先天性白内障治疗新进展
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摘要
先天性白内障是儿童最常见的致盲性眼病之一,随着眼科显微技术的发展,先天性白内障手术成功率已较前有提高,但是由于婴幼儿眼球结构发育不完善,手术时机、手术方式及人工晶状体屈光度数选择方面均不同于成人白内障,且术中、术后的并发症较成人多,术后还需长时间的视觉功能训练。针对先天性白内障的这些特点,通过复习先天性白内障治疗方法的相关文献,对各类先天性白内障的治疗方式进行了归纳总结,希望可以对先天性白内障的治疗提供参考。
Congenital cataract is a common disease that can lead to blindness in children. Improvement in success rates have been observed owing to the development of microsurgical techniques. In children, the timing and methodology of surgery and selection of appropriate power of intraocular lens differs from that of adult cataract due to rapid growth of infantile eyes. In addition, when compared with adult cataract, congenital cataract is associated with higher rate of complications and requires long-term post-surgical training for correction of amblyopia. In view of the aforementioned characteristics, the present study reviewed the relevant literature, with the aim to provide insight into the treatment of congenital cataract.
Congenital cataract is a common disease that can lead to blindness in children. Improvement in success rates have been observed owing to the development of microsurgical techniques. In children, the timing and methodology of surgery and selection of appropriate power of intraocular lens differs from that of adult cataract due to rapid growth of infantile eyes. In addition, when compared with adult cataract, congenital cataract is associated with higher rate of complications and requires long-term post-surgical training for correction of amblyopia. In view of the aforementioned characteristics, the present study reviewed the relevant literature, with the aim to provide insight into the treatment of congenital cataract.
引文
[1]Lambert SR,Lynn MJ,DuBois LG,et al.Axial elongation follow ing cataract surgery during the first year of life in the infant aphakia treatment study[J].Invest Ophthalmol Vis Sci,2012,53(12):7539-7545.doi:10.1167/iovs.12-10285.
[2]Wilson ME,Pandey SK,Thakur J.Paediatric cataract blindness in the developing w orld:surgical techniques and intraocular lenses in the new millennium[J].Br J Ophthalmol,2003,87(1):14-19.
[3]傅培,杨柳,薄绍晔,等.全国0~6岁儿童视力残疾抽样调查[J].中华医学杂志,2004,84(18):1545-1548.doi:10.3760/j:issn:0376-2491.2004.18.013.FU Pei,YANG Liu,BO Shaoye,et al.A national survey on low vision and blindness of 0-6 years old children in China[J].National M edical Journal of China,2004,84(18):1545-1548.doi:10.3760/j:issn:0376-2491.2004.18.013.
[4]YOU Caiyun,WU Xiaoming,ZHANG Yingying,et al.Visual impairment and delay in presentation for surgery in chinese pediatric patients w ith cataract[J].Ophthalmology,2011,118(1):17-23.doi:10.1016/j.ophtha.2010.04.014.
[5]Carrigan AK,DuBois LG,Becker ER,et al.Cost of intraocular lens versus contact lens treatment after unilateral congenital cataract surgery:retrospective analysis at age 1year[J].Ophthalmology,2013,120(1):14-19.doi:10.1016/j.ophtha.2012.07.049.
[6]张辉,龙潭,谢立信.儿童先天性白内障治疗中存在的问题[J].中华医学杂志,2012,92(27):1939-1941.doi:10.3760/cma.j.issn.0376-2491.2012.27.023.
[7]Vasavada AR,Vasavada V.Current Status of IOL implantation in pediatric eyes:an update[J].Expert Rev M ed Devices,2017:1-9.doi:10.1080/17434440.2016.1271706.
[8]Watts P,Abdolell M,Levin AV.Complications in infants undergoing surgery for congenital cataract in the first 12w eeks of life:is early surgery better?[J].J AAPOS,2003,7(2):81-85.doi:10.1016/mpa.2003.S1091-853102420095.
