Artisan屈光性人工晶状体植入术后迟发性偏心观察  

Clinical observation of late-onset decentration of Artisan Phakic intraocular lens for correction of high myopia

作　　者：刘彩娟[1] 粱皓[1] 谭少健[1] 李霞[1] 

机构地区：[1]广西医科大学第一附属医院眼科,南宁530021

出　　处：《中国实用眼科杂志》2013年第8期1025-1028,共4页Chinese Journal of Practical Ophthalmology

基　　金：国家自然科学基金地区基金（81060076）;教育部留学回国人员科研启动基金（2010-1561）;广西医科大学自选课题（个性化植人人工晶状体治疗高度近视的研究）;广西卫生厅自筹经费科研课题（Z2011344）;广西研究生创新科研计划课题（2011105981002M225）

摘　　要：目的分析Artisan屈光性人工晶状体（PIOL）植入术后远期随访人工晶状体在眼内位置及其偏心发生情况，以提高PIOL在眼内长期正位率及眼内稳定性。方法回顾性研究。高度近视患者行PIOL植入术后随访3年以上（平均4．5年）患者20例40只眼，按手术方法不同分为植入PIOL正位组和偏上组，对比术前术后视力、屈光度等临床指标，裂隙灯观察PIOL在前房位置，眼前段照相后测量PIOL在眼内位置，PIOL植入术后远期眼内偏心情况，及对角膜内皮细胞计数的影响。结果术后三年以上观察，34只眼裸眼视力t〉0．5，占87．18％。所有术眼（100％）最佳矫正视力I〉0．5。平均等效球镜屈光度为-0．34D（0．1．25D）。术中植入PIOL光学中心位于瞳孔正中位共30只眼平均观察4．8年（4～6．25年），随诊时16只眼发生PIOL下移，其中6只眼下移明显；平均下移（0．52±0．12）mm，10只眼发生轻度下移，平均下移（0．22±0．12）mm；3例4只眼发生PIOL不全脱位，其中3只眼发生于眼部外伤后，1只眼发生于分娩后；10只眼PIOL眼内位置无明显改变。术中植入PIOL光学中心位于瞳孔中央轻度偏上10只眼[PIOL光学中心位于瞳孔中央偏上方平均（0．38±0．10）mm，平均观察3．4年（3～4年]，目前正位5只眼，保持轻度偏上5只眼，平均偏上（0．26±0．13）mm。角膜内皮细胞密度（ECD）在PIOL术后居中组、轻度偏上组和轻度偏下组安全稳定，明显下移及脱位患者ECD均有不同程度下降。结论PIOL植入术矫正高度近视效果良好，长期随访发现部分病例发生偏心，伴角膜内皮细胞不同程度的下降，术中固定PIOL稍微偏上可能可以对抗术后重力对PIOL的长期作用，从而提高PIOL的长期正位率，减少术后并发症的发生，提高手术安全性。Objective To analyze the occurrence of late-onset decentration of Artisan Phakic in- traocular lens （PIOL） implanted for correction of high myopia, to increase the long-term rate of nor- motopia and stability by modification of surgery skills. Methods A more than 3 years （average 4.5 years） retrospective follow-up study. Forty eyes of 20 patients underwent Artisan PIOL implantation for the correction of high myopia. The patients were divided into 2 group base on the difference of surgery method. Group 1 was PIOL implanted in the centre of pupil, Group 2 was PIOL implanted up the centre of pupil. The clinic data （included visual acuity, refraction, PIOL position） of the pre-operation and post-operation were compared, the occurrence of late-onset decentration and the in- fluence on endothelial cell density （ECD） were observed. Results After more than 3 years follow up, 34 eyes （87.18%） reached an uncorrected visual acuity （UCVA） of 0.5 or better, 40 eyes （100%） kept a best spectacle-corrected visual acuity （BSCVA） of 0.5 or better. The mean spherical equiva-lent （SE） was -0.34 diopters. There were 30 eyes PIOL had implanted in the center of pupil, more than half of eyes （16 eyes） were found down located position, obvious down located in 6 eyes （mean 0.52±0.12mm）, and a little down located in 10 eyes （mean 0.22±0.12mm）, in 4 eyes of 3 pa- tients PIOL dislocated form iris, In other 10 eyes PIOL located at the right position while fol- lowed-up （mean followed up 4.8 years）. There were 10 eyes PIOL had implanted a little up located relative to the pupil （mean up the center 0.38±0.10mm）, the PIOL at the right position in 5 eyes while another 5 eyes kept a relative up position of the pupil （mean up the center 0.26±0.13mm）, mean followed up 3.4 years. In the group of PIOL located at the right position, a little upper loca tion and a little down location of pupil, the ECD showed safe and stabile, but in the eye PIOL clearly down located of pupil and dislocated

关 键 词：Artisan人工晶状体 高度近视 偏心 远期观察 

分 类 号：R776.1[医药卫生—眼科]