Gonvers Michel, Bornet Chantal, Othenin-Girard Philippe
Hôpital Ophtalmique Universitaire Jules Gonin, Avenue de France 15, CH-1004 Lausanne, Switzerland.
J Cataract Refract Surg. 2003 May;29(5):918-24. doi: 10.1016/s0886-3350(03)00065-8.
To study cataract formation in eyes with an implantable contact lens (ICL) used for moderate to high myopia.
University Eye Hospital, Lausanne, Switzerland.
An ICL (model V3 or V4, Staar Surgical AG) was implanted in 75 eyes. Three months after surgery and again at the last follow-up examination, the transparency of the crystalline lens was assessed on transilluminated photographs and the vaulting of the ICL over the crystalline lens was evaluated. Central vaulting was measured precisely on digitized photographs taken with a 75 SL Zeiss slitlamp camera, while peripheral vaulting was estimated on photographs obtained with a Scheimpflug camera. The minimum follow-up was 12 months; the mean was 21.8 months.
At the last follow-up, 20 of the 75 eyes (27%) had an ICL-induced anterior subcapsular cataract (ASCC). The number of cataracts increased with the duration of the follow-up. Cataracts developed more commonly in older patients than in younger patients. All 20 cataracts occurred when the central vaulting was equal to or less than 0.09 mm. In 26 eyes with the same range of vaulting (among which 11 had no vaulting), the lenses were clear at the last visit. The 20 patients with cataract and the 26 patients with clear lenses matched in age and duration of follow-up but not in myopia. No touch between the ICL and the crystalline lens was encountered when the central vaulting was equal to or greater than 0.15 mm. Vaulting showed a slight decrease over time. No statistically significant difference in vaulting was found between models V3 and V4.
Central and/or peripheral contact between the ICL and the crystalline lens may be responsible for the high incidence of ASCC formation in this study. Central vaulting greater than 0.09 mm appears to protect the crystalline lens from cataract formation. However, we recommend aiming for higher central vaulting (0.15 mm) to avoid contact between the ICL and the crystalline lens. This should be attainable by implanting longer ICLs.
研究用于中高度近视的可植入接触镜（ICL）植入眼内后白内障的形成情况。
瑞士洛桑大学眼科医院。
对75只眼植入ICL（型号V3或V4，STAAR Surgical AG公司）。术后3个月以及最后一次随访检查时，通过透照照片评估晶状体的透明度，并评估ICL在晶状体上方的拱高。使用蔡司75 SL裂隙灯相机拍摄的数字化照片精确测量中央拱高，而使用Scheimpflug相机拍摄的照片估计周边拱高。最短随访时间为12个月；平均为21.8个月。
在最后一次随访时，75只眼中有20只（27%）发生了ICL诱导的前囊下白内障（ASCC）。白内障的数量随随访时间的延长而增加。老年患者比年轻患者更易发生白内障。所有20例白内障均发生在中央拱高等于或小于0.09 mm时。在拱高范围相同的26只眼中（其中11只无拱高），最后一次检查时晶状体透明。20例白内障患者和26例晶状体透明患者在年龄和随访时间上匹配，但近视程度不匹配。当中央拱高等于或大于0.15 mm时，未发现ICL与晶状体接触。拱高随时间略有下降。V3和V4型号之间的拱高无统计学显著差异。
本研究中，ICL与晶状体之间的中央和/或周边接触可能是ASCC形成发生率高的原因。中央拱高大于0.09 mm似乎可保护晶状体免于形成白内障。然而，我们建议将中央拱高目标设定得更高（0.15 mm）以避免ICL与晶状体接触。通过植入更长的ICL应该可以实现这一点。
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