摘要目的 在儿童白内障术中应用两种不同的玻璃体切割系统行后囊切开联合前段玻璃体切除术,术中同期植入人工晶状体(IOL),比较术后视轴混浊的发生率.方法 回顾性病例研究.连续收集因先天性及发育性白内障收入山东省眼科研究所并行手术治疗的8岁及以下患儿,2003年6月至2006年6月及2006年7月至2008年6月间分别采用18-G及25-G玻璃体切割系统行后囊切开和前段玻璃体切除术,采用x2检验比较两种手术后视轴混浊的发生率.结果 共19例双眼患儿和16例单眼患儿应用18-G同轴玻璃体切割系统行后囊切开及前段玻璃体切除术,19例双眼和12例单眼患儿利用经睫状体扁平部的25-G玻璃体切割系统进行手术,术后视轴混浊的发生率分别为15％(8/54)和2％ (1/50),二者差异具有统计学意义(x2=5.393,P＜0.05).此外,应用18-G玻璃体切割系统的患儿,有3眼IOL术中植入睫状沟,14眼术后发生明显的虹膜后黏连;而应用25-G玻切系统的患儿,所有患眼IOL均同期稳定植入囊袋内,术后仅有2眼发生轻度的虹膜后黏连.结论 儿童白内障摘除联合IOL植入操作中行后囊膜切开联合前段玻璃体切除手术时,相较于18-G同轴玻璃体切割系统,经扁平部的25-G玻璃体切割系统不仅降低了术后视轴混浊的发生率,而且增加了手术的安全性.

abstractsObjective To observe the incidence of visual axis opacification after pediatric intraocular lens surgery with two different vitrectomy instruments.Methods In a retrospective case series study,the records of children less than 8 years of age who underwent intraocular lens surgery for congenital and developmental cataract in Shandong Eye Institute were retrospectively reviewed.Posterior capsulotomy and anterior vitrectomy were performed with 18-gauge coaxial vitrectomy instruments between June 2003 and June 2006,while pars plana sutureless 25-gauge instruments were used between July 2006 and June 2008.A Chi-square test was used to compare the two methods for the occurrence of visual axis opacification.Results Ninteen children with bilateral cataract and 16 with unilateral cataract underwent posterior capsulotomy and anterior vitrectomy with 18-G coaxial vitrectomy instruments,while 19 children with bilateral cataracts and 12 with unilateral cataract underwent surgery with 25-G vitrectomy instruments.The occurrence of postoperative visual axis opacification was 15％(8/54) and 2％(1/50),respectively.There was a statistically significant difference between the two methods (x2=5.393,P＜0.05).With 18-G vitrectomy instruments,3 eyes had intraocular lenses implanted in the sulcus during surgery and 14 eyes developed iris synechia postoperatively.On the contrary,with 25-G instruments all eyes had well-centered intraocular lenses in the capsule bag and mild iris synechia formation was only observed in 2 eyes.Conclusion Compared to 18-G vitrectomy instruments,posterior capsulotomy and anterior vitrectomy with 25-G instruments decreased the incidence of postoperative visual axis opacification during initial intraocular lens surgery.In addition,modified pars plana sutureless 25-G vitrectomy systems appeared to be safer and more effective.