有晶状体眼Verisyse虹膜夹持型人工晶状体植入矫正超高度近视  

Clinical study of Verisyse phakic iris-fixated intraocular lenses for the correction of severe myopia

作　　者：张素华[1] 曹伟芳[1] 赵炬伟[1] 余黎明[1] 杨坤[1] 

机构地区：[1]山西省眼科医院白内障科,太原030002

出　　处：《中华眼视光学与视觉科学杂志》2014年第12期726-731,共6页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的 探讨有晶状体眼Verisyse虹膜夹持型人工晶状体植入术矫正超高度近视的远期有效性、安全性、稳定性及患者满意度.方法 前瞻性队列研究.选取2005年6月至2012年3月就诊于山西省眼科医院超高度近视患者37例（65眼）,年龄17 ～44（27.5±8.0）岁,等效球镜度-9.00～-27.00 D,平均（-18.55±4.19）D,行有晶状体眼Verisyse虹膜夹持型人工晶状体植入术,术后平均随访时间3～62（42.3±16.7）个月.对比观察术前及术后1d、1周、1个月、3个月、6个月、1年、2年、3年、5年患者视觉效果.观察指标包括：视力（UCVA、BCVA、近视力）、屈光度、眼压、前节OCT测量IOL位置、角膜内皮细胞计数、对比敏感度、手术并发症及问卷调查患者满意度.定义安全性指数为术后平均BCVA与术前平均BCVA的比值,有效性指数为术后平均UCVA与术前平均BCVA的比值.不同时间点间差异采用重复测量设计的方差分析进行比较.结果 所有患者在整个术后随访过程中,安全性指数始终＞1.术后1个月和2年时有效性指数＜1,其余时间点均＞1.随访5年内93％患眼实际等效球镜度与预期等效球镜度差值在±1 D以内,84％患眼实际等效球镜度与预期等效球镜度差值在±0.5 D以内.患眼术前近视力为0.9±0.2,眼压为（15.2±2.7）mmHg,术后随访各时间点与术前相比差异无统计学意义.随访5年内角膜内皮细胞计数丢失率平均为3.0％±2.5％（0.07％～9.1％）.前节OCT测量Verisvse人工晶状体中心与角膜内皮和晶状体间垂直距离分别为（2.20±0.15）mm（＞2.0 mm）及（0.73±0.08）mm（＞0.5 mm）.术后与术前相比各空间频率对比敏感度均明显提高,差异有统计学意义.随访期间2只眼可见Verisyse人工晶状体表面炎性反应物沉积,1只眼瞳孔呈轻度横椭圆形,1例（2眼）因剧烈运动导致IOL半脱位,后经手术复位,＞80％患者人工晶状体夹持处虹膜脱色素.经问卷调查,Objective To evaluate the efficacy,safety,stability and predictability of the Verisyse phakic iris-fixated intraocular lens （PIOL） for the correction of severe myopia.Methods In this prospective cohort study,37 patients （65 eyes）,aged from 17 to 44 years with severe myopia of-9.00--27.00 D （-18.55±4.19 D）,were implanted with Verisyse phakic iris-fixated intraocular lenses from June 2005 to March 2012.Visual acuity,refraction,intraocular pressure,corneal endothelium,Verisyse IOL position,contrast sensitivity,glare sensitivity,surgical complications and poor visual symptoms were observed on 1 day,1 week,1 month,3 months,6 months,1 year,2 years,3 years,and 5 years.Then safety index and efficacy index were obtained from BSCVA and UCVA.Results The mean safety index and efficacy index were better than 1 at most times except at 1 month and 24 months.At 5 years,the mean manifest refraction was within 1 D of the attempted correction in 93％ of eyes and within 0.5 D of the attempted correction in 84％ of eyes.Near vision and intraocular pressure were not significantly different at 5 years.The mean loss of corneal endothelium was 3.0％±2.5％ （0.07％-9.1％）.The distance from the corneal endothelium to the PIOL was 2.20±0.15 mm （＞2 mm） aud 0.73±0.08 mm （＞0.5 mm） from the PIOL to the natural lens.There were statistically significant differences between preoperative and postoperative contrast sensitivity and glare sensitivity.Postoperative complications included 2 eyes with light inflammatory deposits on the PIOL surface,1 eye with an oval pupil and 1 patient （2 eyes） with dislocated PIOLs.More than 80％ of eyes had depigmented irises at the attachment sites.Conclusion Verisvse IOL implantation for the correction of severe myopia is effective,safe,stable and predictable.It can be a supplement for corneal refractive surgery but follow-up is still required for the evaluation of long-term results.

关 键 词：有晶状体眼人工晶状体植入术 近视 退行性 Verisyse虹膜夹持型人工晶状体 治疗结果 

分 类 号：R779.6[医药卫生—眼科]