后房型有晶状体眼人工晶状体植入术安全性的临床分析  

Safety analysis of the implantation of posterior chamber phakic intraocular lens for high myopia

作　　者：董喆[1] 王宁利[1] 甄毅[1] 王怀洲[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100730

出　　处：《眼科》2011年第6期396-400,共5页Ophthalmology in China

摘　　要：目的分析后房型有晶状体眼人工晶状体（posterior chamber phakic refractive lens,PC-PRL）植入眼内对高度近视患者的屈光矫正效果及其安全性。设计回顾性病例系列。研究对象2006年7月至2007年9月在北京同仁医院行PC-PRL植入的高度近视患者35例（68眼）。方法根据术前测量的角膜缘白到白（white to white,W-W）距离及术前屈光检查确定植入的PC-PRL型号,对上述患者行PC-PRL植入术,术后随访43~57个月,观察其术后并发症情况,并记录最后一次随访时的视力、眼压、角膜内皮细胞计数、人工晶状体位置等。主要指标视力、眼压、角膜内皮细胞计数、PC-PRL与相邻组织的距离及术后并发症。结果术后最后一次随访时,68眼中有58眼（85.29%）的裸眼视力达到术前最佳矫正视力;所有患眼的术后最佳矫正视力均达到术前最佳矫正视力,且35.29%（24/68）者超过术前最佳矫正视力。术后平均眼压（17.1±2.6）mm Hg。术后平均角膜内皮细胞计数（2512±312）个/mm2,与术前（2841±257）个/mm2比较,差异无统计学意义（t=0.872,P=0.160）。至术后最后一次随访时,PC-PRL光学部前表面距角膜内皮的距离为（2.341±0.258）mm,与术后3个月时（2.491±0.317）mm比较差异无统计学意义（t=1.407,P=0.076）;PC-PRL光学部后表面与自身晶状体之间的距离为（0.302±0.109）mm,与术后3个月时（0.321±0.102）mm比较差异无统计学意义（t=1.516,P=0.064）。但有2例患者（2眼）发生了PC-PRL后表面与自身晶状体贴近,距离无法准确测量。未见继发性青光眼、视网膜脱离、并发性白内障等并发症的发生。结论 PC-PRL眼内植入能安全、有效地矫正高度近视患者的屈光不正,长期安全性还需进一步观察。Objective To analyze the safety of implantation of posterior chamber phakic refractive lens（PC-PRL） for high myopia.Design Retrospective case series.Participants Sixty-eight eyes of 35 cases with high myopia who were implanted PC-PRL in Beijing Tongren Hospital from Jul.2006 to Sep.2007.Methods Type of PC-PRL was selected according to the distance of white to white and the refractive power.After PC-PRL was implanted,visual acuity,refraction,intraocular pressure and corneal endothelium count were measured at the last follow-up.The follow-up time was 43 to 57 months.Main Outcome Measures Visual acuity,refractive power,intraocular pressure,corneal endothelium count,the distance from PC-PRL to cornea and lens,and the complications.Results At the last follow-up,the uncorrected visiual acuity was equaled to the best corrected visiual acuity（BCVA） before surgery in 85.29%（58/68） eyes.The post-operative BCVA even was better than the BCVA before surgery in 35.29%（24/68） eyes.The mean intraocular pressure was 17.1±2.6 mm Hg.Corneal endothelium cell counts showed 2841±257 /mm2 before surgery and 2512±312 /mm2 after surgery（t=0.872,P=0.160）.At the last follow-up,the distance from anterior surface of PC-PRL to corneal endothelium was 2.341±0.258 mm,compared with 2.491±0.317 mm at three months after surgery,there was no significant difference（t=1.407,P=0.076）;the distance from posterior surface of PC-PRL to lens was 0.302±0.109 mm,also showed no significant difference from that was at 3 months after surgery（0.321±0.102） mm（t=1.516,P=0.064）.Two cases（2 eyes） were found whose posterior surface of PC-PRL contacted with anterior surface of lens,the distance was too small to be measured.The complications,such as glaucoma,retina detachment,and complicated cataract,were not observed in all surgical eyes.Conclusion Implantation of PC-PRL can correct high myopia effectively.The long term safety of PC-PRL should be observed,especially the influence to lens.

关 键 词：后房型有晶状体眼人工晶状体/并发症 高度近视/外科学 

分 类 号：R779.6[医药卫生—眼科]