[9]Solebo AL,Russell-Eggitt I,Cumberland PM,et al.Risks and outcomes associated w ith primary intraocular lens implantation in children under 2 years of age:the IoLunder2 cohort study[J].Br J Ophthalmol,2015,99(11):1471-1476.doi:10.1136/bjophthalmol-2014-306394.
[10]Serafino M,Trivedi RH,Levin AV,et al.Use of the Delphi process in paediatric cataract management[J].Br J Ophthalmol,2016,100(5):611-615.doi:10.1136/bjophthalmol-2015-307287.
[11]任美侠,周健.先天性白内障的手术治疗[J].中国实用眼科杂志,2012,30(3):231-235.doi:10.3760/cma.j.issn.1006-4443.2012.03.001.
[12]刘奕志,吴明星.先天性白内障的手术治疗及展望[J].中国眼耳鼻喉科杂志,2017,17(2):79-81,84.doi:10.14166/j.issn.1671-2420.2017.02.001.LIU Yizhi,WU M ingxing.Advances and outlook of congenital cataract surgery[J].Chinese Journal of Ophthalmology and Otorhinolaryngology,2017,17(2):79-81,84.doi:10.14166/j.issn.1671-2420.2017.02.001.
[13]Nihalani BR,VanderVeen DK.Technological advances in pediatric cataract surgery[J].Semin Ophthalmol,2010,25(5/6):271-274.doi:10.3109/08820538.2010.518836.
[14]Ruth AL,Lambert SR.Amblyopia in the phakic eye after unilateral congenital cataract extraction[J].JAAPOS,2006,10(6):587-588.doi:10.1016/j.jaapos.2006.08.003.
[15]Li SY,Zhang ZP,Ji SJ,et al.Application of minimally invasive 23G vitrectomy via corneal approach for the treatment of pediatric cataract[J].Eur Rev M ed Pharmacol Sci,2014,18(17):2413-2418.
[16]Kugelberg M,Zetterstr?m C.Pediatric cataract surgery w ith or w ithout anterior vitrectomy[J].Journal of Cataract&Refractive Surgery,2002,28(10):1770-1773.doi:10.1016/s0886-3350(02)01332-9.
[17]Guo SQ,Wagner RS,Caputo A.Management of the anterior and posterior lens capsules and vitreous in pediatric cataract surgery[J].J Pediatr Ophthalmol Strabismus,2004,41(6):330-337.
[18]Memon MN,Bukhari S,Bhutto IA.Corneal approach20 Guage vitrectomy system for the management of congenital cataract[J].Pak J M ed Sci,2016,32(2):440-443.doi:10.12669/pjms.322.9149.
[19]Raina UK,Bhambhwani V,Gupta A,et al.Comparison of transcorneal and pars plana routes in pediatric cataract surgery in infants using a 25-gauge vitrectomy system[J].J Pediatr Ophthalmol Strabismus,2016,53(2):105-112.doi:10.3928/01913913-20160208-01.
[20]Chee KY,Lam GC.Management of congenital cataract in children younger than 1 year using a 25-gauge vitrectomy system[J].J Cataract Refract Surg,2009,35(4):720-724.doi:10.1016/j.jcrs.2008.12.012.
[21]Lin HT,Ouyang H,Zhu J,et al.Lens regeneration using endogenous stem cells w ith gain of visual function[J].Nature,2016,531(7594):323-328.doi:10.1038/nature17181.
[22]Boisvert C,Beverly DT,Mc Clatchey SK.Theoretical strategy for choosing piggyback intraocular lens pow ers in young children[J].J AAPOS,2009,13(6):555-557.doi:10.1016/j.jaapos.2009.10.001.
[23]Lindsay RG,Chi JT.Contact lens management of infantile aphakia[J].Clin Exp Optom,2010,93(1):3-14.doi:10.1111/j.1444-0938.2009.00447.x.
