Vajpayee R B, Angra S K, Honavar S G
Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi.
Am J Ophthalmol. 1994 Apr 15;117(4):507-11. doi: 10.1016/s0002-9394(14)70012-1.
Over a period of two years we performed combined penetrating keratoplasty, cataract extraction, and intraocular lens implantation in seven children between the ages of 2 and 12 years old. The interval between trauma and the surgery varied from six weeks to six months (3.5 +/- 1.6 months, mean +/- SD). All of the patients had undergone primary repair of corneal perforation. Fresh corneas preserved in McCarey-Kaufman medium were used. The graft size was 7.5 mm with 0.5 mm disparity. Posterior chamber polymethylmethacrylate C-loop lenses were used in all cases. The surgeon's average postkeratoplasty keratometry was used in the calculation of intraocular lens power. The follow-up period ranged from nine to 36 months (18 +/- 9.1 months, mean +/- SD). Six grafts remained clear at the final follow-up. The visual acuity ranged from 20/40 to 20/200 with final astigmatism ranging from 0.5 diopter to 2.0 diopters. One patient developed a retinal detachment 12 months after surgery, which was successfully reattached. One patient, who had preoperative corneal vascularization, had graft rejection, which was treated medically. Our limited series suggests that the triple ocular procedure is a good choice for the treatment of corneolenticular trauma in children. The proper postoperative treatment includes vigorous antiamblyopia therapy and Nd:YAG laser treatment of after-cataracts.
在两年的时间里，我们对7名年龄在2至12岁之间的儿童进行了穿透性角膜移植术、白内障摘除术和人工晶状体植入术联合手术。外伤与手术之间的间隔时间从6周至6个月不等（平均3.5±1.6个月，均值±标准差）。所有患者均接受了角膜穿孔的一期修复。使用保存在麦凯里-考夫曼培养基中的新鲜角膜。移植片大小为7.5毫米，相差0.5毫米。所有病例均使用后房型聚甲基丙烯酸甲酯C形袢人工晶状体。人工晶状体屈光度的计算采用外科医生角膜移植术后平均角膜曲率计测量值。随访时间为9至36个月（平均18±9.1个月，均值±标准差）。在最后一次随访时，6片移植片保持透明。视力范围为20/40至20/200，最终散光范围为0.5屈光度至2.0屈光度。1例患者在术后12个月发生视网膜脱离，已成功复位。1例术前有角膜血管化的患者发生了移植片排斥反应，已接受药物治疗。我们的有限病例系列表明，三联眼部手术是治疗儿童角膜晶状体外伤的一个不错选择。适当的术后治疗包括积极的弱视治疗和后发性白内障的Nd:YAG激光治疗。
