Kuhli-Hattenbach C, Fronius M, Kohnen T
Klinik für Augenheilkunde, Universitätsklinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
Ophthalmologe. 2020 Mar;117(3):190-198. doi: 10.1007/s00347-020-01053-1.
A congenital cataract is a rare disorder, which is associated with a high risk of amblyopia. Ophthalmologists are faced with many diagnostic and surgical challenges in the management of this disease. Older children can undergo primary treatment with an intraocular lens, whereas children younger than 12 months of age usually initially remain aphakic. The most frequent long-term complication of aphakic eyes following congenital cataract surgery in connection with posterior capsulorrhexis and anterior vitrectomy is aphakic glaucoma, which in individual cases can lead to substantial impairment of vision. Many factors have been reported to increase the risk of postoperative glaucoma, including microphthalmos, fetal nuclear cataract, conspicuous family history and associated ocular malformations, such as persistent fetal vasculature (PFV). Cataract surgery during early infancy is well-established to be the most important factor for the formation of postoperative aphakic glaucoma. In individual treatment planning it has to be considered that although younger age at the time of cataract removal can provide better prerequisites for prophylaxis of amblyopia, it also confers a higher risk of development of aphakic glaucoma. Children undergoing congenital cataract surgery have to be regularly monitored given the lifelong risk for postoperative complications, such as aphakic glaucoma.
先天性白内障是一种罕见疾病，与弱视的高风险相关。眼科医生在这种疾病的治疗中面临许多诊断和手术挑战。年龄较大的儿童可接受人工晶状体一期治疗，而12个月以下的儿童通常最初保持无晶状体状态。先天性白内障手术后，与后囊撕开和前部玻璃体切割相关的无晶状体眼最常见的长期并发症是无晶状体性青光眼，个别情况下可导致视力严重受损。据报道，许多因素会增加术后青光眼的风险，包括小眼球、胎儿核性白内障、明显的家族史以及相关的眼部畸形，如永存原始玻璃体（PFV）。婴儿早期进行白内障手术是术后无晶状体性青光眼形成的最重要因素。在个体化治疗计划中必须考虑到，虽然白内障摘除时年龄较小可为弱视预防提供更好的前提条件，但也会带来更高的无晶状体性青光眼发生风险。鉴于术后并发症（如无晶状体性青光眼）的终身风险，接受先天性白内障手术的儿童必须定期接受监测。
