From the Department of Ophthalmology, Womack Army Medical Center, Fort Bragg, North Carolina (Packer, Vlasov, Greenburg, Coggin, Weightman, Carroll); Department of Clinical Investigation, Womack Army Medical Center, Fort Bragg, North Carolina (Beltran, Berry-Cabán).
J Cataract Refract Surg. 2022 Jun 1;48(6):649-656. doi: 10.1097/j.jcrs.0000000000000818.
To examine the long-term efficacy and safety of myopic implantable collamer lens (ICL) implantation in active duty personnel of U.S. military.
Hospital practice.
Retrospective longitudinal observational study.
1485 patients (median age 25, interquartile range 22 to 29) underwent ICL surgery. Patients received a preoperative examination including uncorrected distance visual acuity (UDVA), intraocular pressure (IOP), manifest refraction measuring corrected distance visual acuity (CDVA), corneal topography and tomography, qualitative grading of perceived ectatic risk, ophthalmic biometry, and baseline endothelial cell counts (ECCs). Outcome measures included UDVA, IOP, vault size, manifest refraction, CDVA, and ECCs. The long-term follow-up data ware drawn from the U.S. military medical record system.
A total of 3105 eyes were evaluated. Patients received ICLs because of either abnormal topography (2111 eyes [68%]) or high myopia (994 eyes [32%]). 94 eyes (80%) maintained UDVA of 20/25 or better up to 8 years postoperatively. The rate of achieving the desired refractive correction was 97% (503 eyes) at 1 year and 90% (81 eyes) at 8 years. Stability of these outcomes was also shown by minimal change in manifest refraction. Documented mean ECC loss was 22% at postoperative year 5. The overall rate of adverse events was 1.2% (36 eyes) including visually significant cataract formation, glaucoma, retinal detachment, and traumatic incision opening. A removal or replacement rate of 4.5% (135 eyes) was observed.
ICL implantation was found to be effective and safe. Vault sizes decreased over time, suggesting an increased risk of cataract formation after 7 years. Further study is necessary to assess long-term clinical significance of ECC decline.
研究美国现役军人行有晶状体眼后房型人工晶状体（ICL）植入的长期疗效和安全性。
医院实践。
回顾性纵向观察性研究。
对 1485 例（中位数年龄 25 岁，四分位间距 22 至 29 岁）行 ICL 手术的患者进行研究。患者接受术前检查，包括未矫正远视力（UDVA）、眼压（IOP）、散瞳验光测量矫正远视力（CDVA）、角膜地形图和断层扫描、感知扩张风险的定性分级、眼科生物测量和内皮细胞计数（ECC）基线。观察指标包括 UDVA、IOP、拱高、散瞳验光、CDVA 和 ECC。长期随访数据来自美国军事医疗记录系统。
共评估 3105 只眼。患者因异常地形图（2111 只眼[68%]）或高度近视（994 只眼[32%]）而行 ICL。94 只眼（80%）术后 8 年 UDVA 保持在 20/25 或更好。术后 1 年和 8 年时，达到理想屈光矫正的比例分别为 97%（503 只眼）和 90%（81 只眼）。散瞳验光结果稳定，表明术后 5 年时 ECC 平均丢失 22%。总的不良事件发生率为 1.2%（36 只眼），包括视力显著白内障形成、青光眼、视网膜脱离和外伤性切口裂开。观察到 4.5%（135 只眼）的取出或替换率。
ICL 植入术效果确切，安全性好。随着时间的推移，拱高减小，提示 7 年后白内障形成的风险增加。需要进一步研究以评估 ECC 下降的长期临床意义。
