有晶状体眼前房型人工晶状体植入术矫正超高度近视眼

目的探讨有晶状体眼前房型人工晶状体（PAC-IOL）植入术矫正超高度近视眼的有效性、安全性及可预测性。方法15例（29只眼）超高度近视眼患者植入Phakic 6H2型PAC—IOL。术后观察患者的视力、屈光度数、眼压、角膜内皮细胞计数、晶状体位置、对比敏感度、眩光敏感度、手术并发症及视觉不良症状。结果术后3个月时患者裸眼视力≥0．5者占79．3％（23／29）,6个月时占82．6％（24／29）;术后3个月时患者最佳矫正视力≥0．8者占69．0％（20／29）,6个月时占69．0％（20／29）,裸眼视力及最佳矫正视力均较术前明显提高,差异有统计学意义（P〈0．05）。术后3个月时患者裸眼视力较术前最佳矫正视力提高两行及两行以上者占70．0％（20／29）,6个月时占72．4％（21／29）。术后3、6个月时屈光度中位数均为-1．00D,较术前均明显减少,差异有统计学意义（P〈0．05）。患者术后3、6个月时眼压、角膜内皮细胞计数与术前相比,3个月与6个月相比,差异均无统计学意义（P〉0．05）。PAC—IOL与角膜内皮和晶状体均保持了有效的安全距离,且弹性襻均位于前房角。术后6个月时,各频段对比敏感度和眩光敏感度较术前均明显提高,差异有统计学意义（P〈0．05）。术后3个月时3只眼,6个月时2只眼均可见PAC—IOL表面炎性反应物沉积;1只眼瞳孔呈轻度椭圆形;8只眼发生PAC-IOL旋转。3例（5只眼）主诉夜间出现眩光症状,其他患者均无明显不适。满意程度较高。结论PAC—IOL植入术矫正超高度近视眼具有良好的有效性、安全性及可预测性,是补充角膜屈光手术不足的有效眼内屈光手术,但其远期效果有待进一步观察。

Implantation of phakic anterior chamber intraocular lens for the correction of severe myopia

OBJECTIVE: To evaluate the efficacy, safety, and predictability of the implantation of phakic anterior chamber intraocular lens (PAC-IOL) for the correction of severe myopia. METHODS: In this prospective study, 15 cases (29 eyes) with myopia at -15.00 - -24.50 dioperts (D) were implanted with Phakic 6H(2) PAC-IOL. Visual acuity, refraction, intraocular pressure, corneal endothelium, the PAC-IOL position, contrast sensitivity, glare sensitivity, operative complications and poor visual symptoms were observed. RESULTS: Postoperative uncorrected visual acuity 0.5 or better was presented in 79.3% eyes (23/29) at 3 months and in 82.6% eyes (24/29) at 6 months. Best corrected visual acuity 0.8 or better was presented in 69.0 % eyes (20/29) at 3 months and in 69.0% eyes (20/29) at 6 months, they were all significantly better than that of preoperative values (P < 0.05); and there was no statistically significant difference between visual acuity at 3 months and 6 months (P > 0.05). Compared with preoperative best corrected visual acuity, postoperative uncorrected visual acuity improved 2 lines or more in 70.0% of eyes (20/29) at 3 months and 72.4% eyes (21/29) at 6 months. The mean postoperative spherical equivalent refraction was -1.00D at 3 months, -1.00D at 6 months, they were significantly lower than that of preoperative values (P < 0.05); and there was no statistically significant difference of spherical equivalent refraction between 3 months and 6 months (P > 0.05). There were no statistically significant difference between pre- and post-operative mean intraocular pressure, corneal endothelial density (P > 0.05) at 3 and 6 months. There was no significant difference of these data between 3 months and 6 months (P > 0.05). The PAC-IOL was located (2.341 +/- 0.116) behind the central cornea, (0.841 +/- 0.140) mm in front of the crystalline lens. The footplates appeared to be correctly positioned in the anterior chamber angle in all eyes. Contrast sensitivity and glare sensitivity in all spatial frequencies increased at 6 months post-operatively as compared with those of preoperative values (best spectacle-corrected) (P < 0.05). Postoperative complications included a slight inflammatory deposits on the PAC-IOL surface at 3 months in 10.3% eyes (3/29) and 6.9% eyes (2/29) at 6 months; oval pupil in 10.3% eyes (3/29); PAC-IOL rotation in 27.6% eyes (8/29); night glare in 17.2% eyes (5/29); all of the other patients were satisfied. CONCLUSIONS: PAC-IOL implantation for the correction of severe myopia is effective, safe and predictable. It can be a supplement for corneal refractive surgery, but follow-up is still required for the evaluation of long-term results.