Position of angle-supported, iris-fixated, and ciliary sulcus-implanted myopic phakic intraocular lenses evaluated by Scheimpflug photography

PURPOSE: To examine postoperative positional stability of myopic phakic intraocular lenses (IOLs). DESIGN: Prospective, nonrandomized clinical study. METHODS: The study included 46 eyes which received an anterior chamber angle-supported (Bausch & Lomb NuVita; 10 eyes), anterior chamber iris-fixated (Ophtec Artisan; 20 eyes) or ciliary sulcus-implanted phakic IOL (Staar ICL; 16 eyes). The distance between the phakic IOL and the crystalline lens and the cornea as well as rotation around the optical axis was evaluated using Scheimpflug photography at 1, 3 to 6, and 12 months postsurgery. RESULTS: The anterior chamber phakic IOLs showed no significant movement in anteroposterior direction. The posterior chamber phakic IOL showed a significant movement toward the crystalline lens between postoperative months 3 and 12. The median amount of rotation around the optical axis between the 3- and the 12-month evaluation was 1.9 degrees (range = 0.0-33.5 degrees) for the NuVita, 0.6 degrees (range = 0.0-3.5 degrees) for the Artisan, and 0.9 degrees (range = 0.2-2.3 degrees) for the ICL. Four NuVita IOLs rotated more than 10 degrees. CONCLUSIONS: The angle-supported anterior chamber phakic IOLs showed a generally stable position regarding distance to cornea and natural lens, but rotation was observed in four IOLs. The iris-fixated phakic IOL showed the highest overall stability. The posterior chamber phakic IOL was stable in terms of rotation but had a tendency to decrease in distance toward the crystalline lens. Intraocular lenses implanted in phakic eyes followed for 12 months demonstrate stable IOL position overall.     

Ultrasound biomicroscopy of silicone posterior chamber phakic intraocular lens for myopia

PURPOSE: To study the intraocular position and anatomic relationships of PRL-III (phakic refractive lens) (PRL) posterior chamber phakic intraocular lens (PCP IOL) for high myopia using ultrasound biomicroscopy (UBM). SETTING: Centro Oftalmológico Real Vision, and Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain. METHODS: Sixteen phakic myopic eyes that had had PRL implantation were examined by UBM 1 month after surgery. The PRL position, PRL-crystalline lens peripheral distance, and central distance between the corneal endothelium and the PRL were measured. RESULTS: Both haptics were on the zonule in 6 eyes, in the ciliary sulcus in 5 eyes, and impacted in the ciliary body in 1 eye. In the 4 remaining eyes, the haptics were in mixed positions. The mean PCP IOL crystalline lens peripheral distance in the minor axis was 588.1 microm +/- 232.5 (SD), and the mean PCP IOL-endothelium central distance was 2082.8 +/- 277.6 microm. CONCLUSIONS: Phakic refractive lens implantation should be done carefully because of the sulcus location of the haptics in many cases. This, with the iris-PRL contact, suggests caution for the long-term outcome.     

High-frequency ultrasound biomicroscopy of silicone posterior chamber phakic intraocular lens for hyperopia

PURPOSE: To study the intraocular position and anatomic relationships of the PRL-III phakic refractive lens (PRL), a posterior chamber phakic intraocular lens (PCP IOL), in cases of hyperopia using ultrasound biomicroscopy (UBM). SETTING: Centro Oftalmológico Real Vision, Madrid, Spain, and Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense, Madrid, Spain. METHODS: Eleven phakic hyperopic eyes of 6 patients who had PRL implantation were examined by UBM 1 month after surgery. The PRL position, PRL-crystalline lens peripheral distance, and central distance between the corneal endothelium and the PRL were measured. RESULTS: Eight eyes had both haptics on the zonule, 2 had 1 haptic in the sulcus and 1 on the zonule, and 1 had 1 haptic in the sulcus and the other in the ciliary body. The mean PCP IOL-crystalline lens peripheral distance in the minor axis was 239.7 microm +/- 179.4 (SD) and the mean PCP IOL-endothelium central distance, 2146.98 +/- 219.6 microm. Contact between the PCP IOL and crystalline lens was observed in 1 eye. CONCLUSIONS: In this study of hyperopic eyes, the PRL was located on the zonule in most cases. However, the location of the haptics in the sulcus and contact between the PCP IOL and the crystalline lens that occurred in some cases suggest further study of possible long-term complications is needed.     

