Taamallah-Malek Ines, Chebbi Amel, Zghal Imene, Hachica Firas, Ouazzani Soumaya, Boujemaa Chiraz, Bouguila Hedi, Nacef Leila, Ayed Saida
Universite Tunis, El Manar, Tunisie.
Tunis Med. 2013 Feb;91(2):150-5.
Thanks to the recent advances of the microsurgical techniques, the results of the congenital cataract surgery in children less than 5 years old have considerably improved. However, the age of implantation and the intraocular lens power calculation remain subjects of controversies.
To evaluate the results of 2.2 mm micro-incision congenital cataract surgery in children less than five years old.
Forty seven consecutive eyes of 26 children who had dense congenital cataract surgery were included in this retrospective study. All children had had the same surgical procedure: anterior approach through 2.2 mm corneal tunnel, posterior capsulorhexis associated to anterior vitrectomy and a primary foldable intraocular lens implantation. The final evaluation was at the same time anatomical and functional depending on the children age.
The median patient age of the children was of 23 months (6 to 54 months) and the sex ratio was 1.36 (15 boys / 11 girls). The cataract was bilateral in 77.7 % of the cases (21/27 children). The intraocular lens was implanted in the capsular bag in 93.6 % of the cases (44/47 eyes) and in the sulcus in 6.3 % of the cases (3/47 eyes). The postoperative complications were mild: inflammatory reaction limited to the anterior chamber in 17 % of the cases (8/47 eyes), opacification of the visual axis with a reproliferation of the epithelial cells behind the implant was observed in 4.25 % of the eyes (2/47 eyes). We noted no case of intraocular lens decentration or secondary glaucoma. The study of the refraction at last follow up showed a sphere average of 2.73 ± 1.21 diopters and mean astigmatism of 1.51 ± 0.82 diopters. The median best corrected distance visual acuity, evaluated in 12 children, was 5.2/10 ranging from 1/10 to 10/10. The amblyopia was also noted to 12/26 children (46.1 %). Among these children, 11/12 (91.6%) had a delay of surgery and 5/12 (41.6 %) had an unilateral cataract.
Currently the anatomical prognosis of the congenital cataract surgery in children less than 5 years old is getting closer to that of the adult. However, the functional prognosis remains still unpredictable depending mainly on the deadline of surgery which remains very late in our series. Thanks to the improvement of the surgical techniques using microincision in cataract surgery and the new generation of foldable implants, the anatomical and functional prognosis of the congenital cataract have significantly improved.
由于显微外科技术的最新进展，5岁以下儿童先天性白内障手术的效果有了显著改善。然而，植入年龄和人工晶状体屈光度数计算仍然存在争议。
评估2.2毫米微小切口先天性白内障手术治疗5岁以下儿童的效果。
本回顾性研究纳入了26例接受致密性先天性白内障手术的儿童的47只连续眼。所有儿童均接受相同的手术操作：通过2.2毫米角膜隧道进行前路手术，后囊膜撕开联合前部玻璃体切除术及一期可折叠人工晶状体植入。根据儿童年龄进行最终的解剖学和功能评估。
儿童的中位年龄为23个月（6至54个月），性别比为1.36（15名男孩/11名女孩）。77.7%的病例（21/27名儿童）白内障为双侧。93.6%的病例（44/47只眼）人工晶状体植入囊袋内，6.3%的病例（3/47只眼）植入睫状沟。术后并发症较轻：17%的病例（8/47只眼）炎症反应局限于前房，4.25%的眼（2/47只眼）观察到视轴混浊伴植入物后上皮细胞再增殖。未发现人工晶状体偏心或继发性青光眼病例。最后一次随访时的屈光研究显示平均球镜度数为2.73±1.21屈光度，平均散光为1.51±0.82屈光度。在12名儿童中评估的中位最佳矫正远视力为5.2/10，范围为1/10至10/10。26名儿童中有12名（46.1%）存在弱视。在这些儿童中，12名中有11名（91.6%）手术延迟，12名中有5名（41.6%）为单侧白内障。
目前，5岁以下儿童先天性白内障手术的解剖学预后已接近成人。然而，功能预后仍然不可预测，主要取决于手术时机，在我们的系列研究中手术时机仍然很晚。由于白内障手术中使用微小切口的手术技术改进以及新一代可折叠植入物，先天性白内障的解剖学和功能预后有了显著改善。
