病理性近视后巩膜加固术后有晶状体眼前房型人工晶状体植入观察

Clinical study of anterior chamber phakic intraocular lens after posterior scleral reinforcement surgery for pathological myopia

目的探讨后巩膜加固术(PSR)后有晶状体眼前房型人工晶状体植入术(ACPIOL)治疗病理性近视的临床疗效。方法对72例(132眼)病理性近视患者行PSR术,1个月后再行ACPIOL术,术后1、6、18个月随访,进行验光、眼轴等检查。结果最佳矫正视力:PSR手术前后分别为4.66±0.33和4.76±0.24,差异有统计学意义(P<0.05);ACPIOL术后1、6、18个月分别为4.87±0.21、4.89±0.28、4.93±0.23,与PSR术前、术后比较均有提高,差异有统计学意义(P<0.05)。屈光度:PSR手术前后分别为(-16.98±4.11)D和(-15.75±6.02)D,差异有统计学意义(P<0.05);ACPIOL术后1、6、18个月分别为(-0.68±1.09)D、(-0.77±0.94)D、(-0.98±0.99)D,差异无统计学意义(P>0.05)。眼轴:PSR手术前后分别为(29.92±2.68)mm和(29.80±2.58)mm,差异无统计学意义(P>0.05);ACPIOL术后18个月眼轴为(29.84±2.56)mm,与术前比较差异无统计学意义(P>0.05)。手术无严重并发症发生。结论对于病理性近视患者先行PSR术控制眼轴延长,再行ACPIOL术进行屈光矫正,术后疗效稳定,远期效果尚待进一步观察。

Objective In pathological myopia, increasing diopter and progressive retinal lesions caused by ocular axial growth influent the long-term effectiveness of refractive surgery. The purpose of this study was to evaluate the efficacy and safety of implanting anterior chamber phakic intraocular lens（ACPIOL） after posterior scleral reinforcement （PSR） surgery for pathological myopia. Methods An anterior chamber phakic intraocular lens was implanted in 132 consecutive eyes of 72 patients with pathological myopia - 16. 98 ±4.11 D and the average annual increase of diopter no less than -0. 5 D after PSR 1 month. Mean age of patients was 29.71 years. The best corrected visual acuity,mean spherical equivalent and ocular axial lenth were assessed at 1