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。     

Retinal detachment in myopic eyes after phakic intraocular lens implantation

PURPOSE: To analyze the risk of retinal detachment in highly myopic patients who underwent implantation of phakic intraocular lenses (PIOLs). METHODS: In a retrospective, non-comparative, interventional case series, the occurrence of retinal detachment was analyzed in 522 consecutive highly myopic eyes (323 patients) that underwent PIOL implantation. Treatment and results were reviewed. Parameters evaluated were best corrected visual acuity before and after retinal detachment surgery and time between refractive surgery and retinal detachment. RESULTS: Fifteen (2.87%) eyes presented with retinal detachment after PIOL implantation, with a mean time between surgery and detachment of 24.4 +/- 24.4 months (range: 1 to 92 months). The risk of retinal detachment in patients with high myopia corrected by PIOL implantation was 0.57% at 3 months, 1.64% at 12 months, 2.73% at 36 months, and 4.06% at 92 to 145 months (Kaplan-Meier analysis). A comparative study between the group of patients with retinal detachment and the remaining patients without retinal detachment was performed. Differences were found in axial length (30.65 +/- 1.97 vs 29.51 +/- 2.02; P=.028, one factor-analysis of variance test). CONCLUSIONS: The risk of retinal detachment in eyes implanted with phakic lenses for the correction of high myopia is higher in eyes with axial length >30.24 mm.     

Phakic intraocular lens to correct high myopic amblyopia in children

PURPOSE: In a clinical investigation, we evaluated anatomical and functional outcomes of posterior phakic chamber lens (ICL) implantation for correction of high myopia with amblyopia in children. METHODS: Twelve eyes of 11 children, age 3 to 16 years, with high myopic amblyopia were operated with implantation of a Staar Surgical ICL. In these patients, conventional therapy with spectacles or contact lenses was unsuccessful. Mean preoperative spherical equivalent refraction was -12.70 D (range -8.00 to -18.00 D) and best spectacle-corrected visual acuity ranged from count fingers to 20/63. Mean follow-up was 20.5 months (range 3 to 48 mo) Preoperative and postoperative anatomical and functional outcomes were compared. RESULTS: We noted good tolerance of ICLs without inflammatory reactions or secondary capsular opacity, stable intraocular pressure, and good ICL position in all eyes. Predictability was +0.71 D (range -0.75 to +2.00 D). Mean postoperative best spectacle-corrected visual acuity was 20/63. Recovery of binocular vision was achieved in six patients and orthotropic position in seven patients. Quality of life was improved in all patients. CONCLUSION: The Staar Surgical phakic ICL appeared to be an effective method to treat high myopia in children with amblyopia. Good results with high satisfaction were noted.     

Clinical evaluation of accommodative intraocular lens implantation in high myopic eyes

PURPOSE: To compare the clinical outcome of AT-45 implantation between high myopic eyes and non-high myopic eyes. METHODS: Retrospective, non-randomized, comparative trial. The medical charts of 28 patients with 35 eyes who had phacoemulsification and AT-45 implantation were retrospectively reviewed. 13 eyes of 10 patients were included in the high myopic group (axial length > or = 26.0 mm) and 22 eyes of 18 patients were included in the non-high myopic group. The clinical data included unilateral best-corrected visual acuity (BCVA) and distance-corrected near visual acuity (DCNVA) at 6 months follow-up after the surgery. The results were compared between the two groups. RESULTS: In the non-high myopic group, 22 eyes (100%) and 19 eyes (86.4%) achieved a BCVA of 20/25 and 20/20 or better respectively. For the high myopic group, the results were 13 eyes (100%) and 12 eyes (92.3%) respectively, at 6 months after the surgery. In the non-high myopic group, 21 (95.4%) and 7 eyes (31.8%) achieved a DCNVA of 20/40 and 20/25 or better. For the high myopic group, the results were 13 (100%) and 4 eyes (30.8%) respectively, at 6 months after the surgery, the differences between the two groups for a BCVA of 20/25 or better and 20/20 or better and a DCNVA 20/40 or better and 20/25 or better were not statistically significant. CONCLUSIONS: Six months clinical outcome of cataract surgery with an AT-45 for the high myopic eyes was satisfactory; it was not significantly different from that of the non-high myopic eyes.     

