Clinical prediction of insufficient vaults after implantable collamer lens implantation

AIM: To determine the factors related to preoperative ocular characters that are predictive of insufficient vault (<250 μm) after implantable collamer lens (ICL V4c; STAAR Surgical) implantation. METHODS: The participants underwent ICL surgery and were divided into the low (<250 μm) and normal (250-1000 μm) vault groups based on the postoperative vault at 3mo. The preoperative biometric parameters and clinical outcomes were compared between the two groups. The relationship between the 3-month vault values and preoperative ocular parameters were evaluated by Generalized estimating equations. RESULTS: Sixteen (23 eyes) and 36 patients (63 eyes) were in the low and normal vault groups, respectively. All implantation procedures were uneventful with no cataract formation in the early postoperative period. The sulcus-to-sulcus lens rise (STSL) and iris ciliary angle (ICA) were correlated with vault at 3mo after surgery. Every 0.1 mm increase in STSL was associated with 38.9 μm decrease in the postoperative 3-month vault. A rise of 1 degree in ICA is associated with a reduction of 4 μm in vault. CONCLUSION: Eyes with a narrow ciliary sulcus are associated with a higher rate of low vault after ICL implantation, suggesting a need for adjustments to the ICL size in these patients. Evaluating the characteristics of the ciliary sulcus contributes valuable information to predict low vault after surgery.     

Vault predicting after implantable collamer lens implantation using random forest network based on different features in ultrasound biomicroscopy images

AIM: To analyze ultrasound biomicroscopy (UBM) images using random forest network to find new features to make predictions about vault after implantable collamer lens (ICL) implantation. METHODS: A total of 450 UBM images were collected from the Lixiang Eye Hospital to provide the patient’s preoperative parameters as well as the vault of the ICL after implantation. The vault was set as the prediction target, and the input elements were mainly ciliary sulcus shape parameters, which included 6 angular parameters, 2 area parameters, and 2 parameters, distance between ciliary sulci, and anterior chamber height. A random forest regression model was applied to predict the vault, with the number of base estimators (n_estimators) of 2000, the maximum tree depth (max_depth) of 17, the number of tree features (max_features) of Auto, and the random state (random_state) of 40.0. RESULTS: Among the parameters selected in this study, the distance between ciliary sulci had a greater importance proportion, reaching 52% before parameter optimization is performed, and other features had less influence, with an importance proportion of about 5%. The importance of the distance between the ciliary sulci increased to 53% after parameter optimization, and the importance of angle 3 and area 1 increased to 5% and 8% respectively, while the importance of the other parameters remained unchanged, and the distance between the ciliary sulci was considered the most important feature. Other features, although they accounted for a relatively small proportion, also had an impact on the vault prediction. After parameter optimization, the best prediction results were obtained, with a predicted mean value of 763.688 μm and an actual mean value of 776.9304 μm. The R² was 0.4456 and the root mean square error was 201.5166. CONCLUSION: A study based on UBM images using random forest network can be performed for prediction of the vault after ICL implantation and can provide some reference for ICL size selection.     

A direct observation of aqueous humour flow in vivo after implantable collamer lens with a central hole implantation

Dear Editor,We present the reported case of the aqueous humour flow observed in vivo after implantable collamer lens(ICL)with a central hole implantation surgery.ICL,a phakic intraocular lens which is located in the posterior chamber,is an effective treatment to correct moderate-tohigh myopia^[1-2].     

Posterior chamber phakic intraocular lens for the correction of high myopic anisometropic amblyopia in adults

This study aims to evaluate the clinical results of posterior chamber implantable collamer lens (ICL) implantation in adults with high myopic anisometropic amblyopia. Thirteen patients aged 27.04±7.24y (range 19.2 to 42.5) were studied. ICL implantation was performed in 13 amblyopic eyes. The mean myopic anisometropia was significantly dropped from -10.70±3.02 D preoperatively to +0.09±1.67 D at 1mo postoperatively. The logMAR CDVA at 3d, 1, 3 and mean 9mo postoperatively improved by a mean of 1.69, 2.50, 3.01 and 3.00 lines and gained more than 2 lines accounted for 23.08% (3 eyes), 41.67% (5 eyes), 63.63% (7 eyes) and 55.56% (5 eyes), respectively. The contrast sensitivity of amblyopic eyes was significantly increased after surgery. Four patients partially recovered near stereopsis (400” to 100”). There was no severe complications were observed. ICL implantation alone can improve vision, contrast sensitivity, and partial restoration of binocular vision in adult patients with high myopic anisometropia.     

