有晶体眼后房型人工晶体植入矫治高度近视的临床观察

徐玉梅; 孟晓丽; 王丽强; 葛梅; 黄一飞

doi:10.3969/j.issn.2095-5227.2015.05.015

有晶体眼后房型人工晶体植入矫治高度近视的临床观察

Clinical observation of phakic intraocular lens implantation for correction of high myopia

摘要

摘要: 目的评价有晶体眼后房型人工晶体眼内植入治疗高度近视的临床效果。方法回顾性分析2011年9月-2012年3月于解放军总医院眼科行有晶体眼后房型人工晶体植入的高度近视病例41例共80眼，年龄19 ～ 41（27.0±6.2）岁，男15例，女26例，植入晶体均为可植入接触镜（implantable contact lenses，ICL），分别于术前、术后1 d、1周、1个月、3个月、6个月、12个月进行裸眼视力（uncorrected visual acuity，UCVA）、最佳矫正视力（best corrected visual acuity，BCVA）、等效球镜（manifest refraction spherical equivalent，MRSE）、眼压（intraocular pressure，IOP）、角膜内皮计数（endothelial cell density，ECD）、前房深度（anterior chamber depth，ACD）、自然晶体与人工晶体间距离（拱高）检测。结果术后平均随访（12.3±3.1）个月。术后UCVA均提高，平均较术前提高9行，其中≥0.5和≥1.0者分别为91.3%和71.25%；术后所有患者BCVA≥术前BCVA，平均1.05±0.25，其中45眼（56.3%）提高≥1行，18眼（22.5%）提高≥2行，3眼（3.7%）提高≥3行；手术的有效指数和安全指数分别为1.13±0.33和1.25±0.35。等效球镜由术前-11.62±3.37 D降至术后-0.15±0.96 D，术后等效球镜≤1 D和≤0.5 D者分别为87.5%和63.8%；术后1周内一过性高眼压7眼（8.75%），6眼药物治疗后稳定，1眼因虹膜孔偏小经YAG激光扩孔控制；术前ECD为（2 861±413）个/mm²，术后1个月为（2 682±498）个/mm²，差异无统计学意义（P> 0.05）；术前ACD为（3.21±0.25） mm，术后为（2.91±0.30） mm，差异有显著统计学意义（P< 0.01）；术后1个月拱高为（711±354）μm；其中有8眼（10%）术后拱高过高≥1 000μm，且在术后3个月内有逐渐降低的趋势，有3眼（3.75%）拱高过低≤200μm；术后1眼（1.25%）出现眩光和光晕。结论 ICL矫正高度近视有效、安全、可预测性好，是一种较为理想的手术方式。

Abstract: Objective To evaluate the clinical efficacy of surgical correction for high myopia using phakic intraocular lens. Methods Clinical data about 80 eyes of 41 patients who had implantation of implantable contact lenses (ICL) for the correction of high myopia in Chinese PLA General Hospital from September 2011 to march 2012 were retrospectively analyzed. There were 15 males and 26 females with the average age of (27.0±6.2) years old (range:19-41 years old). The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction spherical equivalent (MRSE), intraocular pressure (IOP), endothelial cell density (ECD), anterior chamber depth (ACD), space between crystalline lens and intraocular lens (vault) were tested and recorded preoperatively and followed at different time points postoperatively. Results The mean follow-up time was 12.3±3.1 months. Postoperative UCVA were improved in all eyes by 9 lines in snellen chart, with 91.3% ≥ 0.5 and 71.25% ≥ 1.0. BCVA were maintained or improved in all eyes, with 56.3% (45/80) improved by 1 line, 22.5% (18/80) by 2 lines, 3.7% (3/80) by 3 lines. The surgery efficacy index and safety index were 1.13±0.33 and 1.25±0.35, respectively. The mean MRSE was -11.62±3.37 D preoperatively and -0.15±0.96 D postoperatively, 68 eyes (87.5%) were within 1D of emmetropia, 51 eyes (63.8%) were within 0.5 D of emmetropia. Transient IOP elevation occurred in 7 eyes (8.75%) within 1 week postoperatively and stabilized after proper management. ECD was 2 861±413/mm²preoperatively and 2 682±498/mm²postoperatively, which showed no statistically significant difference (P> 0.05). ACD was 3.21±0.25 mm preoperatively and 2.91±0.30 mm postoperatively, which showed statistically significant difference (P< 0.01). The mean vault 1 month postoperatively was 711 +/- 354 µm with 8 eyes (10%) ≥ 1 000 µm and 3 eyes (3.75%) ≤ 200 µm. One eye (1.25%) reported glare and halo postoperatively. Conclusion ICL implantation for the correction of high myopia is effective, safe and predictable.

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