高度近视白内障植入不同类型人工晶体的临床观察

Clinical study of different intraocular lenses implantation in high myopic eyes with cataract

目的观察高度近视白内障植入不同类型人工晶体的临床疗效。方法对高度近视白内障患者58例（65眼）行超声乳化及bigbag人工晶体植入术,按类似的眼轴长度及晶体核硬度分级,选择回顾性分析高度近视白内障行超声乳化及ACR6DSE人工晶体植入术患者44例（46眼）,分别观察术后视力及矫正视力、屈光度及其与术前估计屈光度的差值、对比敏感度、波前像差、术后并发症等。术后随访时间1～24月。结果（1）bigbag组术后1个月裸眼视力≥0.5者38只眼,占58.3%,3个月裸眼视力≥0.5者39只眼,占59.3%;ACR6DSE组术后1个月裸眼视力≥0.5者25只眼,占56.3%,3个月裸眼视力≥0.5者23只眼,占50%。（2）术后3月,实际屈光度数与术前估计值相差bigbag组≤±1D者43只眼,占66.2%;ACR6DSE组相差≤±1D者22只眼,占47.8%。（3）术后24月,Bigbag组后囊膜混浊者4只眼（6.2%）;ACR6DSE组后囊膜混浊者5只眼（10.9%）,晶体偏位1只眼（2.2%）,黄斑水肿1只眼（2.2%）。两组后发障均未行YAG激光治疗,差异无统计学意义。（4）两组对比敏感曲线均低于正常值,差异无统计学意义。（5）总像差RMS值bigbag组低于ACR6DSE组，P〈0．05，差异有统计学意义。结论高度近视白内障植入特殊设计的人工晶体，具有术后预留度数准确、较好术后视觉质量等优点，但能否减少后发障及眼底并发症等，仍需长期大量的临床观察。

Objective To evaluate the clinical effects of phacoemulsification and the bigbag intraocluar lens implantation in patients with myopia and cataract. Methods 58 patients （65 eyes） with myopia and cataract received phacoemulsification and the bigbag intraocluar lens implantation. 44 patients （46 eyes） with myopia and cataract received phacoemulsification and the ACR6D SE intraocluar lens implantation. Postoperative visual acuity and corrected visual acuity, refractive error, contrast sensitivity, wavefront aberrations and postoperative complications were observed. The follow-up time is from 1 to 24 months. Results （1） The visual acuity of bigbag group achieved 0.5 or better in 38 eyes （58.3%） after 1 month and 39 eyes （59.3%） after 3 months; The visual acuity ofACR6D SE group achieved 0.5 or better in 25 eyes （56.3%） after 1 month and 23 eyes （50%） after 3 months. The differences were no statistics meaning. （2） The 43 eyes of bigbag group, 66.2% were within 1.0 diopter （D） of refractive error. The 22 eyes ofACR6D SE group, 47.8% were within 1.0 diopter （D） of refractive error. The differences were no statistics meaning. （3） Within 24 months, 4 eyes （6.2%） of bigbag group have posterior capsule opacification and 0 eye were performed neodymium： YAG laser posterior capsulotomy. 5 eyes （10.9%） of ACR6D SE group have posterior capsule opacification and 0 eye were performed neodymium： YAG laser posterior capsulotomy. 1 eye （2.2%） ofACR6D SE group was defluxion of intraocular lenses. 1 eye （2.2%） of ACR6D SE group has macular edema. The differences were no statistics meaning. （4） The curves of contrast sensitivity of two groups were lower than normal, but the differences were no statistics meaning. （5） The RMS values of the overall wavefront aberrations of bigbag group were lower than that ofACR6D SE group （P〈0.05）. The difference has statistics meaning. Conclusion The bigbag intraocular lens is design for high myopia. It is safe and effective for myopia with cataract to implant bigbag intraocular lens after phacoemulsification. It is more exact obligate degree, better quality of vision. These needs a great deal of clinic observant, the implantation of bigbag intraocular lens could reduce incidence of retinal detachment, macular edema and operative complication etc.