Pentacam辅助有晶状体眼后房型人工晶状体植入术治疗超高度近视的疗效观察

背景有晶状体眼人工晶状体（IOL）植入术是一种安全、有效地矫正高度近视的手术方法。Petacam辅助观察手术后IOL在眼内的位置，为评估手术安全性提供了良好途径。目的探讨有晶状体眼后房型可植入式角膜接触镜（1cL）植入术治疗高度近视的疗效及安全性。方法回顾性分析2009年3月至2012年9月行ICL植入术的高度近视患者18例25眼的近期疗效，患眼术前平均等效球镜度为（-17．52±1．73）D，平均柱镜度为（-0．75±0．28）D，术后随访6～32个月。均采用标准对数视力表行术前术后裸眼视力及最佳矫正视力（BCVA）检查，将小数视力换算成最小分辨角对数（10gMAR）视力，同时测定术前及术后术眼的等效球镜度和眼压，用角膜内皮计检测结膜内皮细胞的形态和数目变化，采用Pentacam眼前节分析系统观察手术前后前房深度、前房角度、术后ICL拱高的变化。采用SPSS19．0统计学软件进行分析，2个组间上述指标的差异用配对t检验进行比较。结果本组25眼均成功植入ICL，术后6个月裸眼视力为0．26±0．15，明显高于术前的1．47±0．26，差异有统计学意义（t=21．71，P=0．00）。术后6个月术眼的等效球镜度明显低于术前，角膜内皮细胞计数明显少于术前，角膜内皮六角形细胞的比例明显低于术前，差异均有统计学意义（等效球镜度：t=-48．60，P=0．00；角膜内皮细胞计数：t=13．07，P=0．00；角膜内皮六角细胞：t=10．79，P〈0．05）；术后6个月前房角度为（25．02±4．77）°，较术前的（38．43±4．04）。减小，差异有统计学意义（￡=15．32，P=0．00）；而术后6个月术眼的眼压和前房深度与术前比较差异均无统计学意义（眼压：t=-1．57，P=0．13；前房深度：t=1．46，P=0．16）。术后6个月ICL拱高为（542．17±39．46）μm，明显低于术后1周时的（363．33±44．37）μm，差异有统计学意义（t=20．86，P=0．00）。2例2眼术后出现轻度眩光，所有术眼观察期内均未发现晶状体混浊。结论ICL保留了生理性调节，对于高度近视眼的矫治安全、有效，但术后应检测角膜内皮细胞的变化。

Evaluation of clinical effectiveness of implantable contact lens for high myopia

Abstract] Background Posterior chamber phakic intraocular lens implantation is a safe and effective method for correction of high myopia. Pctacam-assisted observation of the intraocular lens position in the eye after surgery,provides a good way for the evaluation of operation safety. Objective This study was to evaluate the security and effectiveness of posterior chamber （ phakic ） implantable contact lens （ICL） implantation for high myopia. Methods Twenty-five eyes of eighteen high myopia patients who received ICL implantation were retrospectively analyzed from March 2009 to September 2012. The mean preoperative spherical equivalent （SE） of the patients was （ - 17.52 -± 1.73 ） D and the cylinder was （ - 0. 75 -± 0.28 ） D. The clinical effective indexes included preoperative and postoperative uneorrect visual acuity （UCVA） and best correct visual acuity （BCVA）, SE, intraocular pressure（IOP） , corneal endothelial cell number and percentage of corneal endothelial hexagon cells. In addition,Pentacam analysis system was used to compare the anterior chamber depth,anterior chamber angle and space between crystal lens and ICL between before and 6 months after operation. Written informed consent was obtained from each patient before any medical procedure. Results ICL was successfully implanted in all the 25 eyes. UCVA was 1.47±0.26 and 0.26±0. 15 respectively before and after operation,showing a significant difference between them （t= 21.71 ,P = 0.00 ）. SE, corneal endothelial cell number and percentage of corneal endothelial hexagon cells were significantly lower than those before operation （ SE ： t = -48.60, P = 0. 00 ; corneal endothelial cell number ： t = 13.07,P = 0.00 ; percentage of corneal endothelial hexagon cells ： t = 10.79, P〈0.05 ）. Anterior chamber angle was （ 25.02 ± 4.77 ） μm 6 months after operation and was smaller than （ 38.43 ±4.04 ） ° before operation （ t -- 15.32, P = 0.00 ）. No significant differences were found in IOP and anterior chamber depth between before and after operation （ IOP： t = -1.57 ,P=0. 13 ;anterior chamber depth： t= 1.46 ,P=0. 16）. The spaces between crystal lens and IOL was （363.33± 44.37） μm 6 months after operation,with a significant decline in comparison with （542.17±39.46） μm 1 week after operation （t = 20.86, P = 0.00）. Glare sense appeared in 2 eyes after operation. Conclusions The results indicated that ICL implantation can retain the natural accommodation of lens. ICL implantation appears to be an effective and safe approach to high myopic eyes. However, the changes of corneal endothelial cells after operation should be payed more attention.