[24]Lim ME,Buckley EG,Prakalapakorn SG.Update on congenital cataract surgery management[J].Curr Opin Ophthalmol,2017,28(1):87-92.doi:10.1097/ICU.0000000000000324.
[25]Kumar P,Lambert SR.Evaluating the evidence for and against the use of IOLs in infants and young children[J].Expert Rev M ed Devices,2016,13(4):381-389.doi:10.1586/17434440.2016.1153967.
[26]Struck MC.Long-term results of pediatric cataract surgery and primary intraocular lens implantation from 7 to22 months of life[J].JAM A Ophthalmol,2015,133(10):1180-1183.doi:10.1001/jamaophthalmol.2015.2062.
[27]Gupta A,Kekunnaya R,Ramappa M,et al.Safety profile of primary intraocular lens implantation in children below 2 years of age[J].Br J Ophthalmol,2011,95(4):477-480.doi:10.1136/bjo.2010.184606.
[28]Sukhija J,Ram J,Gupta N,et al.Re:Long-term results after primary intraocular lens implantation in children operated less than 2 years of age for congenital cataract[J].Indian J Ophthalmol,2015,63(5):464-465.doi:10.4103/0301-4738.159900.
[29]Kugelberg M,Kugelberg U,Bobrova N,et al.Aftercataract in children having cataract surgery w ith or w ithout anterior vitrectomy implanted w ith a single-piece AcrySof IOL[J].Journal of Cataract&Refractive Surgery,2005,31(4):757-762.doi:10.1016/j.jcrs.2004.08.044.
[30]Kleinmann G,Zaugg B,Apple DJ,et al.Pediatric cataract surgery w ith hydrophilic acrylic intraocular lens[J].Journal of American Association for Pediatric Ophthalmology and Strabismus,2013,17(4):367-370.doi:10.1016/j.jaapos.2013.04.007.
[31]Attia MS,Khoramnia R,Auffarth GU,et al.Near and intermediate visual and reading performance of patients w ith a multifocal apodized diffractive intraocular lens using an electronic reading desk[J].J Cataract Refract Surg,2016,42(4):582-590.doi:10.1016/j.jcrs.2015.11.047.
[32]Lapid-Gortzak R,van der Meulen IJ,Jellema HM,et al.Seven-year follow-up of unilateral multifocal pseudophakia in a child[J].Int Ophthalmol,2017,37(1):267-270.doi:10.1007/s10792-016-0232-5.
[33]Medsinge A,Nischal KK.Pediatric cataract:challenges and future directions[J].Clin Ophthalmol,2015,9:77-90.doi:10.2147/OPTH.S59009.
[34]Kavitha V,Balasubramanian P,Heralgi MM.Posterior iris fixated intraocular lens for pediatric traumatic cataract[J].Middle East Afr J Ophthalmol,2016,23(2):215-218.doi:10.4103/0974-9233.171777.
[35]Neely DE,Plager DA,Borger SM,et al.Accuracy of intraocular lens calculations in infants and children undergoing cataract surgery[J].J AAPOS,2005,9(2):160-165.doi:10.1016/j.jaapos.2004.12.010.
[36]马勇,王建萍.先天性白内障人工晶状体度数的选择及植入术后对患儿眼轴发育及屈光状态的影响[J].国际眼科杂志,2006,6(3):626-628.doi:10.3969/j.issn.1672-5123.2006.03.035.YONG M a,JIANPING Wang.The choosing of intraocular lens pow er for children w ith congenital cataract and its postoperative influence on children's refractive change and axial grow th[J].International Journal of Ophthalmology,2006,6(3):626-628.doi:10.3969/j.issn.1672-5123.2006.03.035.
[37]Lloyd IC,Ashworth J,Biswas S,et al.Advances in the management of congenital and infantile cataract[J].Eye(Lond),2007,21(10):1301-1309.doi:10.1038/sj.eye.6702845.
[38]Enyedi LB,Peterseim MW,Freedman SF,et al.Refractive changes after pediatric intraocular lens implantation[J].Am J Ophthalmol,1998,126(6):772-781.
