Pérez-Santonja J J, Bueno J L, Zato M A
Department of Ophthalmology, Jiménez-Díaz Foundation, Autonomous University of Madrid, School of Medicine, Spain.
J Refract Surg. 1997 May-Jun;13(3):268-81; discussion 281-4. doi: 10.3928/1081-597X-19970501-13.
Implanting an anterior chamber intraocular lens in a phakic eye is an effective surgical procedure for the correction of high myopia. However, the potential risks on the anterior segment structures are not well-known. We conducted a prospective study to evaluate the effectiveness, predictability, and safety after Worst-Fechner lenses were implanted to correct high myopia.
We studied 32 eyes with preoperative myopia from -9.50 to -27.00 diopters (D) (-16.60 +/- 6.29 D). All 32 eyes were studied by clinical specular microscopy, and the endothelium was analyzed for cell density. Twenty eyes were additionally examined by fluorophotometry for lens transmittance changes. Thirty eyes were additionally examined using the flare mode of a laser flare cell photometer for anterior chamber inflammation; the patients were divided into three subgroups of ten eyes each according to when the postoperative flare measurements were done: 12 months, 18 months, and 24 months. Thirteen phakic eyes with myopia greater than -6.00 D were used as a control group for the flare study. The mean follow-up was 18.3 +/- 8 months (range 6 to 24 mo).
Fifty-seven per cent of eyes (16 of 28) had an uncorrected visual acuity of 20/40 or better 12 months after surgery, and 58% (10 of 17 eyes) at 24 months. Spectacle-corrected visual acuity improved: 0.15 at 12 months and 0.16 at 24 months (0.1 = one line) from preoperative values. Visual acuity was stable after 3 months. Eighty per cent of eyes (25 of 31) at 6 months, 75% (21 of 28) at 12 months, and 76.5% (13 of 17) at 24 months had been correctly planned to within +/-1.00 D of emmetropia. The refractive results were stable 3 months after surgery. The mean endothelial cell loss was 7.2% at 3 months, 10.6% at 6 months, 13% at 12 months, and 17.6% at 24 months after surgery. The mean lens transmittance loss was 0.62% at 3 months, 0.72% at 6 months, 0.82% at 12 months, and 1.03% at 18 months after surgery. Flare values were significantly higher for eyes implanted with Worst-Fechner lenses than were those of the control group in all periods under consideration (Mann-Whitney test, p < 0.05). A decentration greater than 0.5 mm was present in 43% of eyes (14 of 32), and halos in 56% (18 of 32). In three eyes (9.3%), fixation of the lens to the iris was not stable.
Our results for the Worst-Fechner myopia lens confirm earlier findings on the effectiveness of the refractive results. However, our study showed a continual decrease in endothelial cell density, a decrease in lens transmittance, and a chronic subclinical inflammation after the implantation of these lenses. Moreover, decentration was common, and the fixation of the IOL to the iris was not stable in some eyes.
在有晶状体眼内植入前房型人工晶状体是矫正高度近视的一种有效手术方法。然而，其对眼前节结构的潜在风险尚不明确。我们进行了一项前瞻性研究，以评估植入沃斯特 - 费克纳晶状体矫正高度近视后的有效性、可预测性和安全性。
我们研究了32只术前近视度数在-9.50至-27.00屈光度（D）（-16.60±6.29 D）之间的眼睛。所有32只眼睛均通过临床镜面显微镜检查，并分析内皮细胞密度。另外20只眼睛通过荧光光度法检测晶状体透光率变化。30只眼睛使用激光散射细胞光度计的散射模式检测前房炎症；根据术后散射测量时间，将患者分为三个亚组，每组10只眼睛：术后12个月、18个月和24个月。13只近视度数大于-6.00 D的有晶状体眼作为散射研究的对照组。平均随访时间为18.3±8个月（范围6至24个月）。
术后12个月时，57%（28只眼中的16只）眼睛的未矫正视力达到20/40或更好，术后24个月时为58%（17只眼中的10只）。眼镜矫正视力有所提高：术后12个月提高0.15，术后24个月提高0.16（0.1相当于一行），相对于术前值。视力在术后3个月后稳定。术后6个月时，80%（31只眼中的25只）眼睛、12个月时75%（28只眼中的21只）眼睛以及24个月时76.5%（17只眼中的13只）眼睛的屈光结果被正确规划至正视眼±1.00 D范围内。屈光结果在术后3个月后稳定。术后3个月时内皮细胞平均损失率为7.2%，6个月时为10.6%，12个月时为13%，24个月时为17.6%。术后晶状体透光率平均损失率在3个月时为0.62%，6个月时为0.72%，12个月时为0.82%，18个月时为1.03%。在所有考虑的时间段内，植入沃斯特 - 费克纳晶状体的眼睛的散射值均显著高于对照组（曼 - 惠特尼检验，p < 0.05）。43%（32只眼中的14只）眼睛出现大于0.5 mm的偏心，56%（32只眼中的18只）眼睛出现光晕。3只眼睛（9.3%）中晶状体与虹膜的固定不稳定。
我们关于沃斯特 - 费克纳近视晶状体的研究结果证实了早期关于屈光效果有效性的发现。然而，我们的研究表明，植入这些晶状体后内皮细胞密度持续下降、晶状体透光率降低以及存在慢性亚临床炎症。此外，偏心很常见，并且在一些眼睛中人工晶状体与虹膜的固定不稳定。