Ultrasound biomicroscopy of the Artisan phakic intraocular lens in hyperopic eyes

PURPOSE: To study in situ the intraocular position of the Artisan iris-claw intraocular lens (IOL) (model 203) (Ophtec) in phakic hyperopic eyes using ultrasound biomicroscopy (UBM). METHODS: Echograms of the anterior chamber were taken preoperatively and 24 to 317 days postoperatively in 4 eyes implanted with the Artisan IOL (power +4.0 to +6.0 diopters). The preoperative anterior chamber depth (ACD) and the postoperative distance between the IOL and the corneal endothelium (endothelium-optic distance) and between the IOL and the lens were measured. The echograms were assessed for the effect of the IOL on iris tissue. RESULTS: The preoperative ACD ranged from 3.10 to 3.56 mm and the postoperative endothelium-optic distance, from 2.03 to 2.54 mm. The distance between the lens and the posterior surface of the IOL ranged from 0.35 to 0.79 mm. Several UBM echograms showed indentation of iris tissue by the IOL haptics and optic edge, although no pigmentary dispersion was noted. CONCLUSIONS: Adequate space was maintained between the Artisan hyperopic IOL and the corneal endothelium, angle, and crystalline lens. Haptic indentation of the iris, which could lead to pigment erosion, was observed. Preoperative gonioscopy and maintenance of normal intraocular pressure postoperatively suggest the indentation was secondary to inadequate lens vaulting relative to the high natural arch of the iris in hyperopic eyes. Shortening the haptics or increasing the lens vault might resolve this problem.     

Iridocyclitis associated with angle-supported phakic intraocular lenses

PURPOSE: To evaluate incidence, features, risk factors, and prognosis of iridocyclitis after angle-supported phakic intraocular lens (IOL) implantation. SETTING: Private practice, Siena, Italy. METHODS: This retrospective analysis comprised 356 consecutive eyes of 212 patients. In myopic eyes, the ZSAL-4 IOL (205 eyes of 125 patients) or the ZSAL-4 Plus IOL (106 eyes of 63 patients) was used. In hyperopic eyes (45 eyes of 24 patients), the Type 54 IOL was implanted. Haptic posterior angulation was 19 degrees (ZSAL-4), 23 degrees (ZSAL-4 Plus), and 14 degrees (Type 54). RESULTS: Clinically significant iridocyclitis occurred in 11 eyes (3.1%) of 11 patients. Mean patient age was 37.3 years +/- 9.4 (SD). Sixty-four percent were male (odds ratio [OR], 3.0; 95% confidence interval [CI], 0.8 to 7.4, not statistically significant). Iridocyclitis was observed in 4.4% of hyperopic eyes (OR, 1.6; 95% CI, 0.3 to 7.4; not statistically significant) and in 2.9% of myopic eyes. In myopic eyes, it followed the implantation of ZSAL-4 IOL in 3.9% of eyes (OR, 4.1; 95% CI, 0.5 to 33.6; not statistically significant), and of ZSAL-4 Plus IOL in 1%. Mean time from surgery was 8.5 +/- 10.6 months). Presentation included aqueous flare (100%), posterior synechiae (82%), blurred vision (82%), redness (36%), pain (27%), IOL precipitates (18%), and angular synechiae (9%). Only 1 patient had recurrences, leading to IOL explantation and cataract surgery. After topical therapy, best spectacle-corrected visual acuity was fully recovered in 9 of 11 eyes. CONCLUSION: Iridocyclitis can occur months or years after the implantation of angle-supported phakic IOLs. No statistically significant risk factors were identified. Functional prognosis is generally good.     