[39]Plager DA,Kipfer H,Sprunger DT,et al.Refractive change in pediatric pseudophakia:6-year follow-up[J].J Cataract Refract Surg,2002,28(5):810-815.
[40]陈奕烨,亢晓丽.先天性白内障盲与低视力综合治疗的研究进展[J].中华眼科杂志,2013,49(5):472-476.doi:10.3760/cma.j.issn.0412-4081.2013.05.024.CHEN Yiye,KANG Xiaoli.Integrated therapy of congenital cataract to prevent blindness and low vision[J].Chinese Journal of Ophthalmology,2013,49(5):472-476.doi:10.3760/cma.j.issn.0412-4081.2013.05.024.
[41]Birch EE,Wang JY,Felius J,et al.Fixation control and eye alignment in children treated for dense congenital or developmental cataracts[J].Journal of American Association for Pediatric Ophthalmology and Strabismus,2012,16(2):156-160.
[2]Wilson ME,Pandey SK,Thakur J.Paediatric cataract blindness in the developing w orld:surgical techniques and intraocular lenses in the new millennium[J].Br J Ophthalmol,2003,87(1):14-19.
[3]傅培,杨柳,薄绍晔,等.全国0~6岁儿童视力残疾抽样调查[J].中华医学杂志,2004,84(18):1545-1548.doi:10.3760/j:issn:0376-2491.2004.18.013.FU Pei,YANG Liu,BO Shaoye,et al.A national survey on low vision and blindness of 0-6 years old children in China[J].National M edical Journal of China,2004,84(18):1545-1548.doi:10.3760/j:issn:0376-2491.2004.18.013.
[4]YOU Caiyun,WU Xiaoming,ZHANG Yingying,et al.Visual impairment and delay in presentation for surgery in chinese pediatric patients w ith cataract[J].Ophthalmology,2011,118(1):17-23.doi:10.1016/j.ophtha.2010.04.014.
[5]Carrigan AK,DuBois LG,Becker ER,et al.Cost of intraocular lens versus contact lens treatment after unilateral congenital cataract surgery:retrospective analysis at age 1year[J].Ophthalmology,2013,120(1):14-19.doi:10.1016/j.ophtha.2012.07.049.
[6]张辉,龙潭,谢立信.儿童先天性白内障治疗中存在的问题[J].中华医学杂志,2012,92(27):1939-1941.doi:10.3760/cma.j.issn.0376-2491.2012.27.023.
[7]Vasavada AR,Vasavada V.Current Status of IOL implantation in pediatric eyes:an update[J].Expert Rev M ed Devices,2017:1-9.doi:10.1080/17434440.2016.1271706.
[8]Watts P,Abdolell M,Levin AV.Complications in infants undergoing surgery for congenital cataract in the first 12w eeks of life:is early surgery better?[J].J AAPOS,2003,7(2):81-85.doi:10.1016/mpa.2003.S1091-853102420095.
[9]Solebo AL,Russell-Eggitt I,Cumberland PM,et al.Risks and outcomes associated w ith primary intraocular lens implantation in children under 2 years of age:the IoLunder2 cohort study[J].Br J Ophthalmol,2015,99(11):1471-1476.doi:10.1136/bjophthalmol-2014-306394.
[10]Serafino M,Trivedi RH,Levin AV,et al.Use of the Delphi process in paediatric cataract management[J].Br J Ophthalmol,2016,100(5):611-615.doi:10.1136/bjophthalmol-2015-307287.
[11]任美侠,周健.先天性白内障的手术治疗[J].中国实用眼科杂志,2012,30(3):231-235.doi:10.3760/cma.j.issn.1006-4443.2012.03.001.