Long-term observation on safety and visual quality of implantable collamer lens V4c implantation for myopia correction: a 5-year follow-up

AIM: To elucidate the safety and visual quality of implantable collamer lens with central hole (ICL V4c) implantation for correcting moderate and high myopia for at least 5y. METHODS: This retrospective study was conducted on 58 patients (114 eyes) who were followed up for at least 5y after ICL V4c implantation. The observation was done before and on 1d, 1mo, 1 and 5y or more after the surgical procedure. The visual acuity, subjective refraction, intraocular pressure, vault, axial length, central hole position, pupil diameter, visual quality, and adverse events were analyzed. The visual quality includes aberration, the modulation transfer function cutoff frequency (MTF cutoff), objective scattering index (OSI), Stroller’s ratio (SR), and visual quality questionnaire. RESULTS: The average follow-up period was 69.25±3.80mo (range 60–82mo) and the preoperative spherical equivalent (SE) was -8.66±1.97 D. At 5y after operation, the safety index was 1.01±0.02 and the efficacy index was 0.99±0.42 and SE was -0.65±0.63 D. The 59.6% of the eyes achieved an uncorrected distance visual acuity of 20/20, 76.3% of the eyes had SE within ±1.0 D at the last visit. The axial length increased by 0.29±0.71 mm 5y after the surgery (t=-3.843, P<0.001). The mean vault at the last follow-up was 510.59±245.61 μm. The central hole was on the temporal side in 80 eyes (84.2%). The visual quality questionnaire showed that 98.2% patients were satisfied with the surgical procedure. Adverse events occurred in 4 eyes (3.5%), including the posttraumatic toric ICL rotation (2 eyes), iris incarceration (1 eye), and posttraumatic ICL displacement (1 eye) at the last follow-up. CONCLUSION: Long-term ICL V4c implantation is safe, effective, and stable for correcting moderate and to high myopia, and the visual quality with patients is excellent and satisfactory, but the progression of axial length still needs attention after surgery.     

Effect of capsular tension ring implantation on predicted refractive error after cataract surgery in patients with pseudoexfoliation syndrome

AIM: To investigate the effect of capsular tension ring(CTR) implantation on predicted refractive error after cataract surgery in patients with pseudoexfoliation(PEX) syndrome.METHODS: This double-blind randomized clinical trial was conducted on 60 patients with PEX syndrome referring to Imam Khomeini Hospital affiliated to Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, for undergoing cataract surgery. The study population was divided into two groups, namely CTR group(n=30) and non-CTR group(control group;n=30). The refractive error and anterior chamber depth(ACD) were measured 1 wk, 1 mo, and 3 mo after phacoemulsification(PE) surgery.RESULTS: The results indicated no statistically significant difference between the two groups in terms of predicted refractive error(obtained by subtracting preoperative predicted refractive error from actual postoperative refractive error) 1 wk(P=0.47), 1 mo(P=0.30), and 3 mo(P=0.06) after the PE surgery. Regarding the CTR group, the changes of ACD was statistically significant 1 and 3 mo after the PE surgery, compared to those obtained 1 wk post-surgery(P=0.005).CONCLUSION: The CTR implantation in PEX cataractous patients without zonulysis has no statistically significant effect on the predicted refraction and ACD changes after PE. The predicted refraction error has a hyperopic shift in both groups. The results reveal the unnecessary of calculating modified IOL in CTR implantation.     

