Hollick E J, Spalton D J, Ursell P G, Meacock W R, Barman S A, Boyce J F
Department of Ophthalmology, St Thomas' Hospital, London, England, UK.
Am J Ophthalmol. 2000 May;129(5):577-84. doi: 10.1016/s0002-9394(99)00447-x.
To compare the visual outcome, percentage of posterior capsular opacification, and laser capsulotomy rates with polymethylmethacrylate, silicone, and hydrogel intraocular lens implants at 1 and 2 years postoperatively.
Ninety-three eyes of 93 patients were randomized to receive a polymethylmethacrylate, silicone, or hydrogel intraocular lens implant. A standardized surgical protocol was followed by a single surgeon using phacoemulsification with capsulorhexis; any patients with surgical complications were excluded, and all patients received standardized medication and follow-up. Patients were examined at days 1 and 7, months 1, 3, and 6, and years 1 and 2 after surgery. At each assessment, best-corrected logMAR visual acuity and Pelli-Robson contrast sensitivity were measured. Posterior capsular opacification was objectively assessed by digital retroillumination imaging with the use of a dedicated software program and calculated as the percentage area of opacified capsule. Laser capsulotomy was performed if the eye had lost 2 lines of visual acuity with a clinically opaque capsule.
At 2 years postoperatively, the mean percentage area of posterior capsular opacification for hydrogel lenses was 63%; for polymethylmethacrylate, 46%; and for silicone, 17%. Hydrogel intraocular lenses were associated with 17% more posterior capsule opacification than were polymethylmethacrylate lenses (95% confidence interval, 1-33; P =. 037) and 45% more than were silicone lenses (95% confidence interval, 33-58; P <.0001) at 2 years. Polymethylmethacrylate lenses had 28% more posterior capsule opacification than silicone lenses (95% confidence interval, 13-43; P <.0001) at 2 years. Twenty-eight percent of patients with hydrogel intraocular lenses required an Nd:YAG laser posterior capsulotomy at 2 years, compared with 14% with polymethylmethacrylate, whereas no patients with silicone lenses needed a capsulotomy (P =.014). Visual acuity was not significantly different among the three groups, but patients with silicone intraocular lenses had significantly better contrast sensitivity than those with hydrogel lenses (P =.046).
Intraocular lenses made of this specific hydrogel were associated with a significantly higher degree of posterior capsular opacification and more laser capsulotomies than polymethylmethacrylate and silicone intraocular lenses.
比较术后1年和2年时，聚甲基丙烯酸甲酯、硅酮和水凝胶人工晶状体植入后的视力结果、后囊膜混浊百分比及激光晶状体切开率。
93例患者的93只眼被随机分为接受聚甲基丙烯酸甲酯、硅酮或水凝胶人工晶状体植入。由一名外科医生采用超声乳化联合撕囊术，遵循标准化手术方案；排除任何有手术并发症的患者，所有患者接受标准化药物治疗及随访。术后第1天和第7天、1个月、3个月和6个月以及1年和2年对患者进行检查。每次评估时，测量最佳矫正的logMAR视力和佩利-罗布森对比敏感度。使用专用软件程序通过数字后照成像客观评估后囊膜混浊情况，并计算混浊囊膜的面积百分比。如果患眼因临床可见的混浊囊膜导致视力下降2行，则进行激光晶状体切开术。
术后2年时，水凝胶人工晶状体后囊膜混浊的平均面积百分比为63%；聚甲基丙烯酸甲酯人工晶状体为46%；硅酮人工晶状体为17%。术后2年时，水凝胶人工晶状体的后囊膜混浊比聚甲基丙烯酸甲酯人工晶状体多17%（95%置信区间，1-33；P = 0.037），比硅酮人工晶状体多45%（95%置信区间，33-58；P < 0.0001）。术后2年时，聚甲基丙烯酸甲酯人工晶状体的后囊膜混浊比硅酮人工晶状体多28%（95%置信区间，13-43；P < 0.0001）。28%植入水凝胶人工晶状体的患者在术后2年需要进行Nd:YAG激光后囊膜切开术，而植入聚甲基丙烯酸甲酯人工晶状体的患者这一比例为14%，植入硅酮人工晶状体的患者则无人需要进行晶状体切开术（P = 0.014）。三组之间的视力无显著差异，但植入硅酮人工晶状体的患者对比敏感度显著高于植入水凝胶人工晶状体的患者（P = 0.046）。
与聚甲基丙烯酸甲酯和硅酮人工晶状体相比，这种特定水凝胶制成的人工晶状体后囊膜混浊程度显著更高，且需要更多的激光晶状体切开术。
