超高度近视有晶状体眼后房型人工晶状体植入术后残留近视的LASEK治疗效果  

Clinical evaluation of LASEK for residual myopia following phakic posterior chamber implantable contact lens implantation in extreme high myopic eyes

作　　者：郑金华[1] 谷浩[1] 龙秋容[1] 肖桃[1] 罗英英[1] 

机构地区：[1]贵州医科大学附属医院眼科,贵阳550004

出　　处：《中华实验眼科杂志》2017年第6期527-531,共5页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景有晶状体眼后房型人工晶状体（PPC-ICL）植入术及有晶状体眼后房型散光人工晶状体（PPC—TICL）植入术是矫正高度近视及近视合并散光的主要方法，但术后常残留低度近视，需进一步行准分子激光上皮下角膜磨镶术（LASEK）矫治残留近视，这种疗法的有效性和安全性值得关注。目的观察PPC-ICL或PPC—TICL植入术治疗超高度近视及近视散光后LASEK治疗残留近视的安全性和有效性。方法采用前瞻性病例分析研究方法，收集2010年7月至2015年3月于贵州医科大学附属医院眼科就诊的等效球镜度≥-20．00D的超高度近视且接受PPC—ICL植入术或PPC—TICL植入术后6个月仍残留近视者9例14眼，其中行PPC．ICL植入术者4例8眼，行PPC—TICL植入术者5例6眼，术眼最佳矫正视力（BCVA）可提高2行以上。对术眼进行角膜厚度、角膜地形图、角膜内皮细胞计数、眼压和眼底检查，排除禁忌证后行LASEK，术后随访12个月，比较LASEK手术前后裸眼视力（UCVA）、BCVA、角膜上皮下雾状混浊（haze）、拱高、晶状体、眼压变化，评价PPC—ICL或PPC—TICL植入矫正超高度近视后用LASEK矫正残留近视的有效性和安全性。结果所有术眼手术顺利，术后术眼眼前节无明显炎症反应和严重并发症。术前、PPC—ICL植入术后6个月和LASEK术后12个月术眼UCVA、BCVA总体比较差异均有统计学意义（F=31．360、1．778，均P〈0．05），LASEK术后术眼UCVA均高于术前BCVA。术前、PFC—ICL植入术后6个月和LASEK术后12个月术眼屈光度分别为（-22．27±4．29）、（-3．75±2．25）和（-0．42±0．63）D，总体比较差异有统计学意义（F=46．370，P〈0．05），LASEK术后术眼屈光度明显低于术前、PPC—ICL植入术后，差异均有统计学意义（均P〈0．05）。术眼术前、PPC-ICL术后6个月及LASEK植入术后12个月眼压、角膜内皮细胞计数总体比较差异均Background Phakic posterior chamber implantable contact lens （PPC-ICL） or phakic posterior chamber Toric implantable contact lens （PPC-TICL） implantation is an effective way for the correction of high myopia or high myopia with astigmia,but it often has residual myopic power. Exeimer laser-assisted subepithelial keratectomy （LASEK） can correct the residual myopia following PPC-ICL or PPC-TICL,but its effectiveness and safety deserve attention. Objective This study was to analyze the clinical effeetiveness and safety of LASEK for residual myopia after PPC-ICL implantation for extreme high myopia. Methods A prospective cases-observational study was performed, and written informed consent was obtained from each patient before any surgery. Fourteen eyes of 9 patients with residual myopia following PPC-ICL or PPC-TICL for the eyes with spherical equivalent refraction of ≥ -20.00 D were collected in the Affiliated Hospital of Guizhou Medical University from July 2010 to March 2015 ,including PPC-ICL implantation in 8 eyes and PPC-TICL implantation in 6 eyes. LASEK were performed on the eyes to correct the residual myopic power. Uncorrected visual acuity （UCVA） , best corrected visual acuity （BCVA） , haze, the distance of intraoeular lens to lens, corneal thickness, corneal topography, corneal endothelial cell eounting, intraocular pressure （IOP） and fundus were examined and compared before and after surgery. The effectiveness and safety of the surgery were evaluated. Results The operation was smooth and no complication was found after surgery in all of the eyes. The UCVA and BCVA were significantly different in the eyes among before surgery, 6 months after PPC-ICL implantation and 12 months after LASEK （F= 31. 360,1. 778;both at P〈0.05 ） , and the UCVA after LASEK was higher than BCVA before LASEK. The refraetive powers were （-22.27±4.29） , （ -3.75 ±2. 25 ） and （ -0.42±0. 63 ） D before surgery,6 months after PPC-ICL implantation and 12 months after LASEK, showing a signifi

关 键 词：近视/手术 后房/手术 准分子激光上皮下角膜磨镶术 疗效 安全性 随访研究 有晶状体眼后房型人工晶状体 

分 类 号：R779.6[医药卫生—眼科]