超声乳化白内障吸除联合人工晶状体植入术后眼前节相干光断层扫描观察

Objective To investigate quantitative changes of the anterior segment configuration after clear corneal incision phacoemulsification and foldable intraocular lens (IOL) implantation with slit-lamp-adapted optical coherence tomography (SL-OCT). Methods In prospective consecutive case series, clear corneal incision phacoemulsification and foldable intraocular lens implantation were performed in 44 eyes of 40 patients. The changes of the anterior segment configuration were performed by SL-OCT before and 1 day, 1 week, 2 weeks and 1 month after surgery. SPSS 16.0 software was used to analyze statistical difference. Results For all patients, the central corneal thickness (CCT) and the incisional corneal thickness (ICT) increased significantly 1 day after surgery ( CCT increased 99. 59 μm, ICT increased 234. 57 μm;P = O. 490). At 1 month, the CCT almost had returned to baseline, but the ICT had been ticker about 19. 25 μm than baseline (P=0. 001) . The measurements of ACD, AODS00, AOD750, TISAS00, TISA750 also increased significantly 1 day after surgery. Although the ACD had no changes within 2 weeks( all P <0.05), it had been not stable. The changes of the width of the anterior chamber had been stable in the early period after surgery ( all P>0. 05). Conclusion The SL-OCT could impersonality and quantificationally evaluate the anterior segment changes induced by cataract surgery.     

有晶状体眼后房型人工晶状体植入矫正高度近视眼手术前后眼轴变化对比分析

目的 明确有晶状体眼后房型人工晶状体(ICL)植入术术前及术后眼轴长度在不同设定条件下是否存在差别,由此确定术后眼轴测量的方式,为ICL术后发生的白内障进行人工晶状体测算提供指导.方法 选取自2008年5月至2009年12月间于中国医科大学眼科医院行ICL植入术患者70例(135只眼),年龄21～48岁,于术前1周及术后3个月分别行IOL-Master、A超测量眼轴长度.并设定IOL-Master测量方式为正常眼(即phakic眼)及人工晶体眼(Pseudophakic PMMA)模式,A超为正常眼及特殊眼模式,其中特殊眼晶体声速设为1555 m/s.将所得数据进行统计学分析,术前术后各变量采用配对样本t检验,结果术前以IOL-Master测量眼轴长度平均为(28.02±0.22)mm,A超测量眼轴长度平均为(27.81±0.22)mm;术后以IOL-Master正常眼模式及Pseudophakic PMMA 模式测量眼轴长度平均值分别为:(28.01±0.22)及(28.12±0.22)mm;术后以A超正常眼模式及特殊眼模式测量眼轴长度平均值分别为(27.82±0.22)、(26.40±0.21)mm.术前采用A超及IOL-Master测量眼轴,两者比较差异有统计学意义(t=9.722,P=0.000);术前采用A超,而术后IOL-Master Phakic模式及Pseudophakic PMMA模式测量眼轴,与术前相比差异均有统计学意义(t=-9.058,-14.646;P=0.000);术前采用IOL-Master,术后采用A超正常眼及特殊眼模式下的测量的结果与术前比较,差异均有统计学意义(t=10.832,61.470;P=0.000).结论 有晶状体眼后房型人工晶状体植入后对眼轴长度的测量根据选择测量方式的不同较之术前有一定的变化.建议有晶状体眼后房型人工晶状体植入矫正高度近视眼术前及术后对眼轴的测量尽量采用.IOL-Master正常眼模式,如因白内障造成IOL-Master测量困难,则应采用A超正常模式测量眼轴.

Abstract：

Objective To definitute axial length measuring mode of the phakic eyes after posterior chamber implantation of lens. Methods All patients came from the Ophthalmology Hospital of China Medical University . Seventy patients with 135eyes,aged 21-48 years old. Among this group 28 were male,53eyes;42 were female, 82 eyes. A-ultrasound and IOL-Master was used to measure axial length one week before preoperative and three months after ICL implantation. There are two measuring mode in A-ultrasound and IOL-Master: normal and special. All the results were analysed by the SPSS11.5 statistical methods.Results (1) preoperative AXL of A-ultrasound and IOL-Master average are: (27.81 ±0.22) mm,(28. 02 ±0.22) mm; (2) postoperative AXL of phakic and Pseudophakic PMMA mode of IOL-Master average are: (28.01 ±0. 22) mm, (28. 12 ±0.22)mm; (3) postoperative AXL of normal and special mode of A-ultrasound average are: (27. 82 ± 0. 22 ) mm, ( 26. 40 ± 0. 21 ) mm. Conclusion According to the different meansuring mode, there are some difference of AXL between the preoperative and postoperative ICL.The more accurately meansuring mode is IOL-Master phakic mode before and after operation. A-ultrasound normal mode can be used if the lens become so turbid that the AXL can't be obtained by IOL-Master.     