Phakic refractive lens implantation in high myopic patients: one-year results

PURPOSE: To evaluate the efficacy and safety of implantation of a new posterior chamber phakic refractive lens (PRL, Ciba Vision Surgical) in highly myopic eyes. SETTING: Department of Ophthalmology, Medical School, University of Crete, Vardinoyannion Eye Institute of Crete, Crete, Greece. METHODS: Thirty-four myopic eyes of 19 patients were treated for high myopia with implantation of a silicone PRL in the posterior chamber. Mean patient age was 29.0 years +/- 7.9 (SD) (range 18 to 44 years). Manifest refraction in spherical equivalent (MR), uncorrected (UCVA) and best corrected (BCVA) visual acuity (decimal scale), intraocular pressure, higher-order aberrations (root-mean-square [RMS] wavefront error measured with a Shack-Hartmann wavefront sensor WASCA analyzer [Carl Zeiss, Meditec]), possible complications, and subjective symptoms were evaluated. RESULTS: Phakic refractive lenses were successfully implanted in all eyes. Mean follow-up was 17.17 +/- 3.76 months (range 12 to 24 months). There was a statistically significant reduction in the MR (from -14.70 D +/- 2.65 D [range -20.75 D to -10.50 D] to -0.61 D +/- 0.89 D [range -2.25 D to 1.00 D]) (P<.001). Twenty-seven (79%) and 15 eyes (44%) were within +/-1.00 D and +/-0.50 D of target refraction, respectively. Mean UCVA significantly improved (from counting fingers to 0.62 +/- 0.28 (range 0.08 to 1.20) (P<.001). Mean BCVA also improved from 0.70 +/- 0.24 (range 0.10 to 1.00) to 0.85 +/- 0.24 (range 0.10 to 1.20) (P<0.001). Overall, there was a mean increase in BCVA of 1.5 +/- 1.5 lines (range loss of 2 lines to gain of 5 lines). There was no statistically significant difference in higher-order aberrations after PRL implantation (pre-PRL RMS: 0.18 microm +/- 0.08 microm [range 0.09 microm to 0.38 microm]; post-PRL RMS: 0.21 microm +/- 0.08 microm; [range 0.05 microm to 0.38 microm]) (P =.12). CONCLUSION: The PRL showed encouraging results in treating high myopia. Additional patients and longer follow-up period are needed to detect the long-term efficacy and safety of this refractive lens.     

Retinal detachment after phakic intraocular lens implantation in severe myopic eyes

Background

To report the incidence, clinical presentation, and surgical outcomes of retinal detachment in highly myopic patients corrected by implantation of phakic intraocular lenses (PIOLs).

Methods

This is a retrospective interventional non-comparative case series. A total of 530 highly myopic eyes that underwent PIOLs implantation were included in the study. All patients completed at least a 2-year follow-up after PIOL implantation. The incidence of retinal detachment (RD) and subsequent treatments were reviewed. The refractive errors, axial lengths, time between refractive surgery and RD detection, vitreoretinal findings, rate of retinal reattachment, and the pre- and postoperative best-corrected visual acuity (BCVA) were analyzed.

