摘要目的 观察经角膜入路的23-G微创玻璃体手术治疗婴幼儿白内障的疗效和并发症.方法 回顾性系列病例研究.对17例(28眼)先天性白内障的婴幼儿采用经角膜入路的晶状体切除及玻璃体切除术.在近角膜缘的透明角膜上用23-G穿刺刀做两个切口,分别置微套管,一侧与灌注管相连,另一侧伸入玻切头.通过两个微套管进行经角膜入路的前囊圆形切开、晶状体皮质吸出、后囊圆形切开以及前段玻璃体切除.对于2岁以上的婴幼儿,我们通过角膜的隧道切口一期植入折叠型人工晶状体(IOL),而2岁以下的则给予术后配戴框架眼镜,2岁以后二期植入IOL.观察术中术后并发症、术后舒适度以及炎症反应.结果 术中无并发症发生.一期IOL植入4眼.术后第1天除一患儿由于角膜上皮剥脱哭闹外,其余患儿均可以自如眨眼,翌日该患儿角膜上皮痊愈后安静.术后所有患儿角膜清亮,眼部炎症反应轻,前房无出血、渗出,无低眼压及高眼压发生.一周后轻微的结膜充血逐渐消退.随访了4～50个月,所有家长述患儿可以看见物体并自由玩耍.检查见所有术眼视轴有4～6 mm的透明区,瞳孔圆,IOL位置正,均无后发性白内障发生.结论 经角膜入路的23-G微创玻璃体手术治疗婴幼儿白内障并发症少、术后反应轻、患儿不适症状较少,值得在临床中进行推广.

abstractsObjective To determine the curative effect and complications of 23-G vitrectomy via cornea approach for the treatment of infant cataract.Methods Using lentectomy and vitrectomy via cornea approach.This retrospective study involvesd a total of 28 eyes from 17 infants who suffered from congenital cataract.Two incisions were made using a 23-G stab knife in transparent cornea near limbus.Trocars were inserted: one connected to the infusion tube and the other made the vitreous cutter enter anterior chamber.We performed anterior circular capsulotomy, lentectomy and aspiration, posterior circular capsulotomy, and anterior vitrectomy via cornea approach. For patients older than 2 years old,foldable intraocular lenses (IOLs) were implanted through a tunnel incision of the cornea.For patients under 2 years old,frame glasses were prescribed and the IOLs would be implanted after 2 years old.The intraoperative and postoperative complications and comfort level and inflammatory reaction after surgery were observed. Results No complications occurred during the operations.Four eyes were implanted IOLs at the same time.A day after surgery the patients could blink freely except one who cried due to the corneal epithelial abrasion which healed the next day.Postoperatively all the corneas were clear and the eye showed only mild signs of inflammatory reaction.No hyphema, effusion, hypotony, and hypertension.One week later, all the light congestion faded away.All parents stated their babies' visions were well enough to play freely during the follow-up period of 4-50 months.The surgical technique provided a clear 4-6 mmdiameter visual axis and cicular pupil for all eyes.The positions of these intraocular lenses were centered at the pupil area.None developed posterior capsular opacification.Conclusion The 23-Gauge vitrctomy via comea approach for the treatment of infant cataract has fewer complications and the patients have little discomfort.The method should be promoted.