Allemann N, Chamon W, Tanaka H M, Mori E S, Campos M, Schor P, Baïkoff G
Refractive Surgery Service, Department of Ophthalmology, Federal University of São Paulo, Paulista School of Medicine, São Paulo, Brazil.
Ophthalmology. 2000 Aug;107(8):1549-54. doi: 10.1016/s0161-6420(00)00221-9.
To evaluate clinical and refractive results of myopic angle-supported intraocular lenses (IOLs).
Prospective, noncomparative case series.
Twenty-one eyes of 12 patients (7 female) with a mean age of 29.5 years and a follow-up of 24 months. The prospective study included highly myopic eyes (more than -11.00 diopters [D]) with spectacle-corrected visual acuity better than 20/200.
Twenty-one eyes underwent implantation of a single-piece IOL with Z-shaped haptics for angle support (each haptic with two footplates) and an optical zone of 4.5 mm (NuVita, Bausch & Lomb Surgical, Irvine, CA). The dioptric power of the IOL was calculated considering refraction, keratometry, and anterior chamber depth (specific nomogram), and its diameter was determined by adding 0.5 mm to the corneal diameter.
We evaluated the following clinical and refractive data: visual acuity without and with correction (VAsc and VAcc), spherical equivalent (SE) obtained under cycloplegia, slit-lamp biomicroscopy, keratometry, applanation tonometry, endothelial cell count, ultrasound pachymetry, gonioscopy, indirect ophthalmoscopy, subjective complaints, and descriptions of complications.
Mean postoperative VAsc was 20/74. Mean preoperative VAcc (20/50) increased to 20/30; 65% gained at least two lines of VAcc, and no eye had a decrease in VAcc. Preoperative SE (-18.95 D) evolved to -2. 06 D, stabilizing after one month. Iris retraction (pupil ovalization) more than 0.5 mm was noted in eight eyes (40%). Mean keratometry, corneal astigmatism, and ultrasound pachymetry were stable during the study (P > 0.01). Significant endothelial cell loss was demonstrated in the second year. Gonioscopy showed 70 (87. 5%) footplates ideally positioned with no iris depression. Reports of glare and haloes in dark environment were considered light in 80% and not referred in 20%, and spectacles were used for residual refraction in 75%. Intraocular lens exchange was needed in one eye because of undersizing, and the IOL was removed in one eye because of chronic inflammatory reaction associated with ocular hypertension (this patient was excluded from the statistical analysis).
This report demonstrates good efficacy for correction of high myopia by the phakic IOL used during the two years of follow-up. Long-term complications (safety) such as iris retraction and endothelial cell loss remain a concern.
评估近视性前房角支撑型人工晶状体（IOL）的临床及屈光效果。
前瞻性、非对照病例系列研究。
12例患者（7例女性）的21只眼，平均年龄29.5岁，随访24个月。该前瞻性研究纳入了高度近视眼（近视度数超过-11.00屈光度[D]），其矫正视力优于20/200。
21只眼植入了一体式IOL，其袢为Z形用于前房角支撑（每个袢有两个脚板），光学区直径为4.5mm（NuVita，博士伦眼科手术公司，加利福尼亚州欧文市）。根据验光、角膜曲率测量和前房深度（特定列线图）计算IOL的屈光度，其直径通过角膜直径加0.5mm来确定。
我们评估了以下临床和屈光数据：裸眼视力和矫正视力（VAsc和VAcc）、睫状肌麻痹下的等效球镜度（SE）、裂隙灯生物显微镜检查、角膜曲率测量、压平眼压测量、内皮细胞计数、超声角膜测厚、前房角镜检查、间接检眼镜检查、主观症状以及并发症描述。
术后平均裸眼视力（VAsc）为20/74。术前平均矫正视力（20/50）提高到了20/30；65%的患者矫正视力至少提高了两行，且无眼矫正视力下降。术前等效球镜度（-18.95D）变为-2.06D，1个月后稳定。8只眼（40%）出现了超过0.5mm的虹膜后缩（瞳孔椭圆化）。在研究期间，平均角膜曲率、角膜散光和超声角膜测厚保持稳定（P>0.01）。第二年出现了明显的内皮细胞丢失。前房角镜检查显示70个（87.5%）脚板位置理想，无虹膜凹陷。80%的患者报告在黑暗环境中的眩光和光晕情况较轻，20%未提及，75%的患者使用眼镜矫正残余屈光不正。1只眼因尺寸过小需要更换人工晶状体，1只眼因与高眼压相关的慢性炎症反应而取出IOL（该患者被排除在统计分析之外）。
本报告表明，在两年的随访期间，所使用的有晶状体眼人工晶状体矫正高度近视的效果良好。虹膜后缩和内皮细胞丢失等长期并发症（安全性）仍是令人担忧的问题。
