Phakic 6H型有晶状体眼前房型人工晶状体植入矫正高度近视术后角膜内皮细胞密度临床观察

目的 观察Phakic 6H型有晶状体眼前房型人工晶状体(ACP-IOL)植入矫正高度近视手术后远期角膜内皮细胞密度,并评价手术的安全性.方法 收集2001年9月-2006年3月间行Phakic 6H型ACP-IOL.植入术矫正高度近视患者共170例(283眼),经连续随方,对最终行ACP-IOL取出的7例(7眼)患者的临床资料进行回顾性分析.使用SP-2000P型角膜内皮显微镜定期测量角膜中央、上方、下方、颞侧及鼻侧5个方位的角膜内皮细胞密度.结果 7例患者平均随访时间为5年,6例平均角膜内皮细胞丢失数为2 105个/mm2,平均丢失率为73.71％(1例因角膜失代偿无法测量出内皮细胞密度).4例行ACP-IOL取出+透明晶状体摘除+后房型人工晶状体(IOL)植入,1例行ACP-IOL取出+超声乳化白内障吸除+后房型IOL植入,2例行ACP-IOL取出.结论Phakic 6H型ACP-IOL对角膜内皮的远期影响可致角膜内皮功能临界失代偿甚至失代偿,发现角膜内皮功能处于临界失代偿或内皮有明显损伤时须尽快取出ACP-IOL.

Clinical observation on corneal endothelial cell density after Phakic 6H anterior chamber Phakic intraocular lens implantation for high myopia

Objective To observe the long-term changes of corneal endothelial cell density after Phakic 6H anterior chamber Phakic intraocular lens(ACP-IOL) implantation for the correction of high myopia,and evaluate the safety of the surgical procedure.Methods One hundred and seventy patients(283 eyes) undergoing Phakic 6H ACP-IOL implantation for the correction of high myopia between September 2001 and March 2006 were collected and followed up,and the data of 7 patients(7 eyes) with ACP-IOL removal ultimately were retrospectively analysed.The corneal endothelial cell density of central,upper,lower,temporal and nasal parts of cornea was measured by SP-2000P corneal endothelial endoscopy.Results These 7 patients were followed up for an average of 5 years,with an average corneal endothelium loss of 2 105 cells/mm2 and average loss rate of 73.71% in 6 eyes(measurement could not be performed in 1 eye due to corneal endothelium decompensation).The combined procedures of ACP-IOL removal,clear crystalline lens extraction and posterior chamber intraocular lens(IOL) implantation were performed in 4 eyes,ACP-IOL removal,phacoemulsification and posterior chamber IOL implantation in 1 eye,and ACP-IOL removal in 2 eyes.Conclusion Phakic 6H ACP-IOL can lead to critical corneal decompensation and even corneal decompensation in a long term.ACP-IOL must be removed as soon as the corneal endothelium function is in a state of critical decompensation or the endothelium is significantly damaged.