高度近视散光患者行TICL术后旋转稳定性相关影响因素的研究

目的探讨TICL（Toric Implantable Collamer Lens）植入术矫正高度近视散光的临床效果及晶体旋转稳定性的相关影响因素。方法回顾性分析接受TICL植入术的高度近视散光患者35例（70只眼）,平均随访时间（8.8±5.5）个月。采用超声生物显微镜（UBM）观察晶体4个襻的位置,眼前节照相测算术后轴向与预测轴向的偏差。结果经过随访,术前平均柱镜度数（MRC）-（2.88±1.49）D降为术后的-（0.61±0.41）D,术后MRC≤-0.50 D占48.57%（34/70）,在-0.50~-1.00D范围内占51.43%（36/70）。术前平均等效球镜度数（MRSE）-（12.08±4.22）D降为术后的-（0.41±0.61）D。术前最佳矫正视力≥1.0的占44.29%（31/70）,术后裸眼视力≥1.0占55.71%（39/70）。平均术后TICL轴向与术前预测的差别为（6.96±8.37）°,29只眼（41.43%）TICL襻顶点位置在睫状沟内,41只眼（58.57%）不在睫状沟内。TICL旋转的角度和术后人工晶体襻的位置及拱高有明显的相关性。结论 TICL矫正高度近视散光具有较好的安全性、有效性和预测性,术后TICL晶体襻的位置和拱高是引起晶体旋转的两个可能危险因素。

Risk factors associated with rotational stability after implantation of the TICL for high myopic astigmatism

Objective To investigate the clinical outcome and possible risk factors associated with rotational stability after im- plantation of Toric Implantahle Collamer Lens （TICL） for the correction of high myopic astigmatism. Methods In this retrospective clinical study ,70 eyes of 35 patients with high myopic astigmatism were performed TICL implantation in Ningxia Eye Hospital. The mean follow - up was 8.8 -＋ 5.5 months （ranged from 3 months to 14 months）. The ultrasound biomicroscopy was used to observe footplate - position. The post - operative axis deviation from the intended axis was evaluated, and the digital anterior segment photograph was taken. TICL vaulting and footplate position were analyzed through Pearson correlation analysis. Results After mean follow - up of 8.8 months, mean manifest refractive cylinder （MRC） decreased 79.26% from - 2.88 ±1.49D preoperatively to - 0.61 ＋ 0.41D postoperatively. MRC in the range of -0.50 - - 1.00 D occurred in 68.5% （37/54） of eyes,whereas 48.57% （34/70） within -0.50 D. Mean manifest refraction spherical equivalent （MRSE） decreased from - 12.08 ±4.22 D preoperatively to -0.41 ＋ 0.61 D postoperatively. The uncorrected visual acuity of 1.0 or better after operation was 55.71% （39/70） , whereas the best corrected visual acuity （BCVA） of 1.0 or better before operation was 44.29% （31/70）. The mean difference between intended and achieved TICL axes was 6.96 ＋ 8.37~. Footplates of TICLs were in the ciliary sulcus in 29 eyes （41.43%） ,beyond the ciliary sulcus in 41 eyes （58.57%）. The angle of TICL rotation had significant correlation with the footplates - position and the postoperative TICL vaulting. Conclusion Our study further dem- onstrates the safety, efficacy and predictability of TICL for the correction of high myopic astigmatism. The footplate - position of TICL and vault value should be taken account as two relevant risks factor for TICL rotation.