Results

The overall incidence of RD was 1.5?% (eight eyes of seven patients) with a mean time between PIOL implantation and detachment of 23.63?±?18.12?months (range, 2?days–51?months). Mean spherical equivalent (SE) before PIOL implantation was ?17.53?±?3.86 diopters (D) (range, ?11.5D to ?23.5D). Six patients underwent bilateral PIOL implantation. Five eyes were implanted with anterior chamber PIOLs and the other three received posterior chamber PIOLs. A traumatic history was presented before RD detection in four cases. Horseshoe tears, atrophic holes, or giant retinal tears were found in four (50?%), two (25?%), and two (25?%) eyes, respectively. Two eyes (25?%) underwent scleral buckling surgery, five eyes (62.5?%) underwent pars plana vitrectomy surgery, and one eye (12.5?%) underwent both procedures. Anatomical retinal attachment was achieved after first RD surgery in seven eyes. Mean BCVA after PIOL implantation and before RD was 20/40 (decimal refraction, 0.51?±?0.31) compared to that of 20/80 (decimal refraction, 0.26?±?0.12) after the RD surgery. Mean follow-up after RD surgery was 20.63?±?12.93?months (range, 8–42?months).

Conclusions

The incidence of RD after PIOLs implantation is low. Its characteristics do not differ significantly from the natural history of RD in high myopic eyes. PIOL implantation for surgical correction of severe myopia does not seem to increase the risk of RD. Good visual prognosis can be obtained with early surgical intervention.     

Macular choroidal neovascularization in myopic eyes after phakic intraocular lens implantation

PURPOSE: To analyze the development and characteristics of choroidal neovascularization in highly myopic patients corrected by the implantation of phakic intraocular lenses (PIOLs). METHODS: This retrospective, noncomparative interventional case series studied the development of choroidal neovascularization in 522 consecutive highly myopic eyes (spherical equivalent refraction >-6.00 diopters [D] and/or axial length >26 mm) (323 patients) corrected by the implantation of PIOLs, the treatment performed, and the results obtained. Parameters evaluated were best spectacle-corrected visual acuity (BSCVA) before and after treatment of choroidal neovascularization, and the interval between refractive surgery and the development of choroidal neovascularization. RESULTS: Follow-up ranged from 12 to 145 months (mean: 60.4 +/- 39.1 months). In 12 (2.29%) eyes, choroidal neovascularization developed after PIOL implantation at a mean interval time of 33.7 +/- 29.6 months (range: 1 to 87 months). Using Kaplan-Meier analysis, the risk of choroidal neovascularization in patients with high myopia corrected by PIOL implantation was 0.57% at 5 months, 0.81% at 18 months, 1.31% at 24 months, and 3.72% at 87 to 145 months. No statistically significant differences were found between patients with and without choroidal neovascularization in the following parameters: axial length (P=.826), age (P=.296), initial BSCVA (P=.085), spherical equivalent refraction (P=.663), and follow-up (P=.955). CONCLUSIONS: Phakic intraocular lens implantation for the correction of high myopia does not play a role in the development of choroidal neovascularization.     

有晶状体眼人工晶状体植入术矫正高度近视在视觉质量上的优越性

有晶状体眼人工晶状体植入术（PIOL）是一种新的矫正高度近视的手术方法。视觉质量包括视力、对比敏感度（CS）、波前像差及角膜的非球面参数（Q值）等。传统的准分子激光角膜原位磨镶术（LASIK）由于切削改变角膜的非球面性导致术后视觉质量下降。可植入性接触镜（ICL）植入术具有矫治范围大和矫治高度近视及超高度近视安全、有效、手术并发症少的优点,在视觉质量的评价方面也优于LASIK。进一步提出对高度近视患者于术方案的选择,旨在寻求最适合患者的手术方式,进而获得最佳的视觉质量。     

负度数折叠式人工晶状体植入术治疗白内障合并轴性高度近视

目的:探讨超声乳化白内障吸除联合负度数人工晶状体植入术治疗白内障合并高度近视的临床疗效。方法:对30例41眼白内障合并高度近视患者行超声乳化白内障吸除联合负度数折叠式人工晶状体植入术,随访6mo,观察术中和术后并发症、术后视力、眼底情况。结果:术前平均眼轴长度为32.11mm。术后视力<0.1者3眼,0.1～0.5者26眼,>0.5者12眼。术中2眼晶状体后囊膜破裂;1眼角膜水肿,未见视网膜脱离。24眼眼底有明显的高度近视眼底病变。结论:超声乳化白内障吸除联合负度数人工晶状体植入术是治疗白内障合并高度近视眼安全、有效的方法。     

