有晶状体眼后房型人工晶状体植入术矫治高度近视临床研究

目的 研究有晶状体眼后房型人工晶状体植入术矫治高度近视的安全性、有效性及稳定性.方法 774例(883眼),年龄18 ～40岁的高度近视患者行有晶状体眼人工晶状体植入,术后观察两组视力、眼压、屈光度、角膜内皮细胞计数、人工晶状体位置、手术并发症及视觉不良症状.结果 术后2个月裸眼视力＞0.5者占74.6％;术后30 ～36个月时占83.5％,二者差异无统计学意义(P＞0.05).术后3～6个月屈光度改变均在±1.00D之内,眼压、角膜内皮细胞计数与术前比较差异均无统计学意义(P＞0.05).并发症:术后24h内高眼压16眼,3月后发生眼底黄斑出血4眼.主诉夜间眩光症状者5例.结论 有晶状体眼后房型人工晶状体植入术矫治高度及超高度近视眼具有良好的安全性,有效性和可预测性.     

透明晶状体摘除治疗高度近视

评价使用超声乳化行透明晶状体摘除和植入折叠人工晶状体治疗高度近视的疗效、预测性和安全性。方法 :对 45例 80只眼行透明角膜切口 ,超声乳化透明晶状体摘除联合折叠人工晶状体植入治疗高度近视。患者年龄 2 5～ 71岁 ,平均 5 5 13± 8 83岁。平均眼轴长度 2 9 45± 2 0 7mm ,平均等效球镜度数 -11 86± 4 73D ,植入人工晶状体屈光度平均值为9 19± 3 80D。随访 6～ 42个月。结果 :术后最佳矫正视力 80只眼均达到或超过术前最佳矫正视力 ;70只眼 (87 5 % )术后裸眼视力达到或超过术前最佳矫正视力 ;44只眼 (5 5 0 % )术后裸眼视力达到 0 5以上 ;术后屈光度平均值为 -1 96± 1 2 8D ,70只眼 (87 5 % )在预矫屈光度±1D内。术中未发生后囊破裂。随访中 11只眼发生后囊混浊 ,未发现视网膜脱离、黄斑囊样水肿等并发症。结论 :透明晶状体摘除治疗高度近视与目前的角膜屈光手术相比 ,可能更适宜于中年以上不愿戴镜和戴镜不能矫治的高度近视眼患者 ,其远期疗效尚需长期随访。     

有晶状体眼后房型人工晶状体植入术矫治高度近视

目的：：观察有晶状体眼后房型人工晶状体( ICL/TICL )矫治高度近视的安全性和有效性。方法：回顾2010-10/2014-06在我院行有晶状体眼后房型人工晶状体植入术的患者160例310眼,分析其裸眼视力( UCVA)、最佳矫正视力( BCVA)、屈光度、眼压、角膜内皮计数等指标及并发症情况。结果：视力和屈光度显著改善且稳定。术后 UCVA>0.8的有86％,BCVA未见下降,11％比术前提高1行,68％比术前提高≥2行;96％眼的实际屈光度数稳定在预期的±1.00D。有晶状体眼后房型人工晶状体( ICL)植入术后1h有14眼眼压升高,均未超过28mmHg,术中晶状体损失1眼行透明晶状体摘除及人工晶状体植入;术后有晶状体眼后房型环曲面人工晶状体( TICL )旋转1眼,术后视网膜脱离3眼,黄斑出血1眼。结论：有晶状体眼后房型人工晶状体植入术矫治高度近视安全、有效,可预测性高,并发症少,患者满意度高,值得推广,其远期并发症有待进一步观察。     