[12]刘奕志,吴明星.先天性白内障的手术治疗及展望[J].中国眼耳鼻喉科杂志,2017,17(2):79-81,84.doi:10.14166/j.issn.1671-2420.2017.02.001.LIU Yizhi,WU M ingxing.Advances and outlook of congenital cataract surgery[J].Chinese Journal of Ophthalmology and Otorhinolaryngology,2017,17(2):79-81,84.doi:10.14166/j.issn.1671-2420.2017.02.001.
[13]Nihalani BR,VanderVeen DK.Technological advances in pediatric cataract surgery[J].Semin Ophthalmol,2010,25(5/6):271-274.doi:10.3109/08820538.2010.518836.
[14]Ruth AL,Lambert SR.Amblyopia in the phakic eye after unilateral congenital cataract extraction[J].JAAPOS,2006,10(6):587-588.doi:10.1016/j.jaapos.2006.08.003.
[15]Li SY,Zhang ZP,Ji SJ,et al.Application of minimally invasive 23G vitrectomy via corneal approach for the treatment of pediatric cataract[J].Eur Rev M ed Pharmacol Sci,2014,18(17):2413-2418.
[16]Kugelberg M,Zetterstr?m C.Pediatric cataract surgery w ith or w ithout anterior vitrectomy[J].Journal of Cataract&Refractive Surgery,2002,28(10):1770-1773.doi:10.1016/s0886-3350(02)01332-9.
[17]Guo SQ,Wagner RS,Caputo A.Management of the anterior and posterior lens capsules and vitreous in pediatric cataract surgery[J].J Pediatr Ophthalmol Strabismus,2004,41(6):330-337.
[18]Memon MN,Bukhari S,Bhutto IA.Corneal approach20 Guage vitrectomy system for the management of congenital cataract[J].Pak J M ed Sci,2016,32(2):440-443.doi:10.12669/pjms.322.9149.
[19]Raina UK,Bhambhwani V,Gupta A,et al.Comparison of transcorneal and pars plana routes in pediatric cataract surgery in infants using a 25-gauge vitrectomy system[J].J Pediatr Ophthalmol Strabismus,2016,53(2):105-112.doi:10.3928/01913913-20160208-01.
[20]Chee KY,Lam GC.Management of congenital cataract in children younger than 1 year using a 25-gauge vitrectomy system[J].J Cataract Refract Surg,2009,35(4):720-724.doi:10.1016/j.jcrs.2008.12.012.
[21]Lin HT,Ouyang H,Zhu J,et al.Lens regeneration using endogenous stem cells w ith gain of visual function[J].Nature,2016,531(7594):323-328.doi:10.1038/nature17181.
[22]Boisvert C,Beverly DT,Mc Clatchey SK.Theoretical strategy for choosing piggyback intraocular lens pow ers in young children[J].J AAPOS,2009,13(6):555-557.doi:10.1016/j.jaapos.2009.10.001.
[23]Lindsay RG,Chi JT.Contact lens management of infantile aphakia[J].Clin Exp Optom,2010,93(1):3-14.doi:10.1111/j.1444-0938.2009.00447.x.
[24]Lim ME,Buckley EG,Prakalapakorn SG.Update on congenital cataract surgery management[J].Curr Opin Ophthalmol,2017,28(1):87-92.doi:10.1097/ICU.0000000000000324.
[25]Kumar P,Lambert SR.Evaluating the evidence for and against the use of IOLs in infants and young children[J].Expert Rev M ed Devices,2016,13(4):381-389.doi:10.1586/17434440.2016.1153967.
[26]Struck MC.Long-term results of pediatric cataract surgery and primary intraocular lens implantation from 7 to22 months of life[J].JAM A Ophthalmol,2015,133(10):1180-1183.doi:10.1001/jamaophthalmol.2015.2062.
[27]Gupta A,Kekunnaya R,Ramappa M,et al.Safety profile of primary intraocular lens implantation in children below 2 years of age[J].Br J Ophthalmol,2011,95(4):477-480.doi:10.1136/bjo.2010.184606.