透明角膜切口有晶状体眼虹膜夹型人工晶状体植入治疗高度近视

目的：研究透明角膜切口有晶状体眼虹膜夹型人工晶状体植入治疗高度近视的临床疗效和安全性。

方法：对20例28眼高度近视患者表面麻醉下行透明角膜切口虹膜夹型人工晶状体植入术,观察术中和术后并发症、术后视力、眼压、屈光度数、角膜内皮计数、人工晶状体稳定性及晶状体混浊情况。

结果：高度近视患者28眼均顺利植入了虹膜夹型人工晶状体,术中无并发症发生,术后裸眼视力均达到或超过术前最佳矫正视力。术后随访6mo,所有植入的人工晶状体均基本位于正位,无明显倾斜、偏位。未发现白内障、葡萄膜炎、黄斑囊样水肿及视网膜脱离等并发症。

结论：在具备熟练的眼科显微手术技巧的前提下,有晶状体眼虹膜夹型人工晶状体植入,有较好的预测性及稳定性,可获得满意的术后视力,术后并发症较少,是治疗高度近视患者安全、有效的方法。     

高度近视合并白内障患者植入Array多焦点人工晶状体的临床观察

目的:评价白内障超声乳化吸除联合Array SA40N多焦点人工晶状体植入术治疗高度近视合并白内障的临床疗效及其安全性。方法:对25例(31眼)高度近视合并白内障患者行超声乳化白内障吸除联合低度数Array多焦点人工晶状体植入术,观察术中和术后并发症、术后视力和屈光状态。结果:所有患者术中均无并发症发生。术后6mo,所有患者裸眼远视力≥0.5者25眼(81%);最佳矫正远视力≥0.5者28眼(90%)。裸眼近视力≥0.5者12眼(39%);最佳矫正近视力≥0.5者22眼(71%)。术后屈光度数偏差值≤±0.50D者为24眼(77%)。结论:超声乳化白内障吸除联合低度数ArraySA40N多焦点折叠式人工晶状体植入术,是治疗高度近视合并白内障患者安全、有效的手术方法。     

Optimum target refraction for highly and moderately myopic patients after monofocal intraocular lens implantation

PURPOSE: To determine the optimum target refraction for myopic patients who want to see at both near and intermediate distances without correction after cataract surgery. SETTING: Hayashi Eye Hospital, Fukuoka, Japan. METHODS: Sixty-nine eyes of 69 patients scheduled for phacoemulsification and monofocal intraocular lens (IOL) implantation were studied. The following age groups were recruited: 50s, 60s, and 70s. With addition of a spherical lens of 1.0, 1.5, 2.0, 2.5, or 3.0 diopters (D) after best distance correction (simulation of various degrees of myopia), visual acuity at various distances was measured using the all-distance vision tester. With the assumption that visual acuity of 20/30 is necessary for near and intermediate vision, the distances at which the mean visual acuity reached 20/30 were determined. RESULTS: Six patients did not have all examinations; thus, 24 patients in the 50s group, 23 in the 60s group, and 22 in the 70s group were included in the analysis. With simulation of -1.0 or -1.5 D of myopia, sufficient near visual acuity at 0.3 m was not obtained. With -2.0 D of myopia, visual acuity better than 20/30 was obtained at 0.7 m, 0.5 m, and 0.3 m. However, with -2.5 D of myopia, visual acuity reached 20/30 at 0.5 m and 0.3 m; with -3.0 D of myopia, it reached only 20/30 at 0.3 m. There were no significant differences between the age groups in mean visual acuity from far to near distances except for intermediate visual acuity with -1.0 D and -1.5 D of myopia and for near visual acuity with -2.5 D of myopia. CONCLUSIONS: Eyes with a monofocal IOL that simulates -2.0 D of myopia achieved sufficient visual acuity for both near and intermediate distances in 3 age groups. This indicates that -2.0 D is the optimum target refraction in myopic eyes.     

