前房虹膜夹型人工晶状体矫正高度近视疗效观察

目的探讨前房虹膜夹型人工晶状体（AC—PIOLS）植入矫正高度近视的远期疗效和安全性。方法回顾性病例分析研究。对资料齐全的18例30眼行AC—PIOLS植入的高度近视患者随访2a，分别于术前，术后1、6、12、24个月检测裸眼视力（UCVA）、最佳矫正视力（BCVA）、等效球镜屈光度（SE），眼压、角膜内皮计数、前房深度（ACD）、对比敏感度（CSF）、眩光敏感度和波前相差等，并分别将术前与术后1a和术后2a的检查结果进行比较。所有患者术前均签署知情同意书。结果术后1a，14眼（46．7％）近视力较术前提高；术后2a，19眼（63．3％）较术前提高，与术前相比差异有统计学意义（χ^2=26．779，P=0．031）。术后1a，BCVA较术前提高≥1行者为56．7％（17／30），术后2a为60．0％（18／30），差异有统计学意义（χ^2=117．412，P〈0．01）。术后2a SE明显降低，差异有统计学意义（P〈0．05）。术后各频段的CSF均较术前明显提高，尤其在低中频段，差异有统计学意义（P〈0．05）。术后高阶像差较术前增高，球差、彗差与术前比较差异均有统计学意义（P〈0．05）。术后随访2a，各时间点间眼压、角膜内皮细胞计数的差异均无统计学意义（P〉0．05）。术后5眼瞳孔轻度变形，6眼虹膜夹持部出现轻度虹膜色素脱失，4眼主诉眩光和光晕感。结论AC—PIOLS植入术治疗高度近视安全、有效，并且具有良好的可预测性和稳定性，但远期效果尚需进一步观察。

Clinical follow-up of implantation of Verisyse iris-claw phakic intraocular lenses for high myopia

Background Phakic intraocular lenses （PIOLS） implantation is a good way for the correction of high myopic eyes because of the better vision quality. But its safety and long-term effectiveness are concerned. Objective This study was to evaluate the long-term effectiveness, safety,predictability and stability of Verisyse iris-claw phakic intraocular lenses （IC-PIOL） for the correction of high myopia. Methods This is a retrospective cases-observation study. Thirty eyes from 18 patients received the implantation of Verisyse PIOLS for high myopia were followed-up for 2 years. The clinical data was collected and analyzed,including uncorrected visual acuity （UCVA）, best corrected visual acuity （BCVA）, spherical equivalent refraction （SE） , corneal astigmatism, intraoeular pressure （IOP） , corneal endothelium cell counting, anterior chamber depth （ ACD ） , contrast sensitivity （CS） , glare sensitivity and wave front aberration from before surgery and 1,6,12, and 24 months after surgery. Written informed consent was obtained from each patient before the initial of any medical protocol. Results The uncorrective near vision was significantly improved in 14 eyes （46.7%） in 1 year and 19 eyes （63.3%） in 2 years after operation,showing a statistically significant difference in comparison with before operation （χ^2 = 26. 779, P = 0. 031 ）. The uncorrective distance vision improved in 17 eyes （56.7%） in 1 year and 18 eyes （60.0%） in 2 years,presenting a obvious increase in comparison with before operation （χ^2 = 117. 412, P 〈 0. 001 ）. The SE and the corneal astigmatism were significant decreased in postoperation compared with preoperation （ P 〈 0.05 ）. The postoperative CSF and glare contrast sensitivity in all spatial frequencies were increased in comparison with those of preoperative values, especially at low and moderate spatial frequencies （ P 〈 0.05 ）. The higher order aberration increased after implantation of PIOL, and the increase in coma and spherical aberration （SA） was statistically significant in comparison with preoperation （ P 〈 0.05 ）. There was no statistically significant difference was found between preoperation and postoperative 1 year or 2 years in corneal endothelial density and IOP （ P 〈 0.05 ）. The mild and reversible complications included deformation of pupils in 5 eyes, depigmentation of iris in 6 eyes and glare in 4 eyes. Conclusion Implantation of Verisyse PIOLS is an effective,safe and predictable procedure for the correction of high myopic eye. A long-term follow-up and large samples study is still required.