Bowman R J, Yorston D, Wood M, Gilbert C, Foster A
International Center for Eye Health, Institute of Ophthalmology, London, England.
Ophthalmology. 1998 Sep;105(9):1770-4. doi: 10.1016/S0161-6420(98)99052-2.
This study aimed to audit the surgical strategy of primary posterior chamber intraocular lens implantation for cases of recent penetrating trauma involving the lens in an African population.
Retrospective, noncomparative case series.
Seventy-two cases are reported, including all patients who underwent primary intraocular lens implantation for traumatic cataract extraction performed within 1 month of injury between 1988 and 1996.
Demographic characteristics and follow-up attendance rates are analyzed. Surgical technique and the occurrence of intraoperative and postoperative complications are reported. Visual outcomes are reported with detailed analysis for cases of poor visual outcome.
Mean age was 14.3 years (standard deviation = 11.1), 57 (79%) were male and 15 (21%) were female (chi-square = 23.66, P < 0.01). Fifty-eight patients (80%) attended for follow-up with a mean follow-up duration of 14.3 months (standard deviation = 17.3). No demographic or surgical differences were identified between attendees and nonattendees. The posterior capsule had been breached by the trauma in 27 (38%) cases, and 15 of these required anterior vitrectomy. Capsular fixation of the implant was achieved in 49% of patients, the remainder having sulcus fixation. Intraoperative rupture of the posterior capsule occurred in four cases. The only common postoperative complication was acute fibrinous anterior uveitis, which occurred in 29 (40%) patients, and 32% of patients followed up for at least 6 months required secondary posterior capsulotomy. This was more common in younger patients (chi-square = 4.2, P < 0.05). Corrected postoperative visual acuities were available for 51 patients, of which 71% achieved 20/60 or better visual acuity. Patients 6 years of age or younger were less likely to achieve 20/60 (chi-square = 6.61, P = 0.01).
This surgical strategy has proved successful, producing good visual results and causing no sight-threatening complications. Primary posterior capsulotomy may be appropriate for younger patients.
本研究旨在审核在非洲人群中对近期涉及晶状体的穿透性创伤病例进行一期后房型人工晶状体植入的手术策略。
回顾性、非对照病例系列。
报告了72例病例，包括1988年至1996年间在受伤后1个月内接受外伤性白内障摘除并一期植入人工晶状体的所有患者。
分析人口统计学特征和随访出勤率。报告手术技术以及术中及术后并发症的发生情况。报告视力结果，并对视力不佳的病例进行详细分析。
平均年龄为14.3岁（标准差=11.1），57例（79%）为男性，15例（21%）为女性（卡方检验=23.66，P<0.01）。58例患者（80%）接受了随访，平均随访时间为14.3个月（标准差=17.3）。随访者与未随访者之间未发现人口统计学或手术方面的差异。27例（38%）患者的后囊膜因创伤破裂，其中15例需要进行前部玻璃体切除术。49%的患者实现了人工晶状体的囊袋内固定，其余患者采用睫状沟固定。4例患者术中发生后囊膜破裂。唯一常见的术后并发症是急性纤维素性前葡萄膜炎，29例（40%）患者发生该并发症，32%随访至少6个月的患者需要二期后囊膜切开术。这在年轻患者中更常见（卡方检验=4.2，P<0.05）。51例患者有术后矫正视力，其中71%的患者视力达到20/60或更好。6岁及以下的患者达到20/60的可能性较小（卡方检验=6.61，P=0.01）。
该手术策略已被证明是成功的，产生了良好的视力结果，且未引起威胁视力的并发症。一期后囊膜切开术可能适用于年轻患者。