人工晶体植入治疗高度近视并发白内障的临床观察

报道１０１例（１２４只眼）高度近视并发白内障行囊外摘除和囊袋内人工晶体植入术，平均随访１６．４个月。术后脱盲率为９５．９７％，脱残率为７５．００％，后囊混浊率２２．５８％，视网膜脱离发生率为１．６１％。术后后囊破裂占５．６５％。临床观察结果表明，高度近视并发白内障时，选择现代白内障囊外摘除联合囊袋内人工晶体植入术，手术效果满意。     

单眼多焦点人工晶状体植入术眼与对侧透明晶状体眼的视功能对照研究

目的 评价不同年龄的单眼白内障患者植入ReSTOR多焦点人工晶状体(MIOL)后的视功能状况及患者的主观满意度.方法 前瞻性对照研究.研究对象为行超声乳化白内障吸除联合ReSTOR MIOL植入的单眼白内障患者24例,按年龄分为2组:老视组,年龄≥45岁,17例;非老视组,年龄＜45岁,7例.研究参数:裸眼及远矫正状态下的远(4 m)、中(80cm,60 cm)、近视力,对比敏感度和问卷调查.统计学方法采用秩和检验.结果 老视组患者ReSTOR MIOL植入眼近视力优于对侧透明晶状体眼(Z=2.864,Z=2.911;=0.004),远视力、中距离视力及对比敏感度与对侧透明晶状体眼相比较,差异无统计学意义(Z=0.183～1.417,P=0.855～0.156);主观满意度为7～10分,70.6%(12/17)的患者满意度9分以上,双眼脱镜率58.8%(10/17).非老视组患者ReSTOR MIOL植入眼近视力及中距离视力均低于对侧透明晶状体眼(Z=2.197～2.371;=0.028～0.018),MIOL植入眼的对比敏感度普遍低于对侧眼,其中夜晚眩光(3 cd/m2+28 Lux)低频(1.5 c/d)对比敏感度,差异有统计学意义(Z=1.997,P=0.046);主观满意度为6～9分,14.3%(1/7)的患者满意度9分以上,双眼脱镜率85.7%(6/7).结论 伴有老视的单眼白内障患者,MIOL植入眼近视力优于对侧透明晶状体眼,远、中距离视力及对比敏感度差异不明显,主观满意度较高,因此较适合植入ReSTORMIOL;不伴有老视的年轻的单眼白内障患者,MIOL植入眼近、中距离视力均低于对侧透明晶状体眼,远视力差异不明显,主观满意度偏低(与老视患者相比较),因此可以植入ReSTOR MIOL,但是术前需要与患者进行更加详细的沟通.     

Preliminary efficacy and safety of zero diopter lens implantation in highly myopic eyes

PURPOSE: To report the preliminary efficacy and safety of zero diopter (D) intraocular lens implantation in highly myopic eyes. DESIGN: Retrospective surgical case series. METHODS: Three highly myopic eyes with axial lengths greater than 30 mm were implanted with zero D Alcon model MA60MA 3-piece acrylic posterior chamber lenses at the time of cataract surgery. RESULTS: Uncorrected visual acuity improved from counting fingers to 20/20- and 20/40- in two eyes. Best-corrected visual acuity improved from 20/80 and 20/60+ to 20/20- in the same eyes. A third eye was at counting fingers before and after surgery, because of a staphyloma. The range of preoperative, intended postoperative, and achieved postoperative spherical equivalent refractive errors was -15.1 to -25.0 diopters, -0.20 to -1.44 diopters, and +0.13 to +0.50 diopters respectively. CONCLUSIONS: All eyes experienced mild hyperopic refractive errors after surgery. No retinal detachments occurred during the follow-up interval.