后房型有晶状体眼人工晶状体植入术治疗高度近视

目的 评价后房型有晶状体眼人工晶状体(ICL)植入术治疗高度近视术后1年的有效性和安全性.方法 回顾性病例研究.高度近视患者149例(290眼)接受ICL植入手术.其中男107眼,女183眼,平均年龄(29.0±6.5)岁.术前平均等效球镜度(-13.2±5.6)D.随诊时检查视力、眼压、屈光度和其他副作用.结果 所有眼睛的术后裸眼视力都有提高,接近术前最佳矫正视力.最后一次随访时199眼(68.6％)术后裸眼视力高于术前最佳矫正视力1行以上,无最佳矫正视力下降的病例.术后3 h内32眼眼压超过35 mmHg,其中13眼为瞳孔阻滞,19眼考虑为黏弹剂残留.术后随诊时发现3眼眼压在21～25 mmHg之间.2眼术后3个月以后发生黄斑区出血,3个月后出血吸收.3眼(2例)因为术后光晕干扰视物不适而取出ICL.12眼因为术后拱高欠佳而进行了人工晶状体置换术.结论 随诊1年显示ICL植入治疗高度近视是一种安全、有效而并发症少的治疗方法.     

透明晶状体摘除联合人工晶状体植入治疗高度近视的疗效观察

目的 :探讨采用超声乳化联合人工晶状体植入术治疗高度近视的疗效。方法 :对 31例 (41只眼 )高度近视眼经透明角膜切口或巩膜隧道切口行超声乳化联合人工晶状体植入术 ,平均年龄 (44 2 1± 5 33)岁 ,术前最佳矫正视力为指数 / 30cm～ 0 6 ,平均等效球镜度数为 (- 15 5 4± 4 13)D ,平均眼轴长度为 (2 8 4 5± 5 13)mm ,植入人工晶状体屈光度 (- 7 0～ 14 5 )D。结果 :所有病例术后矫正视力均超过术前最佳矫正视力 ,术后裸眼视力达到或超过术前最佳矫正视力者 31只眼(75 6 % ) ,术后裸眼视力达到或超过 0 5者 18只眼 (43 9% )。术后屈光度平均值为 (- 1 85± 1 32 )D ,37只眼 (90 2 % )在设计预矫屈光度± 1D内 ,39只眼 (95 1% )在预矫屈光度± 2D内。术后 6～ 2 4个月 (平均 15个月 )随访期中 ,5只眼 (12 2 % )发生后囊膜混浊。未发现视网膜脱离、黄斑囊样水肿、眼底出血、青光眼、人工晶状体偏位等并发症。结论 :超声乳化透明晶状体摘除联合人工晶状体植入术是治疗高度近视安全、有效的方法 ,具有术后视力好、并发症少、预测屈光状态准确性及稳定性较好等优点。其远期疗效有待观察。     

晶状体超声乳化负屈光度人工晶状体植入矫正高度近视22例

目的:评价晶状体超声乳化负屈光度人工晶状体植入术对高度近视治疗的可行性、有效性、安全性。方法:对22例(31眼)高度近视患者行超声乳化联合负屈光度人工晶状体植入,观察术中、术后并发症,术后视力、术后屈光度等,术后随诊≥3mo。结果:术后矫正视力<0.1者2眼,0.1～0.4者6眼,0.5～0.9者19眼,≥1.0者4眼。术中无并发症发生。术后4眼(13%)后囊膜混浊,无视网膜脱离、眼底出血等并发症发生。结论:晶状体超声乳化负屈光度人工晶状体植入矫正高度近视是一种安全、有效、可行的方法。     

高度近视白内障患者植入Bigbag人工晶状体的疗效观察

目的观察高度近视并发白内障患者行超声乳化吸除联合Bigbag人工晶状体植入术的有效性及安全性。方法 31例（55只眼）高度近视白内障患者行超声乳化吸除联合人工晶状体植入术。其中18例（30只眼）植入Bigbag人工晶状体,13例（25只眼）植入Matrix Acrylic 400型人工晶状体。比较手术前后视力及屈光状态;观察术中及术后并发症。结果 55只眼人工晶状体均植入囊袋内且固定良好,术前裸眼视力均〈4.5,术前最佳矫正视力〉4.8者Bigbag组3只眼（10%）,400组6只眼（24%）;术后1个月Bigbag组最佳矫正视力〈4.5者1只眼,4.5～4.8者10只眼,〉4.8者19只眼,与400组相比差异无统计学意义（χ2=0.066,P〉0.05）;Bigbag组术后1个月屈光度-0.50～-2.00 D,平均（-0.68±0.38）D,与术前相比较差异有统计学意义（t=12.79,P〈0.05）。与术后3个月屈光度比较无统计学意义（t=1.366,P〉0.05）。术后3个月Bigbag组,后囊膜未发现皱褶,2只眼（6.66%）后囊轻度混浊;400组2只眼（8%）后囊膜皱褶,3只眼（12%）后囊轻度混浊,随诊观察至6个月病情无进展。结论白内障超声乳化吸除联合Bigbag人工晶状体植入术治疗高度近视是一种安全、有效的手术方法。Big-bag人工晶状体不但可获得与其它人工晶状体相同的良好视力,还可对后囊膜起到相对稳定的支撑作用,减少并发症的发生。     

