有晶状体眼虹膜固定型人工晶状体植入术后房角宽度的改变

目的 使用光学相干断层扫描(optical coherence tomography,OCT)评估有晶状体眼虹膜固定型人工晶状体(intraocular lens,IOL)近视患者植入术后患者房角宽度的变化.方法 28眼(14例)近视患者植入虹膜固定型IOL矫正高度近视.观察术前、术后患者的等效球镜、角膜内皮细胞计数、眼压以及2点、3点、4点、8点、9点、10点钟位的房角宽度.结果 术前、术后等效球镜分别为(-12.95±0.77)D、(-0.35±0.08)D,差异有显著统计学意义(P＜O.001).术前、术后角膜内皮细胞计数分别为(2859.38±62.27) mm-2、(2783.92±62.67) mm-2,差异有统计学意义(P =0.012).术前、术后眼压分别为(11.87±0.40)mmHg(1 kPa=7.5 mmHg)、(11.80±0.40) mmHg,差异无统计学意义(P=0.800).术后3个月,3点、9点钟位房角较术前变窄,差异均有统计学意义(均为P＜0.05),其他方位房角宽度术前、术后差异均无统计学意义(均为P＞0.05).结论 植入虹膜固定型IOL后高度近视患者部分房角变窄,术后应对患者前房变化情况进行随访观察.     

Pupillary block after phakic anterior chamber intraocular lens implantation

A 49-year-old patient developed pupillary block glaucoma with an intraocular pressure (IOP) of 29 mm hg after implantation of a phakic intraocular lens (IOL) (NuVita, Bausch & Lomb) in the left eye. the anterior chamber deepened again, and the iop decreased to 16 mm hg after a neodymium: YAG iridotomy. Pupillary block glaucoma may occur after phakic IOL implantation without iridotomy, and we advocate that routine iridotomy be performed during phakic IOL surgeries.     

Safety of posterior chamber phakic intraocular lenses for the correction of high myopia: anterior segment changes after posterior chamber phakic intraocular lens implantation

OBJECTIVE: To assess the safety of posterior chamber phakic intraocular lens (PCPIOL) implantation in patients with high myopia. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Twenty eyes of 10 patients were included. INTERVENTION: Staar Collamer Implantable Contact Lens PCPIOLs were implanted for the correction of high myopia. MAIN OUTCOME MEASURES: Intra- and postoperative complications were recorded. Specular microscopy, lens fluorophotometry, laser flare-meter, and ultrasound biomicroscopy were performed before surgery and at different stages of the follow-up period to evaluate endothelial cell density, crystalline lens transmittance, aqueous flare, and anatomic relations of the implanted lenses with the other structures of the anterior segment. RESULTS: There were no intraoperative complications. One patient experienced pupillary entrapment by the lens in the immediate postoperative period, which was resolved without incident. Pigmentary dispersion or cataracts did not appear during the postoperative period. All the lenses remained correctly centered, and no patient reported night halos or glare. Anterior chamber depth showed a statistically significant reduction, between 9% and 12%. Central endothelial density was significantly decreased after surgery. The percentages of cell loss after 3, 6, 12, 18, and 24 months were 4.41%, 4.83%, 5.17%, 5.46%, and 6.57%, respectively. Aqueous flare increased by 49.19% in the first postoperative month in relation to preoperative values. Afterward, it decreased and then remained above preoperative values for the entire follow-up period (33.76% at month 3, 27.81% at month 6, 27.65% at month 12, 23.39% at month 18, and 27.27% at month 24). Crystalline lens transmittance decreased by 0.72% at month 3, by 1.44% at month 6, by 1.95% at month 12, by 2.25% at month 18, and by 2.24% at month 24. Finally, by ultrasound biomicroscopy it was observed that the PCPIOL and the crystalline lens were in contact on the peripheral level in 12 patients (60%) and in the center in another three patients (15%) during at least one checkup. In all the patients, contact between the PCPIOL and the posterior iris surface could be observed. CONCLUSIONS: Posterior chamber phakic IOL implantation for the surgical correction of high myopia is a safe procedure with regard to immediate visual and refractive results. The short-term clinical benefit and lack of immediate surgical complications are impressive. However, the increase in flare, the endothelial cell loss, the decrease in crystalline lens transmittance, and the iris-PCPIOL and crystalline lens-PCPIOL contact are findings that suggest caution regarding the long-term safety of this lens implant.     

