Verbraeken H
Department of Ophthalmology, University Hospital Ghent, Belgium.
Graefes Arch Clin Exp Ophthalmol. 1996 Oct;234(10):618-22. doi: 10.1007/BF00185294.
Classical cataract extraction in young patients with secondary cataract following juvenile chronic uveitis often is complicated by serious problems such as severe postoperative uveitis, hypotonia oculi and phthisis bulbi. Lensectomy with partial anterior vitrectomy might be a less inflammatory way of handling these cases.
Over a 15-year period we have treated 10 eyes of 9 young patients (age from 8 to 30 years) with secondary cataract after chronic uveitis by pars plana lensectomy with partial anterior vitrectomy. A classical two-port technique was used with incisions at 4 mm from the limbus. The follow-up period varied from 3 to 12 years with an average of 8 years. There were five patients with chronic iridocyclitis, two with Fuch's heterochromic irridocyclitis, one with sympathetic ophthalmia and one with idiopathic panuveitis.
Seven eyes were corrected with contact lenses. During the entire follow-up period six had 20/20 visual acuity and one, 20/40. None of these patients reported tolerance problems with the contact lens. One patient has 20/20 visual acuity with spectacles. One patient who initially had 20/20 visual acuity with a contact lens developed retinal detachment 2 years after surgery, during pregnancy, and now has 20/40 vision after retinal surgery. She prefers not to wear the contact lens any longer because of diplopia. The visual acuity of one patient was no better than hand movement and his aphakia was never corrected. Complications included one vitreous haemorrhage necessitating a second vitrectomy, one retinal detachment during pregnancy and one retinal detachment with proliferative vitreoretinopathy. One patient with sympathetic ophthalmia has 20/20 vision after 9 years' follow-up but still needs systemic steroids and cyclosporine.
Pars plana lensectomy, with anterior vitrectomy appears to be a relative safe way to treat secondary cataract in patients during the first 30 years of life.
青少年慢性葡萄膜炎继发白内障的年轻患者行经典白内障摘除术，常并发严重问题，如严重的术后葡萄膜炎、低眼压眼球痨。晶状体切除术联合部分前部玻璃体切除术可能是处理这些病例的一种炎症反应较轻的方法。
在15年期间，我们对9例年轻患者（年龄8至30岁）的10只眼进行了睫状体平坦部晶状体切除术联合部分前部玻璃体切除术，这些患者患有慢性葡萄膜炎继发白内障。采用经典的双切口技术，切口位于角膜缘4mm处。随访时间为3至12年，平均8年。其中5例为慢性虹膜睫状体炎，2例为富克斯异色性虹膜睫状体炎，1例为交感性眼炎，1例为特发性全葡萄膜炎。
7只眼通过佩戴隐形眼镜矫正视力。在整个随访期间，6例患者视力达到20/20，1例为20/40。这些患者均未报告佩戴隐形眼镜有耐受性问题。1例患者戴眼镜视力为20/20。1例最初戴隐形眼镜视力为20/20的患者在术后2年怀孕时发生视网膜脱离，视网膜手术后视力为20/40。由于复视，她不再愿意佩戴隐形眼镜。1例患者视力不超过手动，其无晶状体眼未得到矫正。并发症包括1例玻璃体出血需再次行玻璃体切除术，1例怀孕时发生视网膜脱离，1例伴有增殖性玻璃体视网膜病变的视网膜脱离。1例交感性眼炎患者随访9年后视力为20/20，但仍需全身使用类固醇和环孢素。
睫状体平坦部晶状体切除术联合前部玻璃体切除术似乎是治疗30岁以下患者继发性白内障的一种相对安全的方法。
