有晶状体眼后房型人工晶状体植入术矫正高度近视

目的:观察有晶状体眼后房型人工晶状体(implantable contact lens,ICL)植入术矫正高度近视的有效性、安全性及稳定性。方法:自2011年1月至2013年3月在本院行有晶状体眼后房型人工晶状体植入术的高度近视患者36例(71眼)。随访术前及术后1 d、1周及1、3、6个月。随访内容包括裸眼视力、最佳矫正视力、屈光度数、裂隙灯显微镜检查、眼压、Obscan-Ⅱ角膜地形图、超声生物显微镜(UBM)、角膜内皮细胞计数等,观察屈光状态及术后并发症。结果:36例(71眼)术前裸眼视力和最佳矫正视力分别为0.08±0.02、0.62±0.29;术后裸眼视力和最佳矫正视力分别为0.69±0.30、0.72±0.28;术后裸眼视力较术前裸眼视力明显提高(P<0.01),达到术前最佳矫正视力。术前等效球镜屈光度为(-13.56±4.25)D,术后最后一次随访等效球镜屈光度为(-0.85±0.36)D,与预期屈光度数差别±1.00 D以内者65只眼(91.5%)。术后各随访时间点平均眼压及角膜内皮细胞计数与术前相比较差异无统计学意义(P>0.05)。通过UBM观察术前前房深度(3280±206)μm,术后最后一次随访前房深度减少到(2863±217)μm,两者相比较差异有统计学意义(P<0.05)。通过UBM观察术后各随访时间点ICL拱高均在理想范围内,ICL在眼内位置稳定。4例(6眼)术后1周内发生高眼压,经治疗后眼压恢复正常。1例(2眼)术后发生局限性晶状体前囊下混浊,随访期间病变无进展,术后视力无下降,无需手术治疗。结论:有晶状体眼后房型人工晶状体植入术矫正高度近视具有有效性、安全性及稳定性。术前精确的数据测量是决定术后效果及有效避免术后并发症的关键所在。

Posterior Chamber Phakic Intraocular Lens Implantaion for Correction of High Myopia

Objective To evaluate the efficacy, safety and stability of the implantation of posterior chamber phakic intraocular lens for correction of high myopia. Methods From January 2011 to March 2013, total 71 eyes of 36 patients with high myopia were underwent posterior chamber phakic intraocular lens implantation and followed up for 6 months in our hospital. The follow-up indexes including uncorrected visual acuity（UCVA） , best corrected visual acuity（BCVA） , refraction, slitlamp examination, intraocular pressure, Obscan- II corneal topography, ultrasound biomicroscopy （ UBM ）, corneal endothelial cells morphometry, were recorded at pre-operation, 1 d, 1 week, 1 month,3 months,6 months after operation, respectively. Mean-while, the condition of refraction and postoperative complications were observed. Results The preoperative UCVA and BCVA of 71 eyes in 36 patients were 0.08 ± 0.02 and 0.62 ± 0.29, but the postoperative UCVA and BCVA were 0.69 ± 0.30 and 0.72 ± 0.28, respectively. The postoperative UCVA was obviously improved, which was equal to preoperative BCVA （ P 〈 0. 01 ）. The spherical equivalent refraction was （ -13.56 ± 4.25 ） D and （ -0.85 ± 0.36） D at preoperation and the last postoperative follow-up ,respectively. Tile postoperative spherical equivalent refraction of 65 eyes accounted for 91.5% were within ± 1.00 D of the targeted refraction. The intraocular pressure and corneal endothelial cells morphometry had no significant difference between preoperation and every postoperative time points（P 〉0.05 ）. The anterior chamber depth was significantly decreased from preoperative （3280 ± 206）μm to postoperative （2863 ± 217 ）μm observing by UBM （P 〈 0.05 ）.The central vault and location of phakic intraocular lens were normal and stable at every following-up time points. Six eyes of four patients occurred high intraocular pressure within one week after operation and recovered to normal through treatment. Two eyes of one patient occurred local anterior subcapsular lens opacities ,but the opacities and visual acuity had no development during following-up, so no surgical intervention required. Conclusion The implantation of posterior chamber phakic intraocular lens for correction of high myopia is effective, safe and stable. Accurate preoperative measurement is important for surgical outcomes and helpful for reducing complications.