[28]Sukhija J,Ram J,Gupta N,et al.Re:Long-term results after primary intraocular lens implantation in children operated less than 2 years of age for congenital cataract[J].Indian J Ophthalmol,2015,63(5):464-465.doi:10.4103/0301-4738.159900.
[29]Kugelberg M,Kugelberg U,Bobrova N,et al.Aftercataract in children having cataract surgery w ith or w ithout anterior vitrectomy implanted w ith a single-piece AcrySof IOL[J].Journal of Cataract&Refractive Surgery,2005,31(4):757-762.doi:10.1016/j.jcrs.2004.08.044.
[30]Kleinmann G,Zaugg B,Apple DJ,et al.Pediatric cataract surgery w ith hydrophilic acrylic intraocular lens[J].Journal of American Association for Pediatric Ophthalmology and Strabismus,2013,17(4):367-370.doi:10.1016/j.jaapos.2013.04.007.
[31]Attia MS,Khoramnia R,Auffarth GU,et al.Near and intermediate visual and reading performance of patients w ith a multifocal apodized diffractive intraocular lens using an electronic reading desk[J].J Cataract Refract Surg,2016,42(4):582-590.doi:10.1016/j.jcrs.2015.11.047.
[32]Lapid-Gortzak R,van der Meulen IJ,Jellema HM,et al.Seven-year follow-up of unilateral multifocal pseudophakia in a child[J].Int Ophthalmol,2017,37(1):267-270.doi:10.1007/s10792-016-0232-5.
[33]Medsinge A,Nischal KK.Pediatric cataract:challenges and future directions[J].Clin Ophthalmol,2015,9:77-90.doi:10.2147/OPTH.S59009.
[34]Kavitha V,Balasubramanian P,Heralgi MM.Posterior iris fixated intraocular lens for pediatric traumatic cataract[J].Middle East Afr J Ophthalmol,2016,23(2):215-218.doi:10.4103/0974-9233.171777.
[35]Neely DE,Plager DA,Borger SM,et al.Accuracy of intraocular lens calculations in infants and children undergoing cataract surgery[J].J AAPOS,2005,9(2):160-165.doi:10.1016/j.jaapos.2004.12.010.
[36]马勇,王建萍.先天性白内障人工晶状体度数的选择及植入术后对患儿眼轴发育及屈光状态的影响[J].国际眼科杂志,2006,6(3):626-628.doi:10.3969/j.issn.1672-5123.2006.03.035.YONG M a,JIANPING Wang.The choosing of intraocular lens pow er for children w ith congenital cataract and its postoperative influence on children's refractive change and axial grow th[J].International Journal of Ophthalmology,2006,6(3):626-628.doi:10.3969/j.issn.1672-5123.2006.03.035.
[37]Lloyd IC,Ashworth J,Biswas S,et al.Advances in the management of congenital and infantile cataract[J].Eye(Lond),2007,21(10):1301-1309.doi:10.1038/sj.eye.6702845.
[38]Enyedi LB,Peterseim MW,Freedman SF,et al.Refractive changes after pediatric intraocular lens implantation[J].Am J Ophthalmol,1998,126(6):772-781.
[39]Plager DA,Kipfer H,Sprunger DT,et al.Refractive change in pediatric pseudophakia:6-year follow-up[J].J Cataract Refract Surg,2002,28(5):810-815.
[40]陈奕烨,亢晓丽.先天性白内障盲与低视力综合治疗的研究进展[J].中华眼科杂志,2013,49(5):472-476.doi:10.3760/cma.j.issn.0412-4081.2013.05.024.CHEN Yiye,KANG Xiaoli.Integrated therapy of congenital cataract to prevent blindness and low vision[J].Chinese Journal of Ophthalmology,2013,49(5):472-476.doi:10.3760/cma.j.issn.0412-4081.2013.05.024.
[41]Birch EE,Wang JY,Felius J,et al.Fixation control and eye alignment in children treated for dense congenital or developmental cataracts[J].Journal of American Association for Pediatric Ophthalmology and Strabismus,2012,16(2):156-160.