[有晶状体眼人工晶状体植入术矫正高度近视]

Bi Hong-sheng, Ma Xiao-hua, Cai Wan-ting, Liu Dong-mei, Ji Peng

Jinan Shierming Ophthalmic Hospital, Jinan 250002, China.

Zhonghua Yan Ke Za Zhi. 2006 Feb;42(2):145-9.

OBJECTIVE

To evaluate the efficacy, safety, and predictability of the implantation of phakic anterior chamber intraocular lens (PAC-IOL) for the correction of severe myopia.

METHODS

In this prospective study, 15 cases (29 eyes) with myopia at -15.00 - -24.50 dioperts (D) were implanted with Phakic 6H(2) PAC-IOL. Visual acuity, refraction, intraocular pressure, corneal endothelium, the PAC-IOL position, contrast sensitivity, glare sensitivity, operative complications and poor visual symptoms were observed.

RESULTS

Postoperative uncorrected visual acuity 0.5 or better was presented in 79.3% eyes (23/29) at 3 months and in 82.6% eyes (24/29) at 6 months. Best corrected visual acuity 0.8 or better was presented in 69.0 % eyes (20/29) at 3 months and in 69.0% eyes (20/29) at 6 months, they were all significantly better than that of preoperative values (P < 0.05); and there was no statistically significant difference between visual acuity at 3 months and 6 months (P > 0.05). Compared with preoperative best corrected visual acuity, postoperative uncorrected visual acuity improved 2 lines or more in 70.0% of eyes (20/29) at 3 months and 72.4% eyes (21/29) at 6 months. The mean postoperative spherical equivalent refraction was -1.00D at 3 months, -1.00D at 6 months, they were significantly lower than that of preoperative values (P < 0.05); and there was no statistically significant difference of spherical equivalent refraction between 3 months and 6 months (P > 0.05). There were no statistically significant difference between pre- and post-operative mean intraocular pressure, corneal endothelial density (P > 0.05) at 3 and 6 months. There was no significant difference of these data between 3 months and 6 months (P > 0.05). The PAC-IOL was located (2.341 +/- 0.116) behind the central cornea, (0.841 +/- 0.140) mm in front of the crystalline lens. The footplates appeared to be correctly positioned in the anterior chamber angle in all eyes. Contrast sensitivity and glare sensitivity in all spatial frequencies increased at 6 months post-operatively as compared with those of preoperative values (best spectacle-corrected) (P < 0.05). Postoperative complications included a slight inflammatory deposits on the PAC-IOL surface at 3 months in 10.3% eyes (3/29) and 6.9% eyes (2/29) at 6 months; oval pupil in 10.3% eyes (3/29); PAC-IOL rotation in 27.6% eyes (8/29); night glare in 17.2% eyes (5/29); all of the other patients were satisfied.

CONCLUSIONS

PAC-IOL implantation for the correction of severe myopia is effective, safe and predictable. It can be a supplement for corneal refractive surgery, but follow-up is still required for the evaluation of long-term results.

目的

评估有晶状体眼前房人工晶状体（PAC-IOL）植入矫正高度近视的有效性、安全性及可预测性。

方法

在这项前瞻性研究中，对15例（29只眼）近视度数为-15.00至-24.50屈光度（D）的患者植入Phakic 6H(2) PAC-IOL。观察视力、屈光、眼压、角膜内皮、PAC-IOL位置、对比敏感度、眩光敏感度、手术并发症及视觉不良症状。

结果

术后3个月时，79.3%（23/29）的眼裸眼视力达到0.5或更好，6个月时为82.6%（24/29）。术后3个月时，69.0%（20/29）的眼最佳矫正视力达到0.8或更好，6个月时同样为69.0%（20/29），均显著优于术前值（P<0.05）；3个月与6个月时的视力无统计学差异（P>0.05）。与术前最佳矫正视力相比，术后3个月时70.0%（20/29）的眼裸眼视力提高2行或更多，6个月时为72.4%（21/29）。术后3个月时平均等效球镜度为-1.00D，6个月时为-1.00D，均显著低于术前值（P<0.05）；3个月与6个月时的等效球镜度无统计学差异（P>0.05）。术后3个月和6个月时，术前和术后平均眼压、角膜内皮细胞密度无统计学差异（P>0.05）。这些数据在3个月与6个月之间无显著差异（P>0.05）。PAC-IOL位于角膜中央后（2.341±0.116）mm，晶状体前（0.841±0.140）mm。所有眼的襻在房角位置均正确。与术前（最佳眼镜矫正）相比，术后6个月时所有空间频率的对比敏感度和眩光敏感度均增加（P<0.05）。术后并发症包括3个月时10.3%（3/29）的眼和6个月时6.9%（2/29）的眼在PAC-IOL表面有轻微炎性沉着；10.3%（3/29）的眼出现椭圆形瞳孔；27.6%（8/29）的眼发生PAC-IOL旋转；17.2%（5/29）的眼出现夜间眩光；其他所有患者均满意。