Biglan A W, Cheng K P, Davis J S, Gerontis C C
Department of Ophthalmology, University of Pittsburgh School of Medicine, USA.
Trans Am Ophthalmol Soc. 1996;94:353-73; discussion 374-9. doi: 10.1016/s0002-9394(14)70167-9.
Placement of a secondary intraocular lens (IOL) in a child may be considered in children with congenital monocular cataracts who have had complete opacities removed early in life and who later become contact lens intolerant, in eyes that have received trauma which precluded placement of a primary IOL, and in young adults who have bilateral aphakia who become resistant to use of contact lenses or spectacles.
Clinical records of all children in our practice who received a secondary IOL between January 1988 and December 1994 were reviewed. Indications, biometry, type of procedures, preoperative and postoperative acuity, refractive error, binocular status, and complications were studied.
During the 7-year period, 242 cataract operations were performed. Fifty-nine eyes received a lens implant, and 28 of these were secondary implants. There was a mean interval between the initial cataract operation and the procedure for the secondary implant of 77 months. The mean follow-up was 35 months (range, 3 to 71) for the 28 eyes that received a secondary implant. Two received anterior chamber implants. Eight eyes had insufficient capsular support for an IOL. Six implants were placed in the posterior chamber and required suture fixation to the sclera. Twenty of 28 eyes had a measurable improvement in visual acuity. Only 1 eye had a decrease in visual acuity of 2 lines. Fifteen patients (54%) had a final refraction within 1.50 diopters of the fellow eye, and 75% were within 3.00 diopters. During the follow-up period, 2 eyes developed glaucoma. One had a transient pressure elevation, and the second has required 2 filtration procedures. Three patients required a Nd: YAG capsulotomy. Six patients demonstrated Worth fusion at distance and near, but only 3 patients demonstrated 200 seconds of arc or better stereo acuity.
Placement of contemporary-style, secondary intraocular lenses in children and young adults appears to provide a safe and effective alternative for correction of aphakia in children who become contact lens or spectacle-intolerant.
对于先天性单眼白内障患儿，若早期已完全摘除混浊晶状体且后期无法耐受隐形眼镜；对于因外伤而无法植入一期人工晶状体的眼；以及对于双侧无晶状体的年轻成人，若其对使用隐形眼镜或眼镜产生抗拒，可考虑植入二期人工晶状体（IOL）。
回顾了1988年1月至1994年12月间在我们诊所接受二期人工晶状体植入的所有患儿的临床记录。研究了适应证、生物测量、手术类型、术前和术后视力、屈光不正、双眼状态及并发症。
在这7年期间，共进行了242例白内障手术。59只眼接受了晶状体植入，其中28只为二期植入。初次白内障手术与二期植入手术之间的平均间隔时间为77个月。接受二期植入的28只眼中，平均随访时间为35个月（范围3至71个月）。2只眼植入了前房型人工晶状体。8只眼的囊膜不足以支撑人工晶状体。6只人工晶状体植入后房，需要缝合固定于巩膜。28只眼中有20只视力有可测量的改善。只有1只眼视力下降了2行。15例患者（54%）最终屈光度数与对侧眼相差在1.50屈光度以内，75%在3.00屈光度以内。随访期间，2只眼发生了青光眼。1只眼眼压短暂升高，另1只眼需要进行2次滤过手术。3例患者需要行Nd:YAG激光后囊切开术。6例患者在远距离和近距离显示有Worth融合，但只有3例患者立体视锐度达到或优于200角秒。
对于无法耐受隐形眼镜或眼镜的儿童及年轻成人，植入现代式二期人工晶状体似乎为矫正无晶状体提供了一种安全有效的选择。