有晶状体眼后房型人工晶状体植入治疗高度近视临床观察

目的评价有晶状体眼后房型人工晶状体(ICL)植入术矫治高度近视的临床效果。方法自2009年2月至2011年2月接受ICL植入的高度近视患者82例(160只眼),术前平均屈光度球镜(-13.65±4.25)D,柱镜(-2.65±0.75)D。观察术后裸眼视力、最佳矫正视力、屈光度、内皮细胞计数等情况,分析并发症的发生情况。结果术后裸眼视力:0.5～1.0,平均0.78±0.32。术前最佳矫正视力:0.3～1.0,平均0.59±0.36,术后最佳矫正视力0.79±0.30。达到术前矫正视力92只眼(57.5%),超过术前最佳矫正视力68只眼(42.5%),随访6个月至2年,无明显变化。术后屈光度数平均球镜(-0.75±0.65)D,柱镜(-0.55±0.25)D。角膜内皮细胞计数术前(3126±260)个/mm2,术后6个月为(3069±308)个/mm2,差异无统计学意义。结论有晶状体眼后房型人工晶状体(ICL)植入矫治高度近视及超高度近视安全有效,是高度近视患者的理想治疗方法。     

负度数人工晶状体植入术治疗白内障合并超高度近视眼

目的 观察白内障超声乳化联合负度数Sensar AR40e折叠式人工晶状体植入治疗超高度近视合并白内障的临床疗效.方法 对超高度近视合并白内障行超声乳化白内障吸除联合负度数Sensar AR40e人工晶状体植入术的35例(59只眼)患者进行回顾性研究,记录术前眼轴长度,观察手术并发症和术后视力、屈光度数及其与预期屈光度数的偏差值(屈光度数偏差值).术后随访时间为3～12个月.结果 术前平均眼轴长度为31.34mm.术后最佳矫正视力≥0.2共49只眼(83.05%),≥0.5者共26只眼(44.07%).术后屈光度数偏差值＜±1.00 D共31只眼(52.54%),<±2.00 D共52只眼(88.14%).术中仅1只眼晶状体后囊膜破裂;术后6只眼晶状体后囊轻度混浊,随访期间无视网膜和脉络膜脱离.结论 白内障超声乳化联合负度数人工晶状体植入术治疗白内障合并超高度近视眼安全、有效.植入负度数后房型人工晶状体既可以维持眼内组织的稳定性,又可同时进行屈光矫正.     

有晶状体眼后房型人工晶状体植入术矫正高度近视

探讨有晶状体眼后房型人工晶状体（phakic intraocular lens,PIOL）植入术矫正高度近视的有效性和安全性。 方法：本研究中高度近视患者17例33眼,术前屈光度-8.00～-24.00 (平均-15.46±6.26)D,眼轴长度25.33～33.77(平均30.22±2.55)mm。33眼植入后房型人工晶状体也称植入性接触镜（implantable contact lens,ICL& toric implantable collamer lens, TICL）。其中,22眼植入ICL,11眼植入TICL。术后观察视力、屈光度、眼压、人工晶状体位置等。 结果：所有病例均成功植入后房型人工晶状体。术后1wk,所有手术眼达到或超过术前最佳矫正视力,屈光度和眼压稳定。 结论：有晶状体眼后房型人工晶状体植入术治疗高度近视安全有效,适用屈光度范围广,术后屈光度稳定,视觉质量提高     

