Cao Xin-fang, Wang Yang, Shen Ye, Tong Jian-ping, Xia Jian-hua, Zhou Tian-an, Ye Bei
Department of Ophthalmology, the First Affiliated Hospital, Zhejiang University, Hangzhou, China.
Zhonghua Yan Ke Za Zhi. 2013 Mar;49(3):235-41.
To evaluate the efficacy, safety and clinical value of calculating the posterior chamber phakic intraocular lens (ICL) length according to the corneal horizontal diameter.
This was a retrospective study. A Staar Visian implantable contact lens (ICL) was implanted in 32 patients (64 eyes) with high myopia in the Department of Ophthalmology, the First Affiliated Hospital, College of Medicine, Zhejiang University between November 15, 2005 and January 15, 2011. The lens length was calculated according to the corneal horizontal diameter measured by Orbscan II. Patients were followed up postoperatively at 1 day, 1 week, 1, 3, 6 and 12 months and every 6 months thereafter. The evaluations included visual acuity, manifest refraction, applanation tonometry, endothelial cell count, slit-lamp microscopy to detect cataract, and UBM to assess the degree of ICL tilt and distances between the corneal endothelium, the ICL, and the crystalline lens. All of the preoperative and 12-month follow-up observations were analyzed using SPSS 16.0 software.
No anterior subcapsular cataracts were found in any of the eyes after surgery. Pigmentary dispersion was observed on the anterior and posterior surface of the ICL, but the difference was not statistically significant (χ(2) = 2.24, P = 0.13). The intraocular pressure changed from (15.67 ± 3.23) mm Hg (1 mm Hg = 0.133 kPa) to (15.78 ± 3.23) mm Hg, but the difference was not significant (t = 0.24, P = 0.38). The corneal endothelium-lens (central section) distance measured by UBM postoperatively was (2.97 ± 0.25) mm and the corneal endothelium-ICL (central section) distance was (2.24 ± 0.27) mm; the difference between them was statistically significant (t = 15.77, P < 0.01). The degree of ICL tilt measured by UBM was 1.20° ± 1.05 °. The percentage of eyes with a trabecular-iris angle (TIA) greater than 30°, between 21° and 30°, between 11°and 20°, and smaller than 10° were 29.1%, 50.0%, 11.6%, and 9.3%, respectively. The angle opening distance at 500 micron (AOD500) measured by UBM postoperatively was (0.32 ± 0.15) mm. The contact distance between the iris and the ICL measured by UBM postoperatively was (0.85 ± 0.46) mm and the ICL-lens central distance was (0.47 ± 0.25) mm. The Pearson's correlation coefficients between the ICL-lens central distance and the corneal horizontal diameter, sulcus diameter, anterior chamber depth(ACD) and ICL length were 0.11, 0.16, 0.04 and 0.19, respectively; none were statistically significant. The ICL-lens peripheral distance measured by UBM postoperatively was (0.25 ± 0.20) mm.
Selecting the length of the ICL according to the corneal horizontal diameter is appropriate, and assures the safety, effectiveness and predictability of ICL implantation.
评估根据角膜水平直径计算后房型有晶状体眼人工晶状体（ICL）长度的有效性、安全性及临床价值。
本研究为回顾性研究。2005年11月15日至2011年1月15日期间，浙江大学医学院附属第一医院眼科为32例（64眼）高度近视患者植入了STAAR Visian可植入式隐形眼镜（ICL）。根据Orbscan II测量的角膜水平直径计算晶状体长度。术后对患者进行随访，随访时间点为术后1天、1周、1、3、6和12个月，此后每6个月随访一次。评估内容包括视力、显验光、压平眼压测量、内皮细胞计数、裂隙灯显微镜检查以检测白内障，以及超声生物显微镜（UBM）评估ICL倾斜程度和角膜内皮、ICL与晶状体之间的距离。所有术前及12个月随访观察结果均使用SPSS 16.0软件进行分析。
术后所有眼均未发现前囊下白内障。在ICL的前表面和后表面观察到色素播散，但差异无统计学意义（χ(2)=2.24，P = 0.13）。眼压从（15.67±3.23）mmHg（1 mmHg = 0.133 kPa）变为（15.78±3.23）mmHg，但差异无统计学意义（t = 0.24，P = 0.38）。术后通过UBM测量的角膜内皮 - 晶状体（中央截面）距离为（2.97±0.25）mm，角膜内皮 - ICL（中央截面）距离为（2.24±0.27）mm；两者之间差异有统计学意义（t = 15.77，P < 0.01）。通过UBM测量的ICL倾斜度为1.20°±1.05°。小梁 - 虹膜角（TIA）大于30°、在21°至30°之间、在11°至20°之间以及小于10°的眼的百分比分别为29.1%、50.0%、11.6%和9.3%。术后通过UBM测量的500微米处的房角开放距离（AOD500）为（0.32±0.15）mm。术后通过UBM测量的虹膜与ICL之间的接触距离为（0.85±0.46）mm，ICL - 晶状体中央距离为（0.47±0.25）mm。ICL - 晶状体中央距离与角膜水平直径、沟直径、前房深度（ACD）和ICL长度之间的Pearson相关系数分别为0.11、0.16、0.04和0.19；均无统计学意义。术后通过UBM测量的ICL - 晶状体周边距离为（0.25±0.20）mm。
根据角膜水平直径选择ICL长度是合适的，可确保ICL植入的安全性、有效性和可预测性。