有晶状体眼后房型人工晶状体植入术治疗高度近视术后UBM观察

目的 通过UBM在活体状态下观察有晶状体眼后房型人工晶状体(posterior chamber phakic intraocularlens,PCPIOL)植入术后PCPIOL与虹膜、睫状体和晶状体的位置的关系及变化.方法 取高度近视患者33只眼接受有晶状体眼后房型人工晶状体植入及术后检查,手术在表面麻醉下进行,作透明角膜隧道式切口,可植入式接触镜(implantablecontactlens,ICL)置于透明晶状体与虹膜之间,术中1点位作虹膜周切口.每只眼术前及术后进行全面的眼部检查,在术后1,3,6个月进行UBM检查观察ICL位置.结果 33只眼术前裸眼视力和最好矫正视力分别为0.04±0.06,0.5±0.3;术后分别提高为0.5±0.2,0.8±0.2,术后裸眼和矫正视力均明显好于术前视力(P＜0.05).术后第6个月前房深度为(2802±297)μm,ICL的拱度为329μm,小梁虹膜夹角29.2°.UBM显示所有ICL均与虹膜表面有摩擦,22只眼中两个襻在晶状体悬韧带上;7只眼中一只襻在悬韧带上;另一只襻在睫状突上;4只眼中两只襻在睫状突上.20只眼中PCPIOL的两个襻顶点放置在睫状沟位置;6只眼中PCPIOL发生了旋转.结论 有晶状体眼后房型人工晶状体植入术对高度近视的治疗是一种安全、有效地方法.寻找新的、准确的方法测量睫状沟水平直径对减少因为不合适的ICL长度造成的并发症具有重要意义.

Abstract：

Objective To observe the position of posterior chamber phakic intraocular lens and its relationship to the iris and the crystalline in vivo through UBM. Methods There were 33 eyes with high myopia who accepted surgery treatment All surgeries were performed using topical anesthesia and clear corneal incision. The posterior chamber phakic intraocular lens manufactured with STAAR collamer was implanted between transparent lens and iris. During the course of the surgery, iridectomy was done at one clock. Each eye was examined carefully before and after surgery. The position of ICL was observed at 1, 3 and 6 months. Result All eyes of preoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA)were 0.04± 0.06, 0.5± 0.3 respectively and postoperative were 0.5± 0.2, 0.8± 0.2 respectively. At sixth month of postoperative the anterior chamber depth was 2802± 297 m and ICL central vault was 329 m. UBM verified the contact between ICL and iris. Both haptics were supported by zonula in 22 eyes; one haptic was supported by zonula and other haptic by ciliary body in 7 eyes; Both haptics were supported by ciliary body in 4eyes. The extreme tip of two haptic was at sulcus in 20 eyes. In 6 eyes, rotation of the lens was observed. Conelusions Thephakic IOLs are a safety and effective treatment for the correction of high myopia. It is important that looking for a new and accurate method to measure sulcus diameter in order to reduce complication resulted by inaccurate ICL vault.     

眼前节生物学参数与有晶状体眼后房型人工晶状体植入术后拱高的相关性分析

目的 分析眼前节生物学参数与有晶状体眼后房型人工晶状体(ICL)植入术后拱高的相关性。方法 回顾分析2018年1月～2019年12月于我院行ICL植入术患者的临床资料。记录术前中央前房深度(ACD)、角膜水平白到白(WTW)直径、晶状体厚度(LT)、晶状体矢高(CLR)及术后3个月拱高,分析各项眼前节参数与拱高的相关性。结果 本研究共纳入33例(58眼),术前平均等效球镜为(-10.54±2.84)D,WTW为(11.45±0.27)mm,ACD为(3.12±0.17)mm,LT为(3.72±0.26)mm,CLR为(206.72±157.58)μm,术后3个月平均拱高为(410.31±146.11)μm。年龄与拱高无明显相关性(P=0.058)。术前ACD、WTW、LT、CLR与拱高具有显著相关性,其中ACD、WTW与拱高呈正相关(P=0.001, P=0.039),LT、CLR与拱高呈负相关(P=0.041,P<0.001)。结论 ICL植入术后拱高与术前ACD、WTW呈正相关,与LT、CLR呈负相关。     

