Department of Ophthalmology, Fudan University Eye and ENT Hospital, 83 Fenyang Rd, Shanghai, China.
Graefes Arch Clin Exp Ophthalmol. 2012 Dec;250(12):1725-30. doi: 10.1007/s00417-012-2002-z. Epub 2012 Apr 4.
To report the incidence, clinical presentation, and surgical outcomes of retinal detachment in highly myopic patients corrected by implantation of phakic intraocular lenses (PIOLs).
This is a retrospective interventional non-comparative case series. A total of 530 highly myopic eyes that underwent PIOLs implantation were included in the study. All patients completed at least a 2-year follow-up after PIOL implantation. The incidence of retinal detachment (RD) and subsequent treatments were reviewed. The refractive errors, axial lengths, time between refractive surgery and RD detection, vitreoretinal findings, rate of retinal reattachment, and the pre- and postoperative best-corrected visual acuity (BCVA) were analyzed.
The overall incidence of RD was 1.5 % (eight eyes of seven patients) with a mean time between PIOL implantation and detachment of 23.63 ± 18.12 months (range, 2 days-51 months). Mean spherical equivalent (SE) before PIOL implantation was -17.53 ± 3.86 diopters (D) (range, -11.5D to -23.5D). Six patients underwent bilateral PIOL implantation. Five eyes were implanted with anterior chamber PIOLs and the other three received posterior chamber PIOLs. A traumatic history was presented before RD detection in four cases. Horseshoe tears, atrophic holes, or giant retinal tears were found in four (50 %), two (25 %), and two (25 %) eyes, respectively. Two eyes (25 %) underwent scleral buckling surgery, five eyes (62.5 %) underwent pars plana vitrectomy surgery, and one eye (12.5 %) underwent both procedures. Anatomical retinal attachment was achieved after first RD surgery in seven eyes. Mean BCVA after PIOL implantation and before RD was 20/40 (decimal refraction, 0.51 ± 0.31) compared to that of 20/80 (decimal refraction, 0.26 ± 0.12) after the RD surgery. Mean follow-up after RD surgery was 20.63 ± 12.93 months (range, 8-42 months).
The incidence of RD after PIOLs implantation is low. Its characteristics do not differ significantly from the natural history of RD in high myopic eyes. PIOL implantation for surgical correction of severe myopia does not seem to increase the risk of RD. Good visual prognosis can be obtained with early surgical intervention.
报告高度近视患者行有晶状体眼人工晶状体（PIOL）植入术后视网膜脱离的发生率、临床表现和手术结果。
这是一项回顾性、干预性、非对照的病例系列研究。共纳入 530 例高度近视眼行 PIOL 植入术，所有患者在 PIOL 植入后均完成至少 2 年的随访。回顾性分析视网膜脱离（RD）的发生率及后续治疗情况。分析屈光不正、眼轴长度、屈光手术与 RD 发现之间的时间、眼后段表现、视网膜复位率以及术前和术后最佳矫正视力（BCVA）。
RD 的总发生率为 1.5%（7 例 8 只眼），PIOL 植入与脱离之间的平均时间为 23.63±18.12 个月（范围：2 天-51 个月）。PIOL 植入术前平均等效球镜（SE）为-17.53±3.86 屈光度（D）（范围：-11.5D 至-23.5D）。6 例患者行双眼 PIOL 植入术。5 只眼植入前房 PIOL，3 只眼植入后房 PIOL。4 例在 RD 发现前有创伤史。4 只眼（50%）发现马蹄形裂孔，2 只眼（25%）发现萎缩性裂孔，2 只眼（25%）发现巨大裂孔。2 只眼（25%）行巩膜扣带术，5 只眼（62.5%）行玻璃体切割术，1 只眼（12.5%）行上述两种手术。7 只眼在首次 RD 手术后视网膜解剖复位。PIOL 植入术后和 RD 发生前的平均 BCVA 为 20/40（十进制视力，0.51±0.31），而 RD 手术后的平均 BCVA 为 20/80（十进制视力，0.26±0.12）。RD 手术后的平均随访时间为 20.63±12.93 个月（范围：8-42 个月）。
PIOL 植入术后 RD 的发生率较低。其特征与高度近视眼中 RD 的自然病程无显著差异。PIOL 植入术治疗高度近视的手术矫正似乎不会增加 RD 的风险。早期手术干预可获得良好的视力预后。
