How far is observation allowed in patients with ectopia lentis?
How far is observation allowed in patients with ectopia lentis?
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DOI：
10.1186/s40064-015-1239-5
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发表时间：
2015
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影响因子：
--
通讯作者：
Matsuo T
中科院分区：
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作者：
Matsuo T
晶状体异位的手术时机至今尚未得到很好的描述。这项研究的目的是找到一个基准，以观察多远，将允许在儿童晶状体异位时，他们和他们的家人不愿意通过手术。回顾性分析了2008年4月至2013年3月5年间在一家医院就诊的15例双眼晶状体异位的连续患者（14例儿童和1例成人），以调查继续观察或决定手术干预的原因。诊断为马凡氏综合征6例，家族性晶状体异位6例，散发性晶状体异位3例。9例患者在末次访视时的年龄范围为4 - 17岁（中位数9），继续观察，因为6例儿童戴眼镜时近视和远视力良好，3例儿童戴眼镜时近视视力为0.4，但远视力较差。相比之下，6名患者（5名儿童和1名成人）确定了晶状体切除术，手术时年龄范围为4至36岁（中位数9），末次访视时年龄范围为7至42岁（中位数11），主要是因为近视和远视视力差。5名儿童手术的更具体原因是2名儿童因异位进展导致光轴无晶状体，1名儿童因钝性眼损伤后透镜脱位至前房，2名儿童在学校课堂学习困难。1例成人异位晶状体发生白内障。晶状体切除术，结合前部玻璃体切除术，从两个角膜缘侧孔用25号输液套管和玻璃体切割器进行。另外，两名年龄分别为16岁和36岁的患者双眼均接受了人工晶状体植入术。总之，我们继续观察在近视时视力良好的晶状体异位儿童。近视时的视力，0.4或更好，将为晶状体异位儿童的持续观察提供基准。
Surgical timing for ectopia lentis has not been well described until now. The purpose of this study is to find a benchmark as to how far observation would be allowed in children with ectopia lentis when they and their families are reluctant to go through surgery. Retrospective review was made on 15 consecutive patients (14 children and one adult) with ectopia lentis in both eyes, seen at a referral-based institution in 5 years from April 2008 to March 2013, to survey the reasons for continuing observation or deciding surgical intervention. The diagnoses were Marfan syndrome in six patients, familial ectopia lentis in six, and sporadic ectopia lentis in three. Observation was continued in nine patients with the age at the final visit, ranging from 4 to 17 (median 9) years, because six children had good visual acuity at both near and distant viewing with glasses, and three children had visual acuity of 0.4 at near viewing despites poor visual acuity at distant viewing with glasses. In contrast, lensectomy was determined in six patients (5 children and one adult) with the age at surgery, ranging from 4 to 36 (median 9) years, and the age at the final visit, ranging from 7 to 42 (median 11) years, mainly because of poor visual acuity at near and distant viewing. More specific causes for surgeries in five children were the optical axis to become aphakic due to the progression of ectopia in the course in two children, lens dislocation to the anterior chamber after blunt eye injury in one child, and difficulty in studying at school classes in two children. One adult patient developed cataract in ectopic lenses. Lensectomy, combined with anterior vitrectomy, was done from two limbal side ports with a 25-gauge infusion cannula and vitreous cutter. Two patients at the age of 16 and 36 years, additionally, underwent intraocular lens-suturing in both eyes. In conclusions, observation was continued in children with ectopia lentis who had good visual acuity at near viewing. The visual acuity at near viewing, 0.4 or better, would give a benchmark for continuing observation in children with ectopia lentis.