有晶状体眼后房型人工晶状体植入术矫正高度近视眼术后视觉质量的临床研究

目的评价有晶状体眼后房型人工晶状体(ICL)植入术矫正高度近视及散光患者术后的视觉质量。 方法收集2017年1至12月在湖南省人民医院眼科接受ICL植入术治疗的近视眼和散光患者32例(49只眼)。其中，男性11例(18只眼)，女性21例(31只眼)，年龄21~42岁，平均(26.38±7.39)岁。术前屈光度球镜-6.00~-11.00 D，柱镜-2.50~0 D，等效球镜(-9.39±1.80)D。全部行ICL植入术。记录患者术前、术后1周、术后1个月、术后3个月以及术后6个月的裸眼视力、最佳矫正视力、等效屈光度、客观眼内散射指数(OSI)及调制传递函数截止频率(MTF cut off)。以患者术后裸眼视力和屈光度作为分类变量，采用例数和百分比描述。采用卡方检验进行比较。患者的OSI值和MTF cut off值采用均数±标准差表示。术前和术后各时间点的比较，采用单因素重复测量方差分析。当差异有统计学意义时，进一步采用最小显著差异t检验进行两两比较。 结果49只眼中术后6个月裸眼视力≥1.0者47只眼，占95.92%；≥1.2者33只眼，占66.35%。其中，超过术前最佳矫正视力1行以上者42只眼，占85.71%，无最佳矫正视力下降的病例。术后6个月，等效屈光度为(0.30±0.20)D。OSI值在术前、术后1周、术后1个月、术后3个月以及术后6个月分别为(1.16±0.77)、(1.04±0.60)、(0.99±0.60)、(0.86±0.38)和(0.85±0.37)。经单因素重复测量方差分析，各时间点的比较，差异有统计学意义(F＝2.78，P<0.05)。进一步两两比较，术后各时间点OSI值均低于术前，但术后1周及术后1个月的OSI值与术前OSI值的比较，差异无统计学意义(t＝1.36，0.95；P>0.05)，而术后3个月及术后6个月的OSI值与术前OSI值的比较，差异有统计学意义(t＝5.79，6.05；P<0.05)。术后各随访阶段的OSI值两两比较，差异无统计学意义(F＝0.66，P>0.05)。MTF cut off值在术前、术后1周、术后1个月、术后3个月以及术后6个月分别为(34.04±9.71)、(35.88±9.02)、(37.15±9.89)、(37.11±6.61)和(37.08±3.31)，经单因素重复测量方差分析，各时间点比较，差异有统计学意义(F＝2.14，P<0.05)。术后各时间点的MTF cut off值均高于术前，但术后1周的MTF cut off值与术前MTF cut off值比较，差异无统计学意义(t＝0.13，P>0.05)，而术后1个月、术后3个月以及术后6个月的MTF cut off值与术前MTF cut off值比较，差异有统计学意义(t＝26.36，23.85，17.88；P<0.05)。术后1个月MTF cut off值较术后1周MTF cut off值有明显提高，但比较差异无统计学意义(t＝0.66，P>0.05)。术后1个月、术后3个月以及术后6个月的MTF cut off值两两比较，差异无统计学意义(F＝0，P>0.05)。 结论有晶状体眼后房型人工晶状体植入术矫正高度近视眼及散光具有良好的安全性和有效性，且术后视觉质量较术前有明显改善，术后1个月视觉质量达到稳定状态。

Clinical analysis on optical and visual quality after implantable collamer lens implantation for high myopia correction

ObjectiveThe aim of this study was to evaluate optical and visual quality after implantable collamer lens (ICL) implantation for high myopia and astigmatism correction. MethodsThirty-two subjects (49 eyes) with high myopia and astigmatism correction, who accepted implantable collamer lens implantation at Hunan Provincial People's Hospital from January to December 2017 were enrolled. The time of surgery was 26.38±7.39 years with the range from 21 years-old to 42 years-old. The mean preoperative range of spherical refraction was -6.00 to -11.00 D, cylinder refraction was -2.50 to 0 D, and spherical equivalent was (-9.39±1.80) D. All subjects underwent ICL implantation. Uncorrected visual acuity, best corrected visual acuity, spherical equivalent, objective scatter index (OSI), and modulation transfer function (MTF) cut off frequency, at preoperative, postoperative 1 week, 1 month, 3 months, and 6months, were recorded. The postoperative uncorrected visual acuity and spherical equivalent were used as the categorical variables which were expressed as number and percentage. The Chi-square test was used for statistical analysis. OSI values and MTF cut off values were expressed as mean±standard deviation. One-way analysis of variance was used to compare preoperative and postoperative time points. When the difference is statistically significant, pair wise comparison was perfomred by Least-Significant Difference t test. ResultsAmong of 49 eyes, uncorrected visual acuityat with 1.0 or better was 95.92% (47 eyes), those of at 1.2 or better was 66.35% (33 eyes) at postoperative 6 months. There were 42 eyes (85.71%) gained 1 or more lines; no patients lost lines of best corrected visual acuity. The mean spherical equivalent was (0.30±0.20) D at postoperative 6 months. The OSI value was(1.16±0.77), (1.04±0.60), (0.99±0.60), (0.86±0.38), and (0.85±0.37) at preoperative, postoperative 1 week, 1 month, 3 months, and 6 months, respectively. There were significant differences between each time point (F=2.78, P<0.05) using one-way analysis of variance. Further comparisons showed that the OSI values at each postoperative time point were all lower than that of pre-operation, but there was not shown statistically between postoperative 1 week, postoperative 1 month and before operation (t=1.36, 0.95; P>0.05). While there were significant differences between postoperative 3 months, postoperative 6 months and pre-operation (t=5.79, 6.05; P<0.05). There were no significant differences between postoperative time points (F=0.66, P>0.05). The MTF cut off was (34.04±9.71), (35.88±9.02), (37.15±9.89), (37.11±6.61), and (37.08±3.31) at preoperative, postoperative 1 week, 1 month, 3 months, and 6 months, respectively. There were significant differences between each time point (F=2.14, P<0.05) by one-way analysis of variance. The MTF cut off at postoperative time points were all higher than pre-operation, but there not shown statistically between postoperative 1 week and pre-operation (t=0.13, P>0.05). While there were significant differences between postoperative1 month, postoperative 3 months, postoperative 6 months and pre-operation (t=26.36, 23.85, 17.88; P<0.05). The MTF cut off at postoperative 1 month was higher than postoperative 1 week, however, there was no significant difference (t=0.66, P>0.05). There were no significant differences between postoperative 1 month, postoperative 3 months, and postoperative 6 months (F=0.00, P>0.05). ConclusionsICL was good, safety and effectiveness in high myopia and astigmatism correction. The optical and visual quality was significantly improved after operation, and got a stable state at postoperative 1 month.