有晶状体眼虹膜夹型和后房型人工晶状体植入矫正高度近视术后的视觉质量对比

背景矫正近视的手术可分为激光矫治术和人工晶状体（IOL）植入术。高度近视患者角膜比正常人薄,不适合激光矫治手术,宜考虑IOL植入术。目的对比观察两种有晶状体眼IOL植入术治疗高度近视的视觉质量。方法选取在郑州大学第一附属医院和解放军第91中心医院行前房虹膜夹型人工晶状体（Verisyse PIOL）植入术的高度近视患者19例34眼随机分为两种手术组,其中10例17眼为PIOL组,行后房型人工晶状体（ICL）植入术者9例17眼为ICL组。两种手术均由同一高年资医师完成。随访期为6个月,观察患者术后的裸眼视力、最佳矫正视力、对比敏感度（CS）和波前像差,对2组的检测指标进行比较。结果术后6个月2组间患者裸眼视力和最佳矫正视力的差异均无统计学意义（t=0．489,P〉0．05;t=0．853,P〉0．05）;2组患者间无眩光时在3、6、12、18c／d空间频率下cs的差异均无统计学意义（t=0．906,P〉0．05;t=0．103,P〉0．05;t=0．694,P〉0．05;t=1．583,P〉0．05）;3、6、12、18c／d空间频率下2组间患者的眩光敏感度比较差异均无统计学意义（t=0．323,P〉0．05;t=0．041,P〉0．05;t=0．024,P〉0．05;t=0．363,P〉0．05）。PIOL组三阶彗差（RMS3）、四阶球差（RMS4）、总高阶像差（RMSh）均高于ICL组,其中RMS3、RMSh明显高于ICL组,差异均有统计学意义（t=11．400,P〈0．05;t=11．350,P〈0．05）,2组间RMS4的差异无统计学意义（t=0．240,P〉0．05）。结论虹膜夹型IOL与ICL植入矫正高度近视均能达到预期的效果,术后视力相当,但虹膜夹型IOL的视觉质量稍逊于ICL,远期效果还需进一步随访观察。     

后房型有晶状体眼人工晶状体植入术治疗高度近视及散光

目的 探讨后房型有晶状体眼人工晶状体植入术治疗高度近视及散光的安全性和疗效性.方法 后房型有晶状体眼人工晶状体植人术治疗高度近视及散光22例39只眼.术前屈光度(等效球镜)为-7.0～-24.0D,平均(-14.50D±3.50)0;散光-0.50～-4.50D,平均(-2.25±1.32)D.术后检查视力、眼压、裂隙...     

Outcome of simultaneous phakic implantable contact lens removal with cataract extraction and pseudophakic intraocular lens implantation

PURPOSE: To assess the outcome of simultaneous implantable contact lens (ICL) removal and cataract extraction with pseudophakic intraocular lens (IOL) implantation. SETTING: CODET Aris Vision Institute, Tijuana, Mexico. METHODS: This retrospective noncomparative interventional case series evaluated 14 eyes of 12 patients with ICL implantations who developed a cataract and simultaneously had ICL removal and cataract extraction with IOL implantation. The follow-up time was at least 6 months (range 6 to 24 months). Visual acuity (logMAR), manifest refraction, intraocular pressure, and adverse events were recorded. RESULTS: Of the 12 patients (14 eyes), 10 patients (12 eyes) had ICL surgery to correct high myopia and 2 patients (2 eyes), to correct hyperopia. The mean uncorrected visual acuity after ICL implantation (before cataract development), before cataract surgery, and after cataract surgery were 0.48 +/- 0.32, 0.83 +/- 0.34, and 0.40 +/- 0.27, respectively. The mean best corrected visual acuity (BCVA) before ICL implantation, after ICL implantation, and after cataract surgery were 0.31 +/- 0.21, 0.28 +/- 0.19, and 0.27 +/- 0.21, respectively. The mean final manifest spherical equivalent was 0.30 diopters (D) +/- 1.07 (SD) (range +2.38 to 2.0 D). Ten eyes (71.4%) were within +/-1.0 D of the calculated target. One eye had a tear in the posterior capsule with vitreous loss during cataract surgery. No other intraoperative, perioperative, or postoperative complications were observed. No loss of BCVA was recorded at the last postoperative visit. CONCLUSIONS: Lens opacities and cataract formation are a potential complication of ICL surgery. The removal of the ICL and the cataract with IOL implantation was found to be safe, with predictable refractive results.     