新型中央孔型有晶状体眼后房型人工晶状体植入术后前房角的变化

目的：观察新型中央孔型有晶状体眼后房型人工晶状体(ICL)V4c植入术矫正高度近视术后前房角的变化。

方法：前瞻性临床研究。选择高度近视患者150例300眼,均行ICL V4c植入术,记录术前及术后1d,1、3、6mo,1a的视力、眼压、拱高及前房角的变化。采用重复测量方差分析及LSD-t检验对数据进行分析。

结果：术后1d,1、3、6mo,1a,裸眼视力(UCVA)恢复情况较术前显著提高(F=98.2,P<0.01); 术前与术后各时间点鼻侧AOD500、AOD750、TISA500、TISA750、SSA比较均有差异(F=108.256、112.342、164.856、316.549、115.338,均P<0.01); 术前与术后各时间点颞侧AOD500、AOD750、TISA500、TISA750、SSA比较均有差异(F=102.68、548.47、93.37、316.549、117.698,均P<0.01); 两侧术后1d,1、3mo各房角参数逐渐降低,两两比较均有差异(P<0.05),术后3、6mo,1a各房角参数两两相比均无差异(P>0.05)。

结论：ICL V4c植入术后1d,1、3、6mo,1a水平方向各房角参数较术前变小,3mo后基本趋于稳定状态。     

有晶状体眼虹膜固定型人工晶状体植入术后远期视觉质量

目的 探讨有晶状体眼虹膜固定型人工晶状体(verisyse iris-fixated phakic intraocular lens,Verisyse PIOL)植入术后患者的远期视觉质量.方法 选择行Verisyse PIOL植入术后20例(40眼)高度近视患者,观察术前及术后1个月、4.5a患者裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best spectacle-corrected visual acuity,BSCVA)、等效球镜(spherical equivalent,SE)、散光度等,并行患者满意度调查.结果 术后4.5 a UCVA≥0.5者34眼(87.2％),BSCVA≥0.5者39眼(100.0％);和术前相比,术后4.5 a UCVA、BSCVA差异均有统计学意义(t=15.73、6.52,P=0.00、0.00);术后4.5a与术后1个月相比,UCVA、BSCVA差异均无统计学意义(t=0.70、1.71,P=0.49、0.10);术后1个月UCVA、BSCVA与术前相比,差异均有统计学意义(t=15.94、6.38,P=0.00、0.00).术后4.5a,28眼(70.0％) UCVA等于或高于术前BSCVA,5眼(12.5％)UCVA低于术前BSCVA 2行以上.SE为0～-1.25(-0.34±0.35)D,与术后1个月(-0.31±0.55)D相比差异无统计学意义(t=0.25,P=0.80),38眼SE在预期的0～-1D之间.眼压稳定,为11～19(14.83±1.91) mmHg(1 kPa =7.5 mmHg).散光度术后1个月、术后4.5a分别为(1.57±0.81)D、(1.31±0.67)D,差异有统计学意义(P =0.037).患者满意度问卷调查显示,患者总体满意度较高.结论 Verisyse PIOL矫正高度近视安全有效,预测性好,远期疗效稳定,无严重并发症发生.     

有晶状体眼后房型人工晶状体植入术后前房及前房角的超声活体显微镜观察

目的 应用超声活体显微镜(UBM)评价有晶状体眼后房型人工晶状体(ICL)植入术后前房及前房角的变化.方法 前瞻性系列病例研究.分析15例(30只眼)高度近视患者术前及ICL植入术后1周、1、3、6个月及1年的眼压变化;末次随访(术后1年)时行UBM检查,测最中央前房深度(ACD)、ICL后表面与晶状体之间的距离、小梁虹膜夹角,ICL周边部与晶状体之间的距离.小梁虹膜夹角比较则采用非参数检验;ICL周边部与晶状体之间的距离采用One-way ANOVA分析;术前术后各时间点的眼压比较采用重复测量方差分析和Bonferroni检验;中央ACD比较采用配对t检验.结果 术前眼压为(13.75±2.27)mm Hg(1 mm Hg=0.133 kPa),术后1周、1个月、3个月、6个月及1年时眼压分别为(14.27±1.70)mm Hg、(14.70±2.07)mm Hg、(14.07±2.24)mm Hg、(14.00±2.69)mm Hg和(13.97±2.95)mm Hg,术前及术后各次眼压间进行比较,发现仅术后1个月时眼压与术前、术后3个月时眼压比较差异有统计学意义(t=-3.706、3.898,P<0.05).UBM检查发现中央角膜内表面与晶状体之间的距离为(2.97±0.11)mm,中央角膜内表面与ICL之间的距离为(2.24±0.21)mm,两者之间差异有统计学意义(t=20.63,P<0.01).小梁虹膜夹角在钟表位12:00、3:00、6:00、9:00位差异无统计学意义,仅55.8%手术眼的小梁虹膜夹角>30°,ICL周边部与晶状体之间的距离在钟表位12:00、3:00、6:00、9:00位差异无统计学意义.ICL后表面与晶状体之间的距离为(0.63±0.16)mm,ICL与晶状体无接触.结论 ICL植入术后ICL位于晶状体前,致使术后中央ACD变浅、部分手术眼前房角宽度变窄.ICL与晶状体无接触,与虹膜后表面接触.     

