目的：观察先天性白内障摘除术中行后囊连续环形撕囊(PCCC)防治后发性白内障的疗效及可能出现的并发症.方法：全部病例均采用现代白内障囊外摘除加后囊连续环形撕囊同时联合前段玻璃体切除术或联合人工晶体植入术.手术切口采用角巩膜缘隧道切口,对45例78眼先天性白内障患儿进行手术使晶体后囊中央形成约5 mm 的囊膜缺损区,行前部玻璃体切除术(AV),以避免后发障的发生.结果：Ⅰ期植入人工晶体40眼,术后1周矫正视力≥0.5者16眼,0.5以下34眼,无1眼发生后发障.术后1个月矫正视力≥0.5者18眼,0.5以下45眼,术后3个月到半年矫正视力≥0.5者20眼,0.5以下46眼,其余因年龄小无法检查视力表.术后一周第1次复查,无1眼发生后发障,但每只眼周边前后囊膜均出现轻度混浊,撕囊区清亮,继发性青光眼8例.3~6个月18眼发生纤维机化膜,10眼少量玻璃体脱出于前房,玻璃体轻度浑浊,虹膜后粘连7眼,瞳孔不圆12眼,IOL 偏中心8眼,无1眼发生视网膜脱离及出血.结论：先天性白内障手术治疗的目的是防治弱视,改善视力,术后并发症对手术效果产生重要影响.而 PCCC+AV 是一种经济、安全、高效的防止先天性白内障术后后发障的手术方式,适用于不能配合激光治疗的儿童,但存在一定的复发率.% Objective:To study the surgical operation metheds of posterior continuous capsulorhexis (PCCC) in pediatric cataract.Method: All cases used modern extracapsular cataract extraction and PCCC,combined with anterior vitrectomy or intraocular lens implantation. Operation incision uses corneoscleral limbus tunnel incision. Operations on 45 congenital cataracts with 78 eyes make the center of posterior lens capsule shape membrane defect area with the diameter of about 5 mm. Then in order to avoid posterior capsular opacification,use anterior vitrectomy.Result:In the first period,40 intraocular lenses were implanted.16 cases had a visual acuity of 0.5 or better,34 cases had visual acuity of 0.5 or below one week later.18 cases had a visual acuity of 0.5 or better,45 cases had visual acuity of 0.5 or below one months later.20 cases had a visual acuity of 0.5 or better,46 cases had visual acuity of 0.5 or below from three months to half a year later. The first recheck showed that no posterior capsular opacification happened one week after the operation. However,8 cases had mild turbidity on anterior and posterior capsular around each eye with the central area of the posterior capsule clear and second glaucoma.18 cases had fibrous membrane 3 to 6 months later.10 cases has vitreous prolapse and vitreous body has mild turbidity.7 cases had posterior synechia. Pupils of 12 cases were not round.8 cases had the eccentric of IOL. There was no retinal detachment.Conclusion: The goal of cataract surgery is to avoid amblyopia,and improve eyesight. The postoperative complications have great influence on surgical effects. The technique of PCCC and AV is safe and effective to reduce after-cataract. It applies to children who can not use laser treatment,but there is recurrence rate to some extent.
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