Study On Individualized Surgery For Congenital Cataract In Children

Background:Congenital cataract is the most common blinding eye disease in childhood.Surgery can relieve the form-deprivation amblyopia caused by congenital cataract in children.However,due to the characteristics of anatomy and physiology of infants and young children,as well as the complex and diverse pathogenic factors,the lens of patients with congenital cataract has its unique characteristics.In the previous study of this research team,the structure of each part of the congenital cataract lens,such as the characteristics of the anterior capsule,cortex/nucleus,and posterior capsule,was studied in depth,and a classification of children's congenital cataract lens was formulated Methods,and study the characteristics of the lens of ultrasound biomicroscopy before congenital cataract surgery,so that before congenital cataract surgery,UBM examination can be used to fully grasp the characteristics of lens abnormalities,make a pre-operation plan,and improve the success rate of surgery.Reduce intraoperative complications.But does the type of congenital cataract lens opacity really increase the difficulty and risk of surgery? Is there a certain correlation between different types of congenital lens opacity and surgery? Do I need personalized surgical measures for different types of congenital lens opacity? What kind of personalized surgical plan can improve the success rate of surgery and reduce complications? There is not much literature on the relevant public reports.Objective:This topic intends to study the correlation between different lens abnormalities of congenital cataract and surgery,and explore the personalized surgical plan for children with congenital cataract.Methods:This topic reviewed and analyzed the clinical data of 65 children diagnosed with congenital cataract and received surgical treatment at Guangzhou Women and Children's Medical Center from January 2018 to December 2019.Classify the anterior lens capsule,cortex / nucleus and posterior capsule according to the preoperative lens UBM image feature Analyze the operation time of the capsule,evaluate the operation efficiency of different lens abnormalities in the same mode,study the correlation between different lens abnormalities of congenital cataract and surgery,and summarize the surgical treatment of different lens abnormalities of congenital cataract through typical cases.Personalized surgical plan for children with congenital cataract.Results:There were 65 children(105 eyes)with congenital cataract in this study,39 of them were male(60.00%),26 of them were female(40.00%).There were 40 eyes(61.54%),25 eyes(38.46%),50 right eyes(47.62%),55 left eyes(52.38%).The average age was 19.40 ± 19.33 months,P25 was 4.50 months,P50 was 12.00 months and p75 was 28.00 months.According to the UBM classification,there were 75 eyes(78.13%)of the transparent anterior capsule,14 eyes(14.58%)of the opaque anterior capsule,and 7 eyes(7.29%)of the thickened anterior capsule.Electronic capsulorhexis continuous circular capsulorhexis can be completed in one operation in 80.00% transparent anterior capsule.In 57.14% turbid and thickened anterior capsule,microcapsulotomy forceps should be used to assist manual capsular tearing or vitreous cutting head auxiliary tear bag.The Kruskal-Wallis test was used to statistically analyze the average capsulorhexis time of different types of anterior capsules,and the results were significantly different(H = 34.36,p = 0.000 <0.05);the chi-square test was used to tear the anterior capsules of different types once The number of successful cases of capsules was statistically analyzed,and the results were significantly different(?2 = 13.374,p = 0.001 <0.05).According to UBM classification,45 eyes(46.88%)had jelly like cortex,20 eyes(20.83%)had water / paste like cortex,14 eyes(14.58%)had cortical opacification and calcification,10 eyes(10.42%)were similar to sclerotia,7 eyes(7.29%)had partial cortical absorption.For the three types of jelly like cortex,water / paste like cortex and partial absorption of cortex,I / a can be used to complete the aspiration alone;for similar hard nuclei,phacoemulsification mode should be combined to emulsify the hard nuclei;for the types of cortical turbidity accompanied by mechanization or calcification,phacoemulsification,vitrectomy head or micro tweezers should be used to assist the operation.Kruskal Wallis test was used to analyze the average operation time of different types of cortex / nucleus.The results showed significant difference(H = 34.894,P = 0.000 < 0.05).According to UBM classification,79 eyes(82.29%)had clear posterior capsule,12 eyes(12.50%)had turbid posterior capsule,3 eyes(3.13%)had turbid thickened posterior capsule,and 2 eyes(2.08%)had posterior capsule defect.For the two types of transparent posterior capsule and posterior capsule defect,vitrectomy head biting(anterior approach)can be used directly;66.67% of the turbid posterior capsule can be successfully removed by combining electronic capsulorhexis.The thickening of posterior capsule can be accomplished by manual capsulorhexis with electronic capsulorhexis or capsulorhexis forceps.Kruskal Wallis test was used to analyze the average operation time of different types of posterior capsule.The results showed significant difference(H = 12.114,P = 0.007 < 0.05).Conclusion: 1.This study found that there are different types of anomalies in the congenital cataract lens(anterior capsule,cortex/nucleus,posterior capsule),and different types of local abnormalities.For specific surgical methods,the difficulty of the operation is different.Therefore,different types of local lens abnormalities require different surgical solutions to be perfectly resolved..2.This study proposes the concept of personalized surgery for children with congenital cataracts.Its meaning is: before surgery for children with congenital cataracts,you can perform preoperative assessment based on UBM image features,and perform real-time assessment of local lens abnormalities during surgery.And adopt a targeted surgical plan,including(but not limited to)electronic capsulorhexis,I/A,Phaco,vitreous cutting,etc.,to perform individual different operations for each patient.3.This study summarizes the various personalized surgical methods for the abnormality of various local congenital cataract lens in children(anterior capsule,cortex/nucleus,posterior capsule).For the treatment of various local abnormalities of children's congenital cataract lens,an overall personalized surgical solution is given.