高度近视患者后房型有晶状体眼人工晶状体植入术后拱高的变化及其影响因素

目的　分析高度近视患者行有晶状体眼后房型人工晶状体(ICL)植入术后拱高的变化及其影响因素，并给出术后不同时间点拱高的预测方程。方法　分析2020年8月至11月于徐州市第一人民医院眼科收治的拟行ICL植入术治疗高度近视的患者32例63眼的临床资料,术前记录患者的前房角度、前房深度、前房容积、角膜厚度、白到白间距(WTW)、睫状沟直径（STS）、术前等效球镜度和自然晶状体厚度，同时记录术中植入的ICL尺寸，使用Pentacam眼前节分析系统测量患眼术后1 d、1个月、6个月、12个月的拱高,分析上述观察指标对于术后拱高的影响。通过多元线性逐步回归分析,去除存在共性的变量,筛选出独立因素。以独立因素作为自变量，ICL术后拱高作为因变量，分析各因素对于ICL术后拱高的影响是否有统计学意义。结果　本研究入组患者年龄为（26.59±5.73）岁，术后1个月拱高显著低于术后1 d，术后6个月拱高显著低于术后1个月，术后12个月拱高显著低于术后6个月,差异均有统计学意义(均为P<0．05)。多元线性逐步回归分析结果显示，前房深度和自然晶状体厚度均是高度近视患者ICL植入术后拱高的独立影响因素(均为P< 0.05)。Spearman相关性分析结果显示，术后拱高与前房深度、前房容积和ICL尺寸均呈正相关，与自然晶状体厚度呈负相关（均为P<0.05）。影响高度近视患者 ICL 植入术后1 d、1个月、6个月、12个月拱高的回归方程分别为:术后1 d拱高（μm)=258.226-435.606×自然晶状体厚度(mm)+291.971×前房深度(mm)+75.134×ICL尺寸(mm)+0.166×前房容积(mm³)；术后1个月拱高(μm)=545.797-391.858×自然晶状体状厚度(mm)+221.224×前房深度(mm)+44.786×ICL尺寸(mm)+0.505×前房容积(mm³)；术后6个月拱高(μm)=208.770-287.950×自然晶状体厚度(mm)+254.127×前房深度(mm)+30.280×ICL尺寸(mm)+0.619×前房容积(mm³)；术后12个月拱高(μm)=0.999-251.694×自然晶状体厚度(mm)+250.972×前房深度(mm)+36.120×ICL尺寸(mm)+0.599×前房容积(mm³)。结论　高度近视患者行ICL植入术后12个月内拱高呈降低趋势,前房深度、前房容积、ICL尺寸、自然晶状体厚度均是影响术后拱高的重要因素。     

中央孔型眼内镜植入术后拱高的影响因素

目的 探讨中央孔型眼内镜（ICL）植入术后中央拱高的影响因素及分析导致极端拱高的可能原因。设计 回顾性病例系列。研究对象 2018-2019年北京同仁眼科中心接受V4c型ICL植入术的患者138例（276眼）。方法 回顾患者术前眼部生物测量参数包括屈光度（SE）、角膜水平直径即白到白（WTW）、前房深度（ACD）、前房容积（ACV）、前房角（Angle）、眼轴长度（AL）、晶状体厚度（LT）及术中植入ICL的直径。术后1周用眼前节OCT测量患者的拱高（Vault）。采用多元逐步回归分析确定拱高值和眼部生物参数的相关性。按拱高大小分为三组,分别为低拱高组（＜250 μm）、正常拱高组（250~1000 μm）和高拱高组（>1000 μm）,对三组间眼部参数进行比较,分析造成极端低拱高和极端高拱高的可能影响因素。主要指标 术后拱高值。结果 术后1周平均拱高为（645±247）μm。多元逐步回归分析得到拱高的回归方程为：Vault（μm）=180.954×ACD(mm) +99.805×WTW（mm）-2517.5,调整r2为0.069。低拱高组、正常拱高组、高拱高组三组间的ICL直径（127.9±3.8 mm、127.3±3.6 mm、130.2±2.8 mm）和ACD（2.95±0.29 mm、3.19±0.24 mm、3.29±0.22 mm）均有统计学差异（P均＜0.05）;年龄、SE、Angle、ACV、WTW、CCT、K1、K2差异无统计学意义（P均>0.05）。结论ACD和WTW是影响术后拱高的关键因素。同时,晶状体偏厚是极端拱高的可能影响因素。提示在临床上遇到非年龄性晶状体偏厚者,在ICL的选择上需要综合考虑更多因素。     

