Brady K M, Atkinson C S, Kilty L A, Hiles D A
Children's Eye Services, Children's Hospital of Pittsburgh, Pennsylvania, USA.
Am J Ophthalmol. 1995 Jul;120(1):1-9. doi: 10.1016/s0002-9394(14)73753-5.
To evaluate visual outcome and complications after extracapsular cataract extraction with posterior chamber intraocular lens implantation in children.
Extracapsular cataract extraction with posterior chamber intraocular lens implantation was performed on 20 eyes of 19 patients with traumatic cataract, ten eyes with unilateral congenital or developmental cataract, and 15 eyes (eight patients) with bilateral developmental cataract. Nd:YAG posterior capsulotomy was performed in the early postoperative period as indicated.
Fourteen (70%) of 20 eyes with traumatic cataract had best-corrected pseudophakic visual acuity of 20/40 or better. When we excluded four eyes with macular injuries from analysis, 14 (87%) of 16 eyes had visual acuity of 20/40 or better. In patients with bilateral cataract in whom vision was quantified by Snellen acuity (nine eyes of five patients), nine of nine eyes had best-corrected pseudophakic visual acuity of 20/40 or better. In the remaining three patients, six of six eyes had central steady and maintained fixation. Visual outcome was poorest in patients with unilateral cataract (ten eyes); one eye had best-corrected pseudophakic visual acuity of 20/40; two eyes, 20/60; two eyes, 20/70; one eye, 20/100; and two eyes, 20/200. One additional eye had central steady maintained fixation and noncentral fixation. Five of ten eyes had four or more lines improvement in visual acuity. Postoperative complications occurred in five eyes, each of which had traumatic cataract. Three eyes developed iris capture, one eye had a postoperative intraocular hemorrhage, and another developed a dense secondary membrane. In 45 postoperative postoperative eyes, 27 (60%) received one Nd:YAG laser posterior capsulotomy. A second Nd:YAG laser posterior capsulotomy was performed in 11 (41%) of these 27 eyes.
Extracapsular cataract extraction with posterior chamber intraocular lens implantation in children can be accomplished in selected patients, with generally favorable results. However, many of the patients in this series remain potentially amblyogenic, and long-term follow-up may temper our present visual results.
评估儿童白内障囊外摘除联合后房型人工晶状体植入术后的视力结果及并发症。
对19例创伤性白内障患者的20只眼、10例单侧先天性或发育性白内障患者的10只眼以及8例双侧发育性白内障患者的15只眼（共15只眼）进行了白内障囊外摘除联合后房型人工晶状体植入术。术后早期根据需要进行了钕:钇铝石榴石（Nd:YAG）后囊切开术。
20只创伤性白内障眼中，14只（70%）的最佳矫正人工晶状体视力达到20/40或更好。当我们在分析中排除4只黄斑损伤的眼睛后，16只眼中有14只（87%）的视力达到20/40或更好。在通过斯内伦视力表量化视力的双侧白内障患者（5例患者的9只眼）中，9只眼中有9只的最佳矫正人工晶状体视力达到20/40或更好。在其余3例患者中，6只眼中有6只保持中心稳定注视。单侧白内障患者（10只眼）的视力结果最差；1只眼的最佳矫正人工晶状体视力为20/40；2只眼为20/60；2只眼为20/70；1只眼为20/100；2只眼为20/200。另有1只眼保持中心稳定注视但为偏心注视。10只眼中有5只眼的视力提高了4行或更多。术后并发症发生在5只眼中，均为创伤性白内障。3只眼发生了虹膜粘连，1只眼术后发生眼内出血，另1只眼形成了致密的后囊膜。在45只术后眼中，27只（60%）接受了一次Nd:YAG激光后囊切开术。在这27只眼中，有11只（41%）进行了第二次Nd:YAG激光后囊切开术。
对于部分儿童患者，白内障囊外摘除联合后房型人工晶状体植入术可以完成，且总体效果良好。然而，本系列中的许多患者仍有潜在的弱视发生风险，长期随访可能会改变我们目前的视力结果。