Long-term results of implantation of phakic posterior chamber intraocular lenses

PURPOSE: To study the incidence and progression of lens opacification after implantation of phakic posterior chamber intraocular lenses for myopia and its correlation with vaulting and endothelial cell density (ECD). SETTING: Department of Ophthalmology, University of Vienna Medical School, Vienna, Austria. METHODS: An implantable contact lens (ICL V4, Staar Surgical Inc.) was inserted in 76 myopic eyes. Patients were prospectively followed preoperatively and at 1, 3, 6, 12, 24, and 36 months. The uncorrected visual acuity and best corrected visual acuity (BCVA) were determined. Vaulting was measured optically with a Jaeger II pachymeter, and the crystalline lens was examined at the slitlamp for the presence and characteristics of opacification. Endothelial cell morphometry was performed by specular microscopy, and the ECD was calculated. Eyes in which lens opacification developed were followed for at least 12 months to determine the degree and course of visual impairment. RESULTS: Lens opacification occurred in 11 eyes (14.5%). Opacification was correlated with intraoperative trauma to the crystalline lens, age older than 50 years, and decreased ECD values throughout the observation period. Vaulting of the ICL did not correlate with the risk for lens opacification. After onset of lens opacification, 6 eyes (55%) had a stable BCVA within +/-0.5 lines and 5 eyes had progressive opacification, losing between 3.5 lines and 0.5 lines (mean 1.8 lines +/- 1.1 [SD]). Three eyes (3.9%) in the progressive group had a 1- to 2-line loss of BCVA over preoperative values and subsequently had cataract surgery. CONCLUSIONS: Risk factors for lens opacification after implantation of the model V4 ICL included intraoperative trauma to the crystalline lens and older age. Decreased ECD in eyes with opacification suggests ongoing inflammation as a cause. Patients younger than 45 years may have a significantly lower incidence of opacification.     

Five-year follow-up after anterior iris-fixated intraocular lens implantation in phakic eyes to correct high myopia

Purpose

To evaluate the 5-year follow-up of safety, efficacy, predictability, stability, and complications of anterior iris-fixated phakic intraocular lens (pIOL) implantation to correct high myopia, and patients'' satisfaction after implantation.

Design

Prospective, nonrandomized, and comparative (self-controlled) trial.

Methods

A prospective clinical trial of 84 eyes of 43 patients with high myopia was conducted. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, endothelial cell count, intraocular pressure (IOP), anterior chamber depth, slit lamp biomicroscopy, and indirect ophthalmoscope were measured preoperatively and postoperatively.

Results

At the 5-year follow-up, UCVA was significantly improved, with 85.7% of eyes reaching 20/25 or better. No eyes experienced a loss in BSCVA, and 71.4% gained one or more lines of their preoperative BSCVA. There was a significant reduction in spherical errors in all patients after operation. Loss of endothelial cells was observed 3 years after operation and no more loss was observed 4 years after operation in statistical analysis. No increase in IOP was observed 5 years after operation in statistical analysis. No intraoperative complications were observed in this study. However, pigment precipitates of varying intensities on the lens optic were noted in all patients 1 day after operation, and only five eyes were observed to have the pigment residual five years after operation.

Conclusion

At the 5-year follow-up, the implantation of the anterior iris-fixated pIOL was proved to be effective, predictable and capable of reversibility to correct high myopia in phakic eyes. It was a safety addition to the laser refractive surgery. However, longer follow-up with larger numbers of patients is still necessary to evaluate long-term complications.     

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。     

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。     

Severe endothelial cell loss with anterior chamber phakic intraocular lenses

We report the case of a highly myopic patient who developed severe bilateral endothelial cell loss following implantation of 2 angle-supported anterior chamber pIOL models, the Acrysof Cachet and the GBR (currently off the market). FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.     

