 eyes(7.1%) respectively with or without primary implantation of intraocular lens intraoperatively.The difference was also extremely significant between the two groups(P<0.01).

    Conclusion The phacoemulsification combined with posterior continuous curvilinear capsulorhexis and primary intraocular lens implantation for congenital cataract can decrease the incidence rate of PCO after the operation effectively.

    【Key words】 posterior continuous curvilinear capsulorhexis;cataract;children;after-cataract

    白内障术后后发障的发生是导致患者术后远期视力下降的主要并发症之一。先天性白内障患者多系婴幼儿或儿童，由于他们的血-眼屏障功能尚未发育完善，术后的炎症反应较成人严重。同时，晶状体上皮细胞增生活跃、增殖力强，以致术后后发障的发生率几乎为100%[1]。因此，先天性白内障术后后发障的防治已成为目前眼科领域研究的热点和难点问题之一。我们采用白内障超声乳化吸除联合连续环形后囊撕除和一期人工晶体植入术，治疗先天性白内障患者61例(68眼)，以观察其对术后后发障的影响，现将结果报告如下。

     1 资料与方法

    1.1 一般资料 所有患者均系2001年2月～2004年2月在我院住院并行白内障超声乳化手术的先天性白内障患者，61例(68眼)患者中男39例(43眼)，女22例(25眼)；年龄11个月～26岁，平均(6.82±2.96)岁；其中5例(9眼)眼轴长度>29mm，3例(4眼)合并斜视，2例(4眼)合并眼球震颤，1例(1眼)合并先天性虹膜部分缺损，1例14岁患者曾患结核性胸膜炎。61例(68眼)先天性白内障患者全部施行超声乳化吸除术，其中55眼术中联合连续环形撕除后囊(PCCC)，13眼保留完整后囊膜；52眼联合一期人工晶体(IOL)植入，另有11例(16眼)因各种原因未做一期人工晶体植入。

    1.2 仪器与耗材 使用美国AMO公司生产的Dipomx超声乳化仪。所植入晶体为AMO公司生产的FDL—53PMMA经肝素处理的改良C襻人工晶体，其光学部直径5.5mm，襻长12.5mm。黏弹剂为山东正大福瑞达生产的爱维。

    1.3 手术方法 除年龄<6岁及部分年龄>6岁但不能合作患儿采用全麻加表麻外，其他患者均在表麻下施行手术。术前使用美多丽滴眼3次，充分散大瞳孔。术中作颞上方3.0～3.2mm角巩膜缘隧道切口，内切口在透明角膜内1mm，穿刺进入前房后注入黏弹剂，用截囊针作直径5～6mm前囊环形撕囊，并在角膜缘2点处作1.5mm辅助切口。用BSS进行囊下及层间水分离后，双手利用超乳仪的Ⅰ/A系统与辅助钩在囊袋内操作，将软核与皮质吸除，后囊抛光。前房及囊袋内注入黏弹剂后，用撕囊镊连续环形撕除后囊(对14岁以上及眼轴过长者不做连续环形后囊撕除)，部分患者同时行前部玻璃体切除，如植入IOL则扩大切口至5.5mm，囊袋内植入PMMA人工晶体[11例(16眼)因各种原因未能植入人工晶体]，清除黏弹剂后滴缩瞳剂缩瞳，并行切口水密封。术毕，球结膜下注入庆大霉素2万u和地塞米松2.5mg。

    1.4 随访 全部病例出院后分别在1周和1、3、6个月由专人随访观察，并记录视力(含矫正视力)、前房反应、人工晶体位置及后囊混浊等情况。

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