散瞳对中心孔型V4c ICL植入术后拱高及前房深度的影响

目的：研究散瞳前后V4c有晶状体眼人工晶状体（ICL）植入术后患者拱高、前房深度（ACD）及前房角（ACA）的变化，探讨V4c ICL植入术的效果及术后患者散瞳的安全性。方法：前瞻性观察研究。 选取2018年2─9月于北京大学深圳医院眼科行V4c ICL植入术的近视患者31例（62）眼，在术前及 术后6个月时，分别测量裸眼视力（UCVA）、最佳矫正视力（BCVA）及屈光度。在术后6个月时，使用Sirius眼前节分析系统测量散瞳前后的拱高、ACD及ACA。采用配对t检验对数据进行分析。结 果：术前及术后6个月患者UCVA（LogMAR）分别为1.61±0.14、0.16±0.04，差异有统计学意义 （t=12.844，P<0.001）。术前及术后6个月患者BCVA（LogMAR）分别为0.02±0.05、0.01±0.03，差异 具有统计学意义（t=25.429，P<0.001）。散瞳前后拱高分别为（465±123）μm、（515±135）μm（t=-8.704， P<0.001），散瞳前后ACD分别为（2 966±83）μm、（3 009±89）μm（t=-9.899，P<0.001），差异均有 统计学意义。散瞳后3点位及9点位的ACA较散瞳前明显变宽，差异均具有统计学意义（t=-15.306， P<0.001；t=-15.163，P<0.001；）。结论：V4c ICL植入术是矫正近视的一种有效方法，术后散瞳会使拱高升高及ACD加深，同时ACA宽度增加，术后6个月时对V4c ICL植入患者执行术后散瞳是安全的。     

超声生物显微镜在有晶状体眼后房型人工晶状体植入术中的应用

目的 研究传统测量角膜水平直径方法和超声生物显微镜(ultrasound biomicroscopy,UBM)方法测量睫状沟水平直径来选择后房型人工晶状体(implantable collamer lenses,ICL)的长度,比较两种方法对有晶状体眼ICL术后拱高的影响.方法 回顾性研究2009年5月至2010年12月在我科行ICL植入手术的103例(191眼)近视散光患者,根据术前选择ICL长度的不同分为常规方法组和UBM方法组,分剐测量两组术后6个月的ICL拱高,并对数据进行比较和相关性分析.结果 术前两组一般资料比较差异均无统计学意义(均为P＞0.05).术后6个月常规方法纽ICL平均拱高为(444.63±202.00)μm,UBM方法组为(463.67±226.00)μm,两组比较差异无统计学意义(P=0.094);拱高在理想范围(250～750μm)者,常规方法组占76.1％(70眼),UBM组占77.8％(77眼),两组差异无统计学意义(x2=0.0769,P=0.782);常规方法组ICL拱高和ICL度数相关系数r1=0.002(P1=0.677),UBM组ICL拱高和ICL度数的相关系数r2=0.011(P2=0.349),两组拱高均和ICL度数不相关.结论 在现有检查设备的条件下,通过UBM测量睫状沟的水平距离能够选择更理想的ICL,通过传统方法测量角膜水平直径(白到白的距离)来估算ICL的长度也是可行的.     

有晶状体眼人工晶状体植入术后拱高及其影响因素研究

目的:探讨有晶状体眼人工晶状体(V4c型ICL)植入术后拱高的变化及其影响因素。方法:回顾性分析山西省眼科医院2015年7月至2018年12月中度及高度近视行V4c型ICL植入术60例(118只眼)的临床资料。术眼屈光状态为等效球镜度(-11.26 ±3.87)D。观察术后拱高随时间的变化趋势及可能的影响因素,并对比由...     

