前房型人工晶状体植入治疗高度近视眼

目的探讨前房内植入房角支撑型硬性人工晶状体治疗高度近视眼的预测性、安全性和有效性。方法40例(76只眼)高度近视眼患者,术前屈光度数为-9.50～-26．25 D,平均(-15．89±3.78)D,术前最佳矫正视力0．5～1．0,植入房角支撑型硬性人工晶状体(Phakic 6H型)矫正高度近视眼,平均随访时间为1年。术前术后观察裸眼视力、矫正视力、届光度数、眼压、角膜内皮和眼前节的变化等。结果术后1年,裸眼视力为0．3～1．5,最佳矫正视力0．5～1．5,残余屈光度数为-2.00～+0．50 D,平均(-0．40±0．64)D,屈光度数在≤±1．00 D以内占96．1％。术前和术后1年角膜内皮细胞计数分别为(3174±248)个／mm2和(3067±320)个／mm2,两者比较,差异有统计学意义(P<0．01)。术前和术后1年眼压分别为(16．12±2.32)mm Hg(1mm Hg=0．133 kPa)和(15．29±3．38)mm Hg,两者比较,差异有统计学意义(P<0．05)。4只眼主诉有眩光。2只眼瞳孔呈竖椭圆形,2只眼晶状体下偏约1．0 mm。1例患者双眼在术后8个月时曾出现黄斑区出血。结论有晶状体眼房角支撑型硬性人工晶状体治疗超高度近视眼安全有效,且预测性好,值得进一步临床研究,长期疗效和安全性有待进一步观察。

Anterior chamber phakic intraocular lens implantation in highly myopic eyes

OBJECTIVE: To investigate the stability, predictability and safety of angle-supported phakic intraocular lens (IOL) implantation in high myopia. METHODS: Seventy-six myopic eyes of 40 patients treated with anterior chamber angle-supported phakic IOL (Phakic6H) implantation were followed. The average myopia diopter was (-15.89 +/- 3.78) D (-9.50 to -26.25 D) and the best corrected visual acuity (BCVA) was (0.82 +/- 0.20) (0.5 to 1.0). The average follow-up time was 12 months. All the treated eyes were observed for anterior segment changes, uncorrected visual acuity (UCVA), BCVA, refraction, intraocular pressure (IOP) and corneal endothelium preoperatively and postoperatively. All data were analyzed in statistics. RESULTS: One year after the surgery, the average UCVA was (1.00 +/- 0.35) (0.3 to 1.5) and BCVA was (1.18 +/- 0.29) (0.5 to 1.5). The average residual refraction was (-0.40 +/- 0.64) D (-2.00 to +0.50 D). In 96.1% of eyes, the average residual refraction was within +/- 1.0 diopter. The average corneal endothelial count before and one year after the surgery was (3174 +/- 248)/mm(2) and (3067 +/- 320)/mm(2) (P < 0.01) respectively. The intraocular pressure before and one year after the surgery was (16.12 +/- 2.32) mmHg and (15.29 +/- 3.38) mmHg (P < 0.05) respectively. Two patients (4 eyes) complained of halo and glare. One patient's (2 eyes) pupils were oval and another one (2 eyes) showed decentered phakic IOL. Macular hemorrhage occurred in one patient (2 eyes) after eight months of surgery. CONCLUSIONS: Angle-supported phakic IOL implantation is effective for treatment of high myopia and the results are predictable. It deserves further clinical investigation. The effectiveness and safety of this kind of phakic IOL should be further observed for a long period of time.