透明晶体超声乳化摘除和低或负度数折叠人工晶体植入治疗高度近视

Treatment of Correction of High Myopia with Phacoemulsification and Posterior Chamber FoldableIntraocular Lens Implantation

目的:探讨透明晶体超声乳化吸出并植入后房型折叠人工晶体矫正高度近视的安全性和有效性.方法:对32例(50眼)均采用表麻下经透明角膜切口行透明晶体超声乳化吸出并植入后房型折叠人工晶体.眼轴长平均29.64mm.比较手术前后最佳矫正视力(BCVA),散光度及角膜内皮计数,随访观察手术并发症情况.并对术前BCVA低于0.3的37只患眼应用扫描激光检眼镜(SLO)的微视力软件,检查微视力,评估术后潜在视力.周边视网膜格子样变性7只眼,均行氩激光周边变性区光凝.结果:术后随访平均24月.BCVA由术前0.20±0.19,术后提高到0.61±0.24,其中≥0.5的由术前4只眼(8％)增加到34只眼(68％)。手术前后平均散光度比较,经t检验无显著性差异(P>0.1).手术后无1例发生视网膜脱离,有5只眼发生后发障,均行YAG激光治疗.角膜内皮计数术后平均损失207个/mm2±96个/mm2.且SLO作为术后潜在视力预测手段拥有很高的准确度(94.6％).结论:透明晶体超声乳化摘除加后房型折叠人工晶体植入矫正高度近视是少数屈光矫正有效方法之一,可获得较好的术后BCVA.但是熟练掌握超声乳化手术操作及采取术前积极的预防性治疗是开展此项技术的根本和关键,且需进行长期的临床随访.

Objective: To assess phacoemulsification and posterior chamber foldable intraocular lens (IOL) implantation as an effective, safe technique for the correction of high myopia. Methods: Phacoemulsification and implantation of posterior chamber foldable intraocular lens through clear comea incision was performed on 50 eyes of 32 high myopia patients with clear crystalline lens using surface anesthesia. The mean axial length was 29.64mm. Compared were BCVA, astigmatism and endothelial cell counter pre- and postoperation. Intra- and posteroperative complications were followed. Assessing 37 eyes (BCVA<0.3 preoperatively) by testing the microacuiry using Scaning Laser Ophthalnoscope (SLO)'s microperimetry softwar/hardware for predicting postoperative potential visual acuity. Prophylactic argon laser photocoagulation for rhegmatogenous retinal lesions were performed in 7 eyes. Results: The mean follow-up was 24 months. the mean BCVA improved from 0.20±0.19 preoperatively to 0.61±0.24 postoperatively. The percentage of eyes achieving BCVA of 50/100 or better increased from 8% (4 eyes ) preoperatively to 68% (34 eyes ) postoperatively. The astigmatism was not statistically different for pre- versus postoperation (P>0.01). No retinal detachments were observed during the follow-up. Posterior capsule opacification developed in 5 eyes and neodium: YAG laser posterior capsulotomy was performed. The mean endothelial cell loss 207±96 mm. SLO's microacuity function to predict postoperative potential visual acuity had a high accuracy (94.6%). Conclusion: Clear lens extraction by phacoemulsification and PC-foldable IOL implantation was one of the effective and safe technique for the correction of high myopia, and had a better results. But proficient skill with phacoemulsification and careful prophylactic treatment preoperatively were most important for spread this method and a long clinical follow0up should be needed.