ICL植入术后异常拱高相关影响因素

目的 分析后房型有晶状体眼人工晶状体（ICL V4c）植入术后异常拱高的相关影响因素。方法 回顾性系列病例研究。纳入2014年11月至2017年11月成都爱尔眼科医院ICL植入术后拱高不合适并行ICL更换手术患者60例（67眼）为更换组,手术后随访时间大于6个月。其中拱高小于250 μm为低拱高组,拱高大于750 μm为高拱高组。选取同期ICL植入手术,并且随访期间拱高正常（250~750 μm）患者70例（70眼）作为正常拱高组。术前检查包括裸眼视力（UCVA）、最佳矫正视力（BCVA）、屈光度、眼压、角膜内皮细胞计数（ECD）、晶状体厚度（LT）、角膜水平直径（W-W）以及眼轴长度。超声生物显微镜（UBM）测量的参数包括后房角、睫状突高度（T值）、睫状沟垂直径、睫状沟水平径以及前房深度（ACD）。术后随访大于6个月,复查内容包括UCVA、屈光度数、BCVA、眼压、ECD以及拱高。采用独立样本t检验和多元线性回归方程对数据进行分析。结果 高拱高组和低拱高组在后房角、ICL尺寸、ACD方面差异有统计学意义（均P<0.001）。高拱高组与正常拱高组在ICL尺寸、后房角的差异有统计学意义（均P<0.001）。更换组的拱高相关影响因素包括后房角、ICL尺寸、睫状沟水平径、T值、ACD和LT（调整R²=0.608,F=5.84,P<0.001）。低拱高组更换后仍有8眼拱高小于250 μm。高拱高组更换后拱高都在正常范围内。更换前后的手术眼在观察期间内均未发生前囊下白内障、持续性高眼压、角膜内皮功能失代偿等严重并发症。结论 多因素影响ICL植入术后的拱高,T值、后房角、睫状沟水平径、ACD、ICL尺寸都可能导致异常拱高。对于可能出现异常拱高的病例,可以结合后房角选择ICL尺寸,有助于获得合适的拱高。     

有晶状体眼后房型人工晶状体植入术后前房角的改变及相关因素分析

目的：探讨有晶状体眼后房型人工晶状体植入术后不同时间的前房角变化,分析影响术后前房角度数（ACA）的相关因素。方法：前瞻性非随机的连续病例研究。连续收集2018年9月至2019年2月在郑州大学第一附属医院眼科屈光中心接受有孔型有晶状体眼后房型人工晶状体（ICL）植入术的近视患者81例（81眼）,患者术前,术后1 d、1个月和6个月行Visante眼前段光学相干断层扫描（OCT）检 查,测量术前、术后鼻侧和颞侧ACA及术后拱高。分析术后ACA与术前等效球镜度（SE）、眼轴长度、水平角膜直径、前房深度、前房容积、水平角膜曲率、术前ACA、ICL直径和术后拱高的相关性。 采用重复测量方差分析比较患者不同时间点眼前段各项参数的变化,两两比较采用 Bonferroni检验。 相关性分析采用Pearson相关或Spearman相关分析。结果：术后1 d、1个月和6个月的ACA比较差异 均无统计学意义,术后的鼻侧ACA较术前减少45%～50%（F=268.73,P<0.001）,术后的颞侧ACA 较术前减少44%～49%（F=333.40,P<0.001）。ICL植入术后1 d、1个月和6个月的平均拱高分别为 （640±180）μm、（540±150）μm和（530±160）μm,差异具有统计学意义（F=54.14,P<0.001）;术后 1个月内拱高下降趋势明显,术后1个月至术后6个月期间拱高下降趋势明显减缓。 ICL植入术后鼻 侧ACA与术前前房容积、术前前房深度和术前ACA呈正相关（r=0.426,P=0.003;r=0.377,P=0.008; r=0.525,P<0.001）;与ICL直径、拱高、术前SE、眼轴长度、水平角膜曲率和水平角膜直径无相关性。 ICL植入术后颞侧ACA与术前前房容积、术前前房深度和术前ACA呈正相关（r=0.392,P=0.006; r=0.376,P=0.008;r=0.594,P<0.001）,与ICL直径、拱高、术前SE、眼轴长度、水平角膜曲率和水平角膜直径无相关性。结论：ICL植入术后前房角明显减小,随访期内患者前房角开放度数基本稳定, 没有进一步变窄。     

可植入胶原聚合透镜植入术后早期眼前段观察

目的 观察有晶状体眼可植入胶原聚合透镜（ICL）植入术后早期的眼前段形态.方法 随机选取接受ICL植入术的高度近视37例（65只眼）,测量患者术前、术后1个月和6个月的前房深度、前房角、前房容积、眼压和角膜内皮细胞密度,并对测量结果进行统计学分析.结果 术后前房深度、前房角和前房容积均较术前显著减小,术后1个月和术后6个月相比差异无统计学意义.术后1个月时眼压较术前稍有降低,术后6个月时恢复至术前水平;术后1个月和6个月患眼角膜内皮细胞密度较术前分别降低4.75％和6.87％;术后1个月和6个月ICL拱高分别为（412.61±192.94）m和（365.69±179.75）m,与晶状体无接触.结论 ICL植入术后早期眼前段形态发生显著改变,但随访期内各指标稳定,未引起前房角关闭或眼压升高.仍需对其进行更为长期的临床观察.     

