Zetterström Charlotta, Lundvall Anna, Kugelberg Maria
St. Erik's Eye Hospital, Stockholm, Sweden.
J Cataract Refract Surg. 2005 Apr;31(4):824-40. doi: 10.1016/j.jcrs.2005.01.012.
Bilateral congenital cataract is the most common cause of treatable childhood blindness. Nuclear cataract is usually present at birth and is nonprogressive, whereas lamellar cataract usually develops later and is progressive. Surgery must be performed promptly in cases with dense congenital cataract; if nystagmus has developed, the amblyopia is irreversible. A treatment regimen based on surgery within 2 months of birth combined with prompt optical correction of the aphakia and aggressive occlusion therapy with frequent follow-up has been successful in unilateral and bilateral cases. Both anterior and posterior capsulorhexes are performed in most children. Intraocular lens implantation can be performed safely in children older than 1 year. Anterior dry vitrectomy is recommended in preschool children to avoid after-cataract. Opacification of the visual axis is the most common complication of cataract surgery in children. Secondary glaucoma is the most sight-threatening complication and is common if surgery is performed early. Life-long follow-up is essential in these cases.
双侧先天性白内障是儿童可治疗性失明的最常见原因。核性白内障通常在出生时就存在且不进展，而板层白内障通常较晚出现且会进展。对于致密性先天性白内障病例必须及时进行手术；如果已经出现眼球震颤，弱视则不可逆转。一种基于出生后2个月内进行手术、及时对无晶状体眼进行光学矫正以及积极进行遮盖治疗并频繁随访的治疗方案，在单侧和双侧病例中均取得了成功。大多数儿童都要进行前囊和后囊切开术。1岁以上儿童可安全地进行人工晶状体植入。建议对学龄前儿童进行前部干性玻璃体切割术以避免后发性白内障。视轴混浊是儿童白内障手术最常见的并发症。继发性青光眼是最具视力威胁的并发症，若早期进行手术则很常见。在这些病例中，终身随访至关重要。
