虹膜夹持型前房晶状体植入术治疗高度近视

Implantation of iris-claw phakic anterior chamber intraocular lenses for the correction of severe myopia

目的探讨虹膜夹持型前房晶状体植入术治疗高度近视的疗效和安全性。方法2005年8月至2006年2月在本中心接受前房晶状体植入术治疗高度近视的患眼共12例（21只眼）。观察指标包括裸眼视力、最佳矫正视力、眼压、角膜地形图、瞳孔形态、角膜内皮计数、晶状体在前房的位置形态、人工晶状体表面色素沉着情况。结果患者术前最佳矫正远视球镜度为（-17．28±2．95）D，散光度（-1．90±1．02）D，植入度数平均为（-14．53±9．47）D。平均随访时间（13．2±2．1）个月。术后12个月随访到17只眼，其中裸眼远视力较术前最佳矫正远视力提高1行5只眼（29．41％），提高2行4只眼（23．53％），提高3行3只眼（17．65％），提高4行2只眼（11．76％）；手术后最佳矫正远视力较术前最佳矫正远视力提高1行4只眼（23．53％），提高2行2只眼（11．76％），提高3行2只眼（11．76％），提高4行2只眼（11．76％），提高5行以上5只眼（29．41％）。术前眼压（17．25±2．92）mmHg（1mmHg=0．133kPa），术后6个月眼压为（17．14±2．52）mmHg，12个月为（17．16±2．57）mmHg，差异无统计学意义（P〉0．05）；术前角膜内皮计数（2627．89±229．36）个／mm^2，术后6个月为（2605．28±239．22）个／mm^2，术后12个月为（2603．17±237．12）个／mm^2，差异无统计学意义（P〉0．05）。结论虹膜夹持型前房晶状体植入术治疗高度近视安全、有效，并且具有良好的预测性；但远期效果需进一步观察。

Objective To evaluate the efficiency, predictability, and complications ＇after implantation of iris-clawed phakic intraocular lenses （PIOL） for the correction of severe myopia. Methods In this study, 12 cases （21 eyes） with myopia at -11.5 to -21.0 diopters （D） were implanted with Verisyse iris-clawed PIOL with an optical zone of 6. 0 or 5.5 mm. All cases have been followed-up for more than 6 months. Uncorrected visual acuity （UCVA）, best spectacled-corrected visual acuity （BSCVA）, refraction, intraocular pressure, corneal topography, contour of pupil, corneal endothelial count, PIOL IOL position and pigment deposits on the surface of IOL were observed. Results The mean follow-up period was （13.2 ±2. 14） months. After 12 months of follow-up, 17 eyes were investigated and no eyes experienced a loss in BSCVA. UCVA was significantly improved, Five eyes （29.41%） gained 1 line as compared to their preoperative BSCVA, 4 eyes （23.53%） gained 2 lines, 3 eyes （ 17.65% ） gained 3 lines and 2 eyes （11.76%） gained 4 lines. BSCVA was significantly improved, 4 eyes （23.53%） gained 1 or more lines compared to their preoperative BSCVA, 2 eyes （ 11.76% ） gained 2 lines, 2 eyes （ 11.76% ） gained 3 lines, 2 eyes （11.76%） gained 4 lines and 5 eyes （29.41%） gained 5 or more lines. There was no statistically significant difference between pre- and 6 m or 12 m post-operative intraocular pressure and corneal endothelial density （ P 〉 0. 05 ）. Conclusions Iris-clawed phakic intraocular lenses （PIOL） is an effective, safe and predictable procedure for the correction of severe myopia. Follow-up study is still required for the evaluation of long-term results.