有晶状体眼后房型人工晶状体植入矫正高度近视的临床评价  

Posterior chamber phakic intraocular lens for correction of extreme myopia

作　　者：沈晔[1] 周天安[1] 杜持新[1] 汪阳[1] 夏建华[1] 

机构地区：[1]浙江大学医学院附属第一医院眼科,杭州310003

出　　处：《中华眼科杂志》2007年第11期1000-1004,共5页Chinese Journal of Ophthalmology

基　　金：浙江省社会发展科研基金资助项目（021107236）

摘　　要：目的评价有晶状体眼后房型人工晶状体植入矫正高度近视的有效性、安全性及稳定性。方法选取1997年1月至2005年12月在我院就诊高度近视患者113例（216只眼），平均年龄30岁，均在球周麻醉及表面麻醉下经3．2mm透明角膜切口植入后房型人工晶状体（ICLV2型15例，ICLV4，美国STAAR公司），随访术前及术后1d、1周及1、3、6、12、24、36个月，随访内容包括裸眼视力、最佳矫正视力、角膜地形图、屈光度数、裂隙灯显微镜检查、眼压、角膜内皮计数等。术前检查等效球面屈光度数（17．78±3．88）D，平均随访18．2个月后观察屈光状态，24．3个月后观察术后并发症。结果所有手术均顺利进行，所有患者裸眼视力均有明显提高，最后一次随访等效球面屈光度数为（-1．00±1．40）D，与预期屈光度数差别±1．00D以内者191只眼（88．4％），±0．50D以内者165只眼（76．4％）。术前屈光度数在-20．00D以下的有151只眼，与预期屈光度数差别±1．00D以内者145只眼（96．0％），±0．50D以内者128只眼（84．8％）。随访期间屈光度数差异无统计学意义（P〉0．05），术后1年最佳矫正视力提高1行及以上168只眼（77．8％），4只眼（1．85％）下降1行。4只眼（1．85％）发生需手术治疗瞳孔阻滞性青光眼，3只眼（1．39％）发生晶状体前囊下混浊，均行人工晶状体取出，晶状体摘除及人工晶状体植入术，术后最佳矫正视力无下降。结论有晶状体眼后房型人工晶状体植入矫正高度近视具有有效性、安全性及稳定性。（中华眼科杂志，2007，43：1000-1004）Objective To evaluate the efficacy, safety and stability of posterior chamber phakic intraocular lens implantation for the correction of extreme myopia. Methods This study included 216 eyes of 113 patients with a mean age of 30 years（ 18 -49）from January 1997 to December 2005. An implantable contact lens （ ICL V2 and V4, Staar Surgical Inc. ） was inserted. Patients were examined preoperatively and followed at 1 day, 1 week, 1, 3, 6, 12, 24, and 36 months postoperatively. The examination content included the uncorrected visual acuity, best corrected visual acuity （BCVA）, slitlamp examination, refraction, intraocular pressure, endothelial cell morphometry, etc. Spherical equivalent was （17.78 - 3.88） diopters before the operation. Surgical implantation was performed through a 3.2 mm clear corneal sutureless incision using paraocular anesthesia. The mean follow-up period was 18.2 months （ ranged 6 to 24 months） for refractive data and 24.3 months （ranged 6 to 36 months） for the complications. Results Successful implantation was achieved in all patients. Postoperatively, all eyes had a significant increase in uncorrected visual acuity. The mean spherical equivalent refraction at the last examination was （ - 1.00 ± 1.40）, within ± 1.00 D of the targeted refraction in 191 eyes （88.4%） and within ± 0.50 D in 165 eyes （76.4%）. In eyes in which the preoperative myopia was less than 20.00 D （ n = 151 ）, the achieved refraction was within ± 1.00 D of the intended refraction in 145 eyes （96.0%） and within ±0.50 D in 128 eyes （ 84.8% ）. The refraction remained stable with a statistically insignificant change （ P 〉 0.05 ） at each interval during the follow-up. The best corrected visual acuity （BCVA） improved by 1 or more lines in 168 eyes （77.8%） at 1 year after the operation. Four eyes （ 1.85% ） lost 1 line of BCVA. Pupillary block glaucoma requiring surgical intervention occurred in 4 eyes （ 1.85% ）. Three eyes （ 1.39% ） developed cataract 1 year

关 键 词：近视 晶人工体 临床评价 晶状体 

分 类 号：R686[医药卫生—骨科学]