Biglan A W, Cheng K P, Davis J S, Gerontis C C
Department of Ophthalmology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Am J Ophthalmol. 1997 Feb;123(2):224-34. doi: 10.1016/s0002-9394(14)71040-2.
To report results of secondary intraocular lens implantation after cataract surgery in children.
We reviewed clinical records for a 5-year period of patients who had cataract surgery in childhood and received a secondary intraocular lens implant. We studied indications for secondary intraocular lens placement; surgical procedures for intraocular lens implantation; preoperative and postoperative visual acuity, refractive error, and binocular status; and complications of the procedure.
A secondary intraocular lens was placed in 28 eyes of 25 patients who had cataract surgery in childhood. In 20 eyes, the lenses were placed in the ciliary sulcus. The other eight eyes had insufficient capsular support for an intraocular lens; in two, the intraocular lens was placed in the anterior chamber and, in six, in the posterior chamber with suture fixation to the sclera. Twenty of 28 eyes (71%) had measurable improvement in visual acuity; only one 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; 21 (75%) were within 3.00 diopters. During follow-up, two eyes developed glaucoma. One had transient pressure elevation; one required two filtration procedures. Three patients required Nd:YAG capsulotomy. Six patients demonstrated Worth fusion at distance and near; three demonstrated 200 seconds of arc or better stereo visual acuity.
Secondary placement of an intraocular lens in the posterior chamber appears to be a safe, effective alternative for correction of aphakia in the contact lens- or spectacles-intolerant child or young adult.
报告儿童白内障手术后二期人工晶状体植入的结果。
我们回顾了5年间儿童期接受白内障手术并接受二期人工晶状体植入患者的临床记录。我们研究了二期人工晶状体植入的适应证；人工晶状体植入的手术方法；术前和术后视力、屈光不正及双眼视状态；以及该手术的并发症。
25例儿童期接受白内障手术的患者的28只眼中植入了二期人工晶状体。20只眼的人工晶状体植入睫状沟。另外8只眼的囊膜对人工晶状体的支撑不足；其中2只眼的人工晶状体植入前房，6只眼的人工晶状体植入后房并缝合固定于巩膜。28只眼中有20只（71%）视力有可测量的改善；只有1只眼的视力下降了2行。15例患者（54%）的最终屈光度数与对侧眼相差在1.50屈光度以内；21例（75%）相差在3.00屈光度以内。随访期间，2只眼发生青光眼。1只眼眼压短暂升高；1只眼需要进行两次滤过手术。3例患者需要行Nd:YAG后囊切开术。6例患者在远距离和近距离均表现出Worth融合；3例患者的立体视锐度为200秒弧度或更好。
对于不能耐受隐形眼镜或眼镜的儿童或年轻成人，二期人工晶状体植入后房似乎是矫正无晶状体眼的一种安全、有效的替代方法。
