Sánchez-Galeana César A, Smith Ronald J, Sanders Donald R, Rodríguez Francisco X, Litwak Sergio, Montes Miguel, Chayet Arturo S
CODET Aris Vision Institute, Tijuana, B.C., Mexico.
Ophthalmology. 2003 Apr;110(4):781-5. doi: 10.1016/s0161-6420(02)01973-5.
To describe a case series to determine the incidence of lens opacities after posterior chamber phakic intraocular lens (IOL) implantation (STAAR Surgical, Monrovia, CA) for very high ametropias.
Retrospective, noncomparative, interventional case series.
Fourteen eyes of 170 consecutive eyes with high ametropias in whom lens opacities developed after posterior chamber phakic IOL implant (PCPIOL).
Posterior chamber phakic intraocular lens implant.
Lens opacity appearance, localization, and clinical course.
Fourteen eyes developed lens opacities 125 +/- 116 days after phakic IOL implant. All eyes had anterior subcapsular opacities, and two eyes also developed nuclear sclerosis. The anterior opacities did not extend posteriorly within the lens, and there were no posterior subcapsular cataracts. Seventy-one percent of opacities were first seen </=3 months, and 86% were seen </=7 months postoperatively. Seventy-nine percent of opacities were seen in the first or second implants of surgeons being trained; 19% of the first 16 cases and 0% of the next 43 cases of one surgeon developed opacities. Mean follow-up after opacity diagnosis was 9.1 +/- 6.8 months. Nine of the 14 (64%) opacities were asymptomatic. Two eyes developed nocturnal glare, with no loss of best-corrected visual acuity (BCVA) and one had loss of BCVA. Two additional eyes with both nuclear sclerotic and anterior subcapsular lens opacities had visual symptoms and/or loss of BCVA and underwent phakic IOL explantation, cataract extraction by phacoemulsification, and PCPIOL implant with good visual outcome. In the entire series, 5 of 170 (2.3%) implantations had symptomatic opacities in which 111 implantations were the first or second case of the implanting surgeon.
Lens opacities are a potential complication of phakic IOL implantation. Most lens opacities were first seen in the early postoperative period and were most likely due to surgically induced trauma. The anterior subcapsular type was most common and tended not to be rapidly progressive during the follow-up period. The presence of nuclear sclerotic cataract was visually significant and progressive. Long-term follow-up is warranted to evaluate the rate of progression and course of lens opacities after phakic IOL implant surgery.
描述一组病例，以确定后房型有晶状体眼人工晶状体（IOL，STAAR Surgical公司，蒙罗维亚，加利福尼亚州）植入术后治疗高度屈光不正时晶状体混浊的发生率。
回顾性、非对比性、干预性病例系列。
170例连续的高度屈光不正患者的14只眼，这些患者在植入后房型有晶状体眼人工晶状体（PCPIOL）后出现晶状体混浊。
后房型有晶状体眼人工晶状体植入。
晶状体混浊的出现、定位及临床过程。
14只眼在有晶状体眼人工晶状体植入术后125±116天出现晶状体混浊。所有眼睛均有前囊下混浊，2只眼还出现核硬化。前部混浊未在晶状体内向后扩展，且无后囊下白内障。71%的混浊在术后≤3个月首次被发现，86%在术后≤7个月被发现。79%的混浊出现在接受培训的外科医生的首例或第二例植入手术中；一位外科医生的前16例中有19%出现混浊，后43例中无混浊出现。混浊诊断后的平均随访时间为9.1±6.8个月。14只眼中有9只（64%）混浊无症状。2只眼出现夜间眩光，最佳矫正视力（BCVA）未下降，1只眼BCVA下降。另外2只既有核硬化又有前囊下晶状体混浊的眼睛有视觉症状和/或BCVA下降，接受了有晶状体眼人工晶状体取出、超声乳化白内障摘除及PCPIOL植入，视觉效果良好。在整个系列中，170例植入中有5例（2.3%）出现有症状的混浊，其中111例是植入外科医生的首例或第二例手术。
晶状体混浊是有晶状体眼人工晶状体植入的一种潜在并发症。大多数晶状体混浊在术后早期首次被发现，很可能是手术创伤所致。前囊下型最常见，在随访期间往往不会迅速进展。核硬化性白内障的存在具有视觉意义且会进展。需要进行长期随访以评估有晶状体眼人工晶状体植入术后晶状体混浊的进展速度和病程。