Comparison of anterior section parameters using anterior segment optical coherence tomography and ultrasound biomicroscopy in myopic patients after ICL implantation

AIM: To compare the agreement of anterior chamber depth (ACD) and central vault measurements obtained by anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) of post surgical high myopic eyes with posterior chamber phakic intraocular lens (Visian ICL; STAAR Surgical) implantation. METHODS: Fifty-two phakic eyes of 28 high myopic patients who underwent implantable Collamer lens (ICL) surgery for the correction of high myopia were studied. The postoperative ACD, the distance between the corneal endothelium and the anterior surface of ICL (cornea-ICL) and the central vault were measured with the AS-OCT system and the UBM system. Intraclass correlation coefficient (ICC) and the Bland-Altman plot were used to evaluate the repeatability and agreement of two devices. RESULTS: The mean ACD, cornea-ICL and central vault in the 52 phakic eyes after ICL surgery was 3.19±0.28 mm, 2.47±0.28 mm, 0.50±0.19 mm by AS-OCT and 3.13±0.25 mm, 2.49±0.25 mm, 0.44±0.19 mm by UBM, respectively. Pairwise comparison of ACD and central vault measurements showed significant differences between AS-OCT and UBM (P<0.05). However, no statistically significant difference was found between these imaging techniques in cornea-ICL (P>0.05). The Pearson correlation coefficient (r) between AS-OCT and UBM measurements for ACD, cornea-ICL and vault was 0.88, 0.80 and 0.89, respectively (P<0.001). The ICC was 0.89-0.94 for the measurements of AS-OCT and UBM. Bland-Altman analysis showed the 95% limits of agreement of ACD, cornea-ICL, central vault measurements between these two devices were -0.20 to 0.32 mm, -0.36 to 0.32 mm and -0.12 to 0.24 mm, respectively. CONCLUSION: Central ACD and vault measurements using AS-OCT demonstrated a slight significantly higher value than using UBM in phakic eyes after ICL surgery. These two devices should not be used interchangeably for measurements of central ACD and vault in patients after phakic intraocular lens implantation.     

应用Sirius眼前节分析系统选择ICL直径的临床观察

目的：分析和评价应用Sirius眼前节分析系统选择有晶状体眼后房型人工晶状体（ICL）直径的可行 性。方法：回顾性病例对照研究。收集2016年1月至2017年8月在湖南省人民医院行ICL植入术的 高度近视患者73例（146眼）。所有患者均通过术前Sirius眼前节分析系统测量各项眼前节指标,如水 平可见虹膜直径（HVID）、水平前房直径（HACD）、前房深度（ACD）等,综合这些指标应用STAAR 公司提供的ICL计算软件结果来选择ICL直径。术后随访3个月至1年。采用Friedman M检验、重复 测量方差分析、配对t检验和多元线性回归分析对手术前后的数据进行分析。结果：所有患者术后裸 眼远视力（UDVA）较术前提高（x2 =156.08,P<0.001）。术后各时期有效指数、安全指数均大于1。术 前和随访期间眼压差异无统计学意义（P=0.054）;角膜内皮细胞计数（ECD）、ACD、房角宽度（ACA） 术后均较术前减少（t=4.63、31.17、23.57,均P<0.001）。术后拱高为（483±231）μm,其中理想拱高眼 数占比83.6%;将理想拱高眼的指标纳入回归分析,得到公式：ICL直径（mm）=6.474+0.43×HVID（mm） +0.299×ACD（mm）（R2 =0.44,F=36.23,P<0.001）。所有患者未出现白内障及房角粘连、青光眼等 并发症。结论：应用Sirius眼前节分析系统选择的ICL直径在治疗高度近视方面安全、有效。通过 Sirius眼前节分析系统获得的HVID、ACD值可作为ICL直径选择的重要参数。