透明晶状体摘除治疗短眼轴和厚晶状体老视眼

Clear lens phacoemulsification for correction of presbyopia characterized by a short axial length and thick lens

目的 :评价透明晶状体摘除治疗短眼轴、厚晶状体老视眼的可行性和有效性。方法 :选取短眼轴、厚晶状体老视患者 (包括有青光眼前驱症状但尚未经临床诊断为青光眼者和 /或老视程度较重者 ) 41例 50只眼行透明晶状体超声乳化摘除联合折叠人工晶状体植入术。患者年龄 52～ 75岁 ,平均为 ( 6 2 .6 0± 1 0 .38)岁。眼轴平均长度为 ( 2 2 .4 2± 0 .6 4)mm ,晶状体平均厚度为 ( 5.2 3± 0 .37)mm。视远及视近时等效球镜的平均度数分别为 ( + 2 .1 9± 1 .1 8)D和 ( + 4 .6 4±1 .1 3)D。眼压在 1 1～ 30mmHg范围内 (其中 2 2 %的患者眼压在 2 1～ 30mmHg范围内 )。植入人工晶状体平均屈光度为( + 2 3.4 3± 1 .81 )D。随访时间为 6～ 2 4个月 ,平均为 ( 1 4 .35± 7.97)个月。结果 :①术后裸眼远、近视力在 0 .5以上者分别为 88%和 58%。② 50只眼术后最佳矫正远、近视力均达到术前最佳矫正远、近视力。③术后裸眼远、近视力达到术前最佳矫正远、近视力者分别占 92 %和 94 %。④术后视远、视近的平均等效球镜度数分别为 ( - 0 .98± 0 .56 )D和 ( + 2 .80± 0 .6 2 )D ,有 86 %的患者在设计预矫屈光度± 1D内。⑤术后 2w后所有患者眼压均在 1 1～ 2 1mmHg正常范围内 ,随访期内未再发生青光眼前驱症状。

Objective:To evaluate the safety and effectiveness of clear lens phacoemulsification for correction of presbyopia characterized by a short axial length and thick lens.Methods:Phacoemulsification with foldable intraocular lens implantation was performed on clear lenses in 41 patients(50 eyes) with presbyopia. A short axial length and thick lens were found in each patient. Some patients suffered from attacks of transient blurring of vision associated with halos around lights,eye ache or headache. Others had to wear glasses with high diopter corrections because of severe presbyopia. The average age of the patients was 62.60±10.38 years(52～75 years). The mean axial length of the eyes was (22.42±0.64)mm,the mean lens thickness was (5.23±0.37)mm,the respective mean spherical equivalents were (+2.19±1.18)D and (+4.64±1.13)D when viewing distant and near objects,and the mean correction for intraocular lenses was (+23.43±1.81)D. Intraocular pressure for all eyes ranged from 11 to 30 mmHg,22% of which ranged from 21 to 30 mmHg. The follow-up period was 6～24 months with an average of (14.35±7.97)months.Results:Distant and near uncorrected visual acuity(UCVA) after surgery was improved in all cases,with 88% and 58% of eyes achieving 0.5 or better,respectively. In 92% and 94% of eyes,postoperative distant and near UCVA was equal to or better than the best corrected visual acuity(BCVA) before surgery,respectively. The mean postoperative spherical equivalents were (-0.98±0.56)D and (+2.80±0.62)D when viewing distant and near objects. In 86% of eyes,actual postoperative refraction was within ±1 D of the estimated postoperative refraction. Intraocular pressures for all eyes ranged from 11 to 21 mmHg after 2 weeks postoperatively. No tearing of the posterior capsule or vitreous loss occurred during surgery. No glaucoma,bullous keratopathy or cystoid macular edema were observed during the follow-up period. Quality of life improved significantly after surgery(P=0.038).Conclusion:Clear lens phacoemulsification is safe and effective for correction of presbyopia in eyes with a short axial length and thick lens,but should be used cautiously. A long follow-up period is necessary so complications can be fully assessed.[