Bigbag人工晶状体在高度近视合并白内障眼中的应用及稳定性探讨

目的利用前节OCT检查证实Bigbag人工晶状体在囊袋中的稳定性,探讨Bigbag人工晶状体在高度近视并发白内障的临床应用效果。方法 90例(169眼)高度近视并发性白内障患者超声乳化吸除术后,45例86眼(研究组)行Bigbag人工晶状体植入术,45例83眼(对照组)行AMO AR40e人工晶状体植入术,观察术中及术后并发症、眼压、术后最佳矫正视力(bestcorrected visual acuity,BCVA)、裸眼视力和屈光状态、角膜内皮细胞计数、后囊膜皱褶。前节OCT检查术前及术后前房深度(an-terior chamber depth,ACD)。术后随访1～3个月。结果术中无后囊膜破裂等手术并发症。前节OCT检查ACD结果显示:研究组术前、术后3d、1个月平均ACD分别为(3.54±0.24)mm、(5.27±0.21)mm、(5.25±0.18)mm;对照组平均ACD分别为(3.61±0.16)mm、(4.11±0.35)mm、(3.91±0.24)mm。两组间术前ACD、术后两组内不同时间ACD比较差异均无统计学意义(均为P>0.05),术后两组间比较差异均有统计学意义(均为P<0.05)。术后1个月研究组BCVA<0.1者4眼,0.1～0.4(包括0.4)者18眼,0.4～0.8者57眼,>0.8者7眼,术后1个月、3个月BCVA、裸眼视力与对照组相比差异均无统计学意义(均为P>0.05)。两组术后3个月实际屈光度数与术前预留屈光度数差值≤±1.0D者研究组54眼(62.79%)、对照组40眼(48.19%),差异有统计学意义(P<0.05)。研究组1眼(1.16%)、对照组5眼(6.02%)出现后囊膜混浊及皱褶。研究组术后未见严重并发症,对照组2眼(2.41%)术后3周左右发现视网膜脱离。结论 Bigbag人工晶状体植入后稳定性好;可获得与其他人工晶状体无差异的术后视力;对后囊膜有稳定支撑作用,降低了后囊膜皱褶的发生率;对高度近视并发性白内障患者安全、有效。     

激光性角膜手术与眼内屈光手术矫治超高度近视眼

目的:评价及探讨矫治超高度近视眼的各类屈光手术的有效性、稳定性和安全性。方法:随机选择临床中观察到的超高度近视患者行各类屈光手术者108眼,近视范围-10.00～-24.50D,术前屈光度平均为(-12.25±1.53)D,散光平均为(-1.52±0.55)D;手术方式的选择:(1)I组52眼,行LASIK术:(2)II组23眼,行透明晶状体超声乳化摘除加后房型人工晶状体植入术。(3)III组33眼行有晶状体眼虹膜固定型人工晶状体植入术。术后随访观察平均6mo,主要观察术后裸眼视力、最佳矫正视力、屈光度、眼压及眼前段、眼底情况。结果:三组术后裸眼视力均比术前提高,术后裸眼视力≥0.5者分别是42眼(80.8%),20眼(87.0%),28眼(84.8%),术后屈光度分别为(-2.10±2.38)D,(-1.75±1.33)D,(0.83±1.16)D,主要并发症I组术后6mo黄斑出血1眼,II组术后15mo视网膜脱离1眼,III组平均角膜内皮细胞丢失率为4.5%。结论:对于超高度近视,晶状体性屈光手术效果优于LASIK术。对超高度近视行屈光手术,要根据患者年龄,眼部情况,手术医师的技术等,选择安全、有效、稳定性好的手术。     