Pigment dispersion and Artisan phakic intraocular lenses: crystalline lens rise as a safety criterion

PURPOSE: To validate the theory that crystalline lens rise can be used as a safety criterion to prevent pigment dispersion in eyes with an Artisan phakic intraocular lens (IOL) (Ophtec BV). SETTING: Monticelli Clinic, Marseilles, France. METHOD: A comparative analysis of crystalline lens rise in 9 eyes with pigment dispersion and 78 eyes without dispersion was performed. All eyes had previous implantation of an Artisan IOL. Anterior segment imaging was done using an anterior chamber optical coherence tomography (AC OCT) prototype. Crystalline lens rise was defined by the distance between the anterior pole of the crystalline lens and the horizontal plane joining the opposite iridocorneal recesses. RESULTS: The study confirmed that crystalline lens rise can be considered a safety criterion for implantation of Artisan-type phakic IOLs. The higher the crystalline lens rise, the greater the risk for developing pigment dispersion in the area of the pupil. This complication occurred more frequently in hyperopic eyes than in myopic eyes. Results indicate there is little or no risk for pigment dispersion if the rise is less than 600 microm; 67% of eyes with a rise of 600 microm or more developed pupillary pigment dispersion. In some cases in which the IOL was loosely fixated, there was no traction on the iris root and dispersion was prevented or delayed. CONCLUSIONS: Crystalline lens rise should be considered a new safety criterion for Artisan phakic IOL implantation and should also be applied to other types of phakic IOLs. The distance remaining between the crystalline lens rise and a 600 microm theoretical safety level allows one to calculate how long the IOL can safely remain in the eye.     

Surgical correction of severe myopia with an angle-supported phakic intraocular lens

PURPOSE: To evaluate the effectiveness, predictability, and safety of a fourth-generation angle-supported anterior chamber phakic intraocular lens (IOL) in patients with severe myopia. SETTING: Refractive Surgery and Cornea Unit, Alicante Institute of Ophthalmology, Miguel Hernández University School of Medicine, Alicante, Spain. METHODS: In this prospective study, 23 eyes (16 patients) with a mean preoperative myopia of -19.56 diopters (D) +/- 1.76 (SD) (range -16.75 to -23.25 D) were implanted with the ZSAL-4 phakic IOL. Basic examinations were performed before and after surgery in all patients. Eighteen eyes were also studied by clinical specular microscopy, and the endothelium was analyzed for cell density, coefficient of variation in cell size, and hexagonality. The location of the IOL in the anterior chamber was evaluated in 10 eyes by A-scan biometry. To evaluate haptic geometry, a theoretical mechanical model was used. The follow-up was 24 months in all patients. RESULTS: Uncorrected visual acuity was 20/40 or better in 13 eyes (56.0%) 12 months after surgery and in 14 eyes (60.8%) at 24 months. Best spectacle-corrected visual acuity improved 0.19 at 12 and 24 months (0.1 = 1 line) from preoperative values. The efficacy index was 1.12 at 24 months and the safety index, 1.45. The mean postoperative spherical equivalent was -0.65 +/- 0.65 D at 24 months. The postoperative spherical equivalent was within +/-1.00 D of emmetropia in 19 eyes (82.6%) at 12 and 24 months. The mean endothelial cell loss was 3.50% at 12 months and 4.18% at 24 months. The coefficient of variation in cell size decreased from 0.34 before surgery to 0.28 at 24 months after surgery. The IOL was located 0.79 +/- 0.24 mm in front of the crystalline lens. Postoperative complications included night halos in 6 eyes (26.1%) at 12 and 24 months and pupil ovalization in 4 eyes (17.4%). Intraocular lens rotation was observed in 10 eyes (43.5%) at 24 months. Two eyes (8. 7%) developed a slight inflammatory response during the first 6 months. Our mechanical model predicted that the compression forces against the angle structures were greater at the first footplate than at the second. CONCLUSIONS: Implantation of the ZSAL-4 IOL in the anterior chamber of phakic eyes was effective and predictable in correcting severe myopia. However, the ZSAL-4 did not prevent pupil ovalization, IOL rotation, or low-grade postoperative uveitis. Improvements in haptic design following our mechanical model could decrease these haptic-related complications.     

有晶状体眼前房角固定型人工晶状体植入术的进展

有晶状体眼前房角固定型人工晶状体植入术是近年来发展起来的矫正高度和超高度近视的一项新技术，随着晶状体材料的改良和临床经验的积累，这种屈光手术逐渐显示出了安全、有效、预测性好、可逆性、保留调节功能和对角膜内皮损伤小等优点。因此，在未来的几年里，前房角固定型人工晶状体植入术作为一种屈光手术将会扩大它的临床应用范围。就该手术的历史、人工晶状体的设计、手术适应证与禁忌证、手术技术、并发症及其防治等方面进行综述。     

Position of myopic iris-claw phakic intraocular lens by Scheimpflug photography and ultrasound biomicroscopy

PURPOSE: To evaluate the position of iris-claw phakic intraocular lens (ICPIOL) in highly myopic eyes by Scheimpflug photography (SP) and ultrasound biomicroscopy (UBM). METHODS: Nine eyes of five patients aged 31+/-10 years with average spherical equivalent of -16.04+/-5.46 D (range -7.88 to - 22.88 D) were enrolled in this prospective study and implanted with Verisyse ICPIOLs (AMO). The anterior segment was evaluated by SP and UBM preoperatively and for at least 1 month postoperatively. The statistical significance may be questionable due to the limited number (nine) of eyes. RESULTS: By SP and UBM, the distance between corneal endothelium and lens (anterior chamber depth) preoperatively was 3.10+/-0.14 and 3.07+/-0.11 mm, respectively; between ICPIOL and corneal endothelium (pseudo-anterior chamber depth), 1.88+/-0.09 and 1.99+/-0.12 mm, respectively; between lens and posterior surface of ICPIOL (IL), 0.76+/-0.13 and 0.67+/-0.06 mm, respectively; between superior optic edge and iris (SOEI), 0.23+/-0.23 and 0.58+/-0.24 mm, respectively; between inferior optic edge and iris (IOEI), 0.07+/-0.13 and 0.41+/-0.22 mm, respectively; between ICPIOL haptics and the angle of anterior chamber (HA), 0.90+/-0.17 and 1.45+/-0.13 mm, respectively. ACD was well correlated between the two methods, but PACD, IL, OEI, HA were not. The postoperative measures, except IL, were significantly different between the two methods. CONCLUSION: The differences between measurements by SP and UBM reveal the ICPIOL's position variations with change of body position. Nevertheless, it seems adequate that space is maintained between ICPIOL and corneal endothelium, angle, and crystalline lens. The ICPIOL implanted in phakic eyes seems a safe alternative for treatment of high myopia.     

虹膜夹型人工晶状体矫正高度近视的前节OCT检查分析

目的:使用前节OCT分析高度近视植入虹膜夹型人工晶状体后眼内的结构变化。方法:植入前房晶状体矫正高度近视6眼(11.5D至22.0D),使用前节OCT采集前节图像测量术前前房深度,术后人工晶状体与角膜内皮间距离(内皮—晶状体距离),人工晶状体与正常晶状体间距离。结果:术前前房深度为3.27～3.91mm,术后内皮—晶状体距离为2.07～2.24mm。人工晶状体后表面与正常晶状体间的距离为0.82～1.32mm。图像显示虹膜色素层没有明显改变。结论:前房深度较术前减少36.1%～44.6%。前节OCT对于检测虹膜夹型前房晶状体的位置有帮助。     

Ultrasound Biomicroscopy of Iris-claw Phakic Intraocular Lens Implantation

Purpose: To study in situ the intraocular position of iris-claw phakic intraocular lens (ICPIOL) in myopic eyes using ultrasound biomicroscopy (UBM). Methods: UBM echograms of the anterior segment were taken preoperatively and 62 to 115 days postoperatively in 6 eyes implanted with the Verisys ICPIOL (AMO). The echograms were assessed for the effect of the ICPIOL on iris tissue. Results: The preoperative distance between the corneal endothelium and the lens ranged from 2.96 to 3.09 mm, and the postoperative distance between the ICPIOL and the corneal endothelium, from 1.86 to 2.03 mm. The distance between the lens and the posterior surface of the ICPIOL ranged from 0.61 to 0.76 mm. The distance between the superior, inferior optic edge and the iris ranged from 0.49 to 1.00 mm, 0.21 to 0.51 mm respectively. The shortest distance between the ICPIOL haptics and the angle of anterior chamber ranged from 1.25 to 1.65 mm. The indentation of iris tissue by the ICPIOL haptics without pigmentary dispersion and distortion of posterior curvature of iris was observed. Conclusion : Adequate space is maintained between the Verisyse myopic ICPIOL and the corneal endothelium, angle, and crystalline lens. Haptic indentation of the iris without pigment erosion and distortion of iris curvature is noted. The ICPIOL implanted in phakic eyes is a safe alternative for treatment of high myopia.     

Intraokularlinsen zur Korrektur von Refraktionsfehlern

In this overview, the current status of intraocular lens surgery to correct refractive error is reviewed. The interventions are divided into additive surgery with intraocular lens implantation without extraction of the crystalline lens (phakic intraocular lens, PIOL) or the removal of the crystalline lens with implantation of an IOL (refractive lens exchange, RLE). Phakic IOLs are constructed as angle-supported or iris-fixated anterior chamber lenses and posterior chamber lenses that are fixated in the ciliary sulcus. The implantation of phakic IOLs has been demonstrated to be an effective, safe, predictable and stable procedure to correct higher refractive errors. Complications are rare and differ for the three types of PIOL; for anterior chamber lenses these are mainly pupil ovalization and endothelial cell loss.     

Intraocular lenses for the correction of refraction errors. Part 1: phakic anterior chamber lenses

In this overview, the current status of intraocular lens surgery to correct refractive error is reviewed. The interventions are divided into additive surgery with intraocular lens implantation without extraction of the crystalline lens (phakic intraocular lens, PIOL) or the removal of the crystalline lens with implantation of an IOL (refractive lens exchange, RLE). Phakic IOLs are constructed as angle-supported or iris-fixated anterior chamber lenses and posterior chamber lenses that are fixated in the ciliary sulcus. The implantation of phakic IOLs has been demonstrated to be an effective, safe, predictable and stable procedure to correct higher refractive errors. Complications are rare and differ for the three types of PIOL; for anterior chamber lenses these are mainly pupil ovalization and endothelial cell loss.     

Vorderkammerintraokularlinsen bei Aphakie

The intraocular correction of aphakia in the anterior chamber currently consists of two options: an angle supported intraocular lens (IOL, Kelman Multiflex) and an iris fixated IOL (Artisan/Verisyse). The angle supported IOL is fixated with four haptic points in the anterior chamber and the iris fixated IOL is enclavated to the anterior iris surface. Acceptable results of both IOLs are reported in the literature; however both IOLs show some long-term complications in some eyes. Alternatives to these anterior chamber IOLs to correct aphakia are the retropupillary fixated Artisan and sclera fixated IOLs.     

Anterior segment OCT and phakic intraocular lenses: a perspective

Perfect tolerance is expected when one implants a phakic intraocular lens (pIOL) in the anterior segment. Not only should the material be compatible, but the pIOL must respect the anatomy of the anterior chamber. Based on 3 years of experience using an anterior segment optical coherence tomographer (Visante OCT, Carl Zeiss Meditec), I have defined numerous safety criteria for pIOLs. The internal dimensions of the anterior chamber must be considered along different meridians. I propose an objective measurement of the iris dome, the crystalline lens rise (CLR), which is the distance between the anterior pole of the crystalline lens and a line joining the 2 opposite iridocorneal angles. In a series with the Artisan IOL (Ophtec), pigment dispersion syndrome appeared in 70% of cases in which the CLR was greater than 600 microm. Angle-supported IOLs must be placed relative to the anterior chamber's largest diameter; in the same series of cases, the anterior chamber was oval with a large vertical axis in 74% of cases. The posterior face of an angle-supported IOL must have a 700 microm vault to respect the physiological modifications of the crystalline lens. It is difficult to know the posterior chamber's exact diameter as it varies with the horizontal or vertical axis. It also undergoes constant modifications due to accommodation and aging.     

Air-assisted Descemet-stripping automated endothelial keratoplasty with posterior chamber iris-fixation of aphakic iris-claw intraocular lens

We report a combination of surgical techniques during Descemet-stripping automated endoithelial keratoplasty and intraocular lens (IOL) exchange in patients with pseudophakic bullous keratopathy and angle-supported anterior chamber IOLs. During this procedure, the anterior chamber IOL is exchanged for a posterior chamber iris-claw IOL enclavated to the posterior iris; the anterior chamber is kept filled with air using an air-fluid exchange machine during descemetorhexis and insertion of the donor endothelial disk.     