Corneal edema and penetrating keratoplasty after anterior chamber phakic intraocular lens implantation

Phakic intraocular lens (IOL) implantation is an increasingly popular option in surgical correction of refractive error. To date, reports of long-term morbidity are infrequent in the literature. We encountered 3 patients who experienced corneal decompensation and cataract progression following angle-fixated anterior chamber phakic IOL placement.     

Intraocular pressure in myopic patients after Worst-Fechner anterior chamber phakic intraocular lens implantation

PURPOSE: To assess intraocular pressure measured with a Goldmann tonometer over a period of 1 year after implantation of a Worst-Fechner anterior chamber phakic intraocular lens to correct myopia of -7.00 D or more. METHODS: We performed a prospective, non-masked study of 100 patients (100 myopic eyes) who had a Worst-Fechner phakic intraocular lens implanted to correct myopia of -7.00 D or greater. Central corneal Goldmann tonometry was performed before surgery and 1, 3, 6, and 12 months after surgery. The influence of different variables was assessed. RESULTS: IOP showed a significant increase of a mean 2.1 mmHg at 3 months after surgery (P=.001). There was not a statistically significant difference between IOP before surgery and 6 months after PIOL implantation (P=.244) or 1 year after surgery (P=.845). In one eye, the lens was explanted 11 months after surgery because of the presence of ocular hypertension. No variables studied showed a statistically significant difference from before to after surgery. CONCLUSIONS: Worst-Fechner anterior chamber phakic intraocular lens implantation led to a slight transitory increase of intraocular pressure during the first 3 months after surgery, but returned to preoperative levels by 6 months after implantation.     

前房深度对有晶状体眼后房型人工晶状体植入术后前房形态的影响

目的观察术前前房深度（ACD）对有晶状体眼后房型人工晶状体（PPC-ICL）植入术后房角形态的影响。方法回顾性系列病例研究。连续选取已接受PPC-ICL植入术的近视患者80例（132眼）。根据患者术前ACD分为3组：A组：ACD＜3.0 mm;B组：3.0≤ACD＜3.5 mm;C组：ACD≥3.5 mm。术前和术后3个月时分别采用前节光学相干断层扫描仪（AS-OCT）对患者进行眼前节生物测量。检测指标包括中央ACD、0°与180°方位房角开放距离（AOD500）、虹膜小梁空间面积（TISA500）和巩膜突角（SSA）。使用方差分析、直线相关分析和配对t检验对数据进行分析。结果所有患者术前AOD500（0°、180°）（r=0.51、0.47）,TISA500（0°、180°）（r=0.55、0.52）和SSA（0°、180°）（r=0.46、0.58）测量值均与ACD呈正相关（P＜0.01）。术后3个月时,3组患者平均ACD、AOD500、TISA500以及SSA测量值较术前均下降（P＜0.05）。3组患者的AOD500（F=7.00、5.08）、TISA500（F=6.42、3.06）以及SSA（F=7.20、4.73）差异有统计学意义（P＜0.05）,其中A组患者的3个指标值均低于B组和C组（P<0.01）,而B组和C组相比差异无统计学意义。3组患者的AOD500、TISA500和SSA在术后发生相同比例的下降,差异无统计学意义。3组拱高差异有统计学意义（F=5.37,P＜0.05）,A组和B组拱高均显著低于C组（P<0.05）。术后3个月时AOD500（0°、180°）（r=0.54、0.50）,TISA500（0°、180°）（r=0.49、0.48）及SSA（0°、180°）（r=0.60、0.61）手术前后变化率均与拱高呈正相关（P＜0.01）。3组患者随访期内均未见房角关闭,手术前后眼压差异均无统计学意义。结论PPC-ICL植入术后房角形态发生显著改变,浅前房患者术后前房更浅、房角更窄,且拱高较高者术后前房形态改变更为明显。     

Anterior chamber iris-fixated phakic intraocular lens for anisometropic amblyopia

We report a child who had implantation of an iris-fixated Artisan phakic intraocular lens (IOL) to correct high unilateral myopia to support the therapy of anisometropic amblyopia. After IOL implantation, the patient continued occlusion therapy to further treat the amblyopic eye. One year postoperatively, the best corrected visual acuity in the amblyopic eye was 1.00 and binocular stereovision had developed. The visual acuity remained stable through 3 years of follow-up. There were no complications, although postoperative endothelial cell loss was significant.