两种不同手术矫治高度近视的对比研究

目的：比较有晶状体眼后房型人工晶状体(implantable contact lens,ICL)植入术与透明晶状体摘除术联合后房型人工晶状体植入术两种术式矫治高度近视的安全性、有效性及稳定性。

方法：选取高度近视患者56例100眼,分为两组：Ⅰ组ICL植入术组患者32例58眼,Ⅱ组透明晶状体摘除联合后房型人工晶状体植入术组患者24例42眼。手术前、后观察两组患者的视力、屈光度、眼压、角膜内皮细胞计数、前房深度、晶状体透明度、手术并发症及视觉不良症状。

结果：Ⅰ组和Ⅱ组术后3mo的裸眼视力>0.5者分别为69.0%和71.4%; 术后1a,裸眼视力>0.5分别为72.4%和73.8%。术后1a,Ⅰ组62.1%、Ⅱ组57.1%患者的屈光度在预期屈光度±1.0D之内; ICL光学部后表面与透明晶状体的距离0.35～0.54(平均0.40±0.16)mm; 术后一过性高眼压发生率：Ⅰ组为12.1%,Ⅱ组为7.1%; 角膜内皮细胞计数与术前相比,差异有统计学意义(P<0.001)。Ⅰ组其他手术并发症：ICL移位1眼,前囊下晶状体局限性混浊2眼,夜间出现眩光4眼。Ⅱ组后囊膜轻度混浊3眼,夜间出现眩光3眼,视近困难12眼。

结论：有晶状体眼后房型人工晶状体植入术与透明晶状体摘除术矫治高度近视具有较好的安全性、有效性和稳定性,但仍需长期随访,注意远期并发症的发生。     

Phakic posterior chamber intraocular lens for high myopia

PURPOSE: To evaluate the efficacy, predictability, stability, and safety of the surgical correction of high myopia using a phakic posterior chamber intraocular lens (PPC IOL). SETTING: Centro Oftalmológico de Valencia-CEOVAL, Valencia, Venezuela. METHODS: A retrospective study was performed to analyze 18 eyes of 12 patients who had implantation of a modified PPC IOL, the implantable contact lens (ICL), for the treatment of high myopia. The target postoperative spherical equivalent (SE) refraction was emmetropia. RESULTS: The mean follow-up was 26.6 months +/- 11.3 (SD) (range 12 to 36 months). The mean preoperative SE was -15.27 +/- 3.47 diopters (D) (range -10.0 to -21.25 D) and the mean postoperative SE, -0.62 +/- 0.81 D (range -2.75 to +0.75 D). Eleven eyes (61.1%) had an SE within +/-1.00 D of emmetropia. The best spectacle-corrected visual acuity was maintained or improved in all except 1 eye, which lost more than 2 lines of Snellen visual acuity. Two eyes (11.1%) developed pupillary block the first day after surgery. Four eyes (22.2%) had moderate pigmentary dispersion. Two eyes (11.1%) had lens opacification, 1 with mild peripheral anterior capsule opacification and the other eye with central anterior subcapsular opacification. One eye (5.5%) had a significant decrease in anterior chamber depth after surgery. CONCLUSIONS: Implantation of an ICL was effective for the correction of high myopia. Predictability must be improved and the long-term safety of the ICL determined. The main concerns over potential cataract formation, pigmentary dispersion, and angle-closure glaucoma remain.     

Implantable contact lens for high myopia.

PURPOSE: To evaluate the efficacy, safety, and biocompatibility of a collagen polymer implantable contact lens (ICL) (Staar Collamer) as a posterior chamber phakic intraocular lens (IOL) to correct high myopia. SETTING: Departments of Ophthalmology, Helsinki University Central Hospital, Helsinki, and Tampere University Hospital, Tampere, Finland. METHODS: A Staar Collamer posterior chamber phakic IOL was implanted in 38 eyes of 22 patients with a mean age of 39 years (range 24 to 54 years). The mean preoperative myopia was -15.10 diopters (D) (range -7.75 to -29.00 D). Surgical implantation was performed through a 3.0 mm clear corneal sutureless incision using paraocular anesthesia. The patients were followed clinically up to 3 years. The mean follow-up was 13.6 months (range 6 to 24 months) for refractive data and 22.3 months (range 6 to 35 months) for complications. The possible inflammatory response to the ICL was measured using a laser flare meter in 12 eyes. RESULTS: Postoperatively, all eyes had a significant increase in uncorrected visual acuity, allowing all but 3 patients (5 eyes) to manage most activities without spectacles. The mean spherical equivalent refraction at the last examination was -2.00 D +/- 2.48 (SD) (range +0.13 to -13.00 D), within +/-1.00 D of the targeted refraction in 31 eyes (81.6%) and within +/-0.50 D in 27 eyes (71.1%). In eyes in which the preoperative myopia was less than -18.00 D (n = 28), the achieved refraction was within +/-1.00 D of the intended refraction in 27 eyes (96.4%) and within +/-0.50 D in 24 eyes (85.7%). The refraction remained stable with a statistically insignificant change (P >.05) at each interval during the follow-up. The best corrected visual acuity (BCVA) improved by 1 or more lines in 23 of 32 eyes (71.9%) at 1 year. Two eyes (6.3%) lost 1 line of BCVA. Laser flare photometry showed normal aqueous flare values (11.71 +/- 6.61 photon counts/ms) in the 12 eyes measured at least 6 months after ICL implantation. Pupillary block glaucoma requiring surgical intervention occurred in 3 patients (7.9%). One patient (2.6%) developed cataract 1.5 years after ICL implantation; both ICLs were removed, and the refractive errors were corrected by lensectomy and implantation of low-power posterior chamber IOLs. One patient (2.6%) showed progression of dry macular degeneration at 17 months. CONCLUSION: At 1 year, ICL implantation had good visual and refractive results with excellent biocompatibility. Long-term follow-up is required to confirm that significant complications do not occur in most patients over time.     

三种有晶状体眼IOL植入矫正高度近视的临床评价

目的 评价3种有晶状体眼IOL植入矫正高度近视的有效性、安全性和稳定性.方法 选取2003年12月至2009年12月就诊高度近视患者110例(208只眼),平均年龄31岁,其中59例(113只眼)行房角支撑型IOL植入术,29例(53只眼)行虹膜夹持型IOL植入术,21例(41只眼)行后房型IOL植入术,平均随访时间分别为54个月(3～72个月)、15.7个月(3～24个月)和7.2个月(3～15个月).定义安全性指数为术后平均BSCVA与术前平均BSCVA的比值,定义有效性指数为术后平均UCVA与术前平均BSCVA的比值.对手术前后角膜内皮细胞计数比较采用配对t检验.结果 术后3个月和1年时有效性指数均大于1.只有植入房角支撑型IOL的患者随访至术后5年,有效性指数下降为0.85,但仍有16%的患眼裸眼视力≥1.0,85%的患眼≥0.5.所有患者术后的随访过程中,安全性指数始终大于1.植入房角支撑型IOL的患者随访术后5年时,46%的患眼实际屈光度数与预期矫正度数在±0.50 D以内,68%的患眼实际屈光度数与预期矫正度数在±1.00 D以内.植入虹膜夹持型IOL的患者随访至术后1年时,78%的患眼实际屈光度数与预期矫正度数在±0.50 D以内,100%的患眼的实际屈光度数与预期矫正度数在±1.00 D以内.植入后房型IOL的患者随访至术后3个月时,95%的实际屈光度数与预期矫正度数在±0.50 D以内,100%的实际屈光度数与预期矫正度数在±1.00 D以内.房角支撑型IOL植入术后5年时角膜内皮细胞计数的减少与术前相比具有统计学意义(t=9.769,P=0.000),而植入虹膜夹持型IOL的患者在术后1年和植入后房型IOL的患者在术后3个月时的角膜内皮细胞计数与术前相比无统计学意义(t=1.180,0.583;P=0.249,0.566).术后1个月内分别有16只眼出现高眼压,局部应用降眼压眼液后恢复正常.植入房角支撑型IOL的患者术后最主要的并发症是瞳孔失圆,虹膜夹持组为夹持处虹膜色素的脱失,植入后房型IOL的患者为自然晶状体的混浊.结论 有晶状体眼IOL植入治疗高度近视早期预测性好、安全,但手术长期并发症的发生需要引起关注.(中华眼科杂志,2011,47:531-538)

Abstract：

Objective To evaluate the efficacy, safety and stability of three kinds of phakic intraocular lens implantation for the correction of high myopia. Methods This study included 208 eyes of 110 patients with a mean age of 31 years(21-53) from December 2003 to December 2009. Angle-supported lens(Phakic 6H, OII) were inserted into 113 eyes, iris-fixated lens(Artisan, OPHTEC) were inserted into 53 eyes and implantable contact lens(ICL) (V4, STAAR)were inserted into 41eyes. The average follow-up time of the three groups were 54.0 months(3-72 months), 15.7 months(3-24 months)and 7.2 months(3-15 months)respectively. Results At 3 months and 12 months, the efficacy indexes of the three groups were all above 1.00. Only the angle-supported group was followed up to 72 months postoperatively when the efficacy index dropped to 0.85, but still UCVA was 1.0 (20/20) or better in 16% eyes and 0.5 (20/40) or better in 85% eyes. The safety indexes of the three groups were always above 1.00 during the follow up. In the angle-supported group, 46% eyes were within ±0.50 D of the desired refraction and 68% eyes were within ±1.00 D at 5 years postoperatively. In the iris-fixated group, 78% eyes were within ±0.50 D of the desired refraction and 100% eyes were within ±1.00 D at 1 years postoperatively. In the ICL group, 95% eyes were within ±0.50 D of the desired refraction and 100% eyes were within ±1.00 D at 3 months postoperatively. No statistically significant differences were found between preoperative and 3-month postoperative endothelial cell density in the ICL group. Also, there was no statistically significant reduction in endothelial cell density at 1 years in the iris-fixated group. However, when preoperative and 5-year postoperative measurements were compared in the angle-supported group, the total decrease in cell density is statistically significant(t=9.769, P=0.000). 16 eyes developed high IOP within 1 month postoperatively which resolved after intervention. In the three groups(angle-supported, iris-fixated and ICL), the most common complications were pupil ovalization, iris atrophy plus pigment dispersion and lens opacification respectively. Conclusion Although phakic IOL implantation is predictable and safe for treatment of high myopia in short-term, the long-term complications should be concerned and treated well.     

Blendempfindlichkeit und Halos nach “phakic IOL”-Operation zur Behandlung einer hohen Myopie

BACKGROUND: Phakic IOLs are currently under clinical investigation for the correction of high myopia with acceptable postoperative refractive results. Although daytime vision is usually very good some patients complain of visual disturbances, described as glare and halos, during the night time, leading to difficulties in driving vehicles. PATIENTS AND METHODS: The quality of vision after phakic IOL surgery was investigated pre- and postoperatively using various tests for objective measurements of glare and halo in 40 myopic eyes (-9.0 to -20.0 D). Based on the implanted phakic IOL, eyes were divided into 4 groups of 10 eyes each where an Artisan 5.0 was implanted, an Artisan 6.0, a NuVita, and an ICL. RESULTS: All patients were happy with the postoperative refractive outcome and during daytime no visual discomfort was reported. In contrast, most patients reported visual disturbances during dim light conditions and at night time, described as glare and halos. The objective measurements showed in most eyes increased glare and halos which was most prominent in eyes with an ICL, followed by the NuVita IOL. In contrast, patients with an Artisan 6.0 reported significantly less glare and halo problems. CONCLUSIONS: All currently available phakic IOLs, in particular the ICL and the NuVita lead to a decreased visual performance during night time. Therefore, this phenomenon must be explained to the patient prior to surgery. An increase in the size of the optic should lead to an improvement with reduction of postoperative glare and halos.