Ultrasound biomicroscopy and Scheimpflug photography of angle-supported phakic intraocular lens for high myopia

PURPOSE: To evaluate the equivalence of Scheimpflug photography (SP) and ultrasound biomicroscopy (UBM) in determining corneal epithelium-intraocular lens (IOL) and border IOL-iris distances. SETTING: Universit?t Erlangen-Nuremberg, Erlangen, Germany. METHODS: In 26 eyes of 17 patients who had a NuVita MA20 angle-supported anterior chamber intraocular lens (Chiron-Domilens), SP and UBM were used to evaluate the distance between the endothelium and the anterior IOL face in central and peripheral regions (12 o'clock and 6 o'clock positions) and between the border of the anterior IOL face and the iris. The Wilcoxon test was used for statistical analysis. RESULTS: The mean central endothelium-anterior IOL face distance was 2.01 mm and 2.00 mm by SP and UBM, respectively. The mean peripheral endothelium-anterior IOL border distance was 1.28 mm and 1.58 mm, respectively, and the mean peripheral anterior IOL face-iris distance, 0.89 mm and 0.75 mm, respectively. CONCLUSIONS: The difference between the 2 methods in the central endothelium-anterior IOL face distance was not significant (methods were equivalent), but the difference in the peripheral endothelium-anterior IOL face distance was. This may be the result of difficulty in obtaining the exact transition point between the IOL and the haptics by SP examination. The difference between the 2 methods in the IOL border-iris distance was also significant because of the irregularity of the iris surface; therefore, measurements were performed at different sites along this structure. The significant differences in the peripheral endothelium-IOL and IOL border-iris distances indicate that although both methods are useful, they are not equivalent.     

Scheimpflug biometry of the anterior segment after implantation of foldable iris-fixated lenses

PURPOSE: To evaluate intraocular dimensions of the anterior segment of myopic phakic eyes after implantation of foldable iris-fixated lenses. METHODS: Seventeen myopic eyes that received a foldable iris-fixated phakic intraocular lens (PIOL) were assessed. Distances between the cornea and the IOL-optic edge and between the IOL optic and the crystalline lens were evaluated using Scheimpflug photography 3 months postoperatively. RESULTS: The average postoperative distance between the central corneal endothelium and the anterior surface of the IOL was 2.01 +/- 0.26 mm. The distance between the corneal endothelium and the peripheral edge of the IOL averaged 1.32 +/- 0.18 mm at the 12 o'clock position and 1.34 +/- 0.21 mm at the 6 o'clock position. The distance between the crystalline lens and the posterior surface of the IOL averaged 0.73 +/- 0.09 mm. CONCLUSIONS: The high quality of the three-dimensional Scheimpflug images allowed measurements of intraocular distances in PIOL implanted eyes. Distances between the foldable iris-fixated IOL and crucial surrounding tissues could be determined 3 months postoperatively.     

Biometry of phakic intraocular lens using Scheimpflug photography

PURPOSE: To examine lateral and axial positioning of phakic intraocular lenses (IOLs) with iris fixation in the anterior chamber and to examine short-term stability of the IOL position. SETTING: The Netherlands Opthalmic Research Institute, Amsterdam, the Netherlands. METHODS: Thirty patients participated in the study. Thirty-one eyes were implanted with the 204 type myopia IOL, 14 eyes with the 206 myopia IOL, and 8 eyes with the 203 hyperopia IOL. Scheimpflug slitlamp photographs were made through the optical axis along 4 meridians of the eyes. Ray tracing was used to obtain the lateral and axial position of the IOLs. RESULTS: Centration of the IOL with respect to the pupil's center and the tilt angle of the IOL with respect to the optical axis of the eye were measured. Standard deviation of decentration was 0.21 mm vertically and 0.16 mm horizontally. Standard deviation of tilt was 1.30 degrees vertically and 0.90 degrees horizontally. Tilt and decentration are proportional to each other. Vaulting, the distance between the crystalline lens and the IOL, was constant over a period of 24 months, ranging from 0.2 to 0.8 mm, depending primarily on the radius of curvature of the crystalline lens. A geometric model for this dependence was formulated. CONCLUSION: Phakic IOLs with iris fixation can be positioned in the eye with submillimeter precision. Axial position of iris-fixated phakic IOLs over time is excellent. Axial position and vaulting can be predicted when the radius of curvature of the crystalline lens is known. The IOL behaves as if mounted slightly above a sphere-the anterior surface of the crystalline lens.     

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。