Хирургическая тактика и особенности интраокулярной коррекции у детей с врожденными катарактами первого года жизни.

Abstract

Purpose. The optimization of microsurgical tactics in case of the primary IOL implantation in children of the first year of life with congenital cataracts. Material and methods. There were examined 230 children (264 eyes) with congenital cataracts (CC), in general anesthesia conditions, who underwent in age from 2 to 5 months (109 eyes, 41.3%) and 6-11 months (155 eyes, 58.7%) cataract extraction with implantation of intraocular lens «Acrysof» SN60AT and Hoya iSert model 251. The optical power of the IOL was 27.0-41.0D, the value of hypo-correction was from 6.0 to 12.0D. Microphthalmia of degree 1-2 with a decrease in the anterior-posterior axis of the eye by 1-2mm was revealed in 18.7% of cases (49 eyes), the size of 23 eyes (8.9%) exceeded the age norm (the «myopia» group), posterior lenticonus with diameter from 2.5 mm to 5.0 mm was detected in 31 eyes (11.8%) and persistent hyperplastic primary vitreous syndrome (PHPV) was in 17 eyes (6.4%). Early and long-term late postoperative complications were studied. Results. The analysis of clinical material allowed to formulate the optimal technique to perform various phases of the surgery (opening of the anterior capsule, removal of lens masses, the approach to posterior capsule, in the presence of posterior lenticonus and the PHPV syndrome), taking into account the clinical polymorphism of congenital changes of the lens and the eye, allowing to create a stable capsular bag, that is necessary for long-term stable IOL fixation in the growing eye of the child. Inflammatory reactions in the form of fibrinous-plastic iritis with the formation of a single pigment and stromal irido-capsular adhesions and deposits on the anterior surface of the IOL were noted in the structure of early postoperative complications in 29 eyes (10.9%). Secondary cataracts (209 eyes, 79.2%) in the form of Adamuk- Elschnig’s balls (178 eyes, 67.4%), fibrosis of the posterior lens capsule (147 eyes, 55.7%) alone or their combinations (56 eyes, 21.2%) dominated in the longterm follow-up period. Exudative-proliferative reactions with formation of irido-capsular adhesions, development of pre-lens «fibrinous» membrane, precipitates on the IOL were observed in 7 children (13 eyes, a 4.9%). Conclusion. The developed microsurgical tactics of CC extraction in children of the first year of life allows to create optimal conditions for intra-capsular IOL implantation, its long-term stable fixation in a fastgrowing eye of the child, to avoid a development of intraoperative and postoperative complications in the majority of children, to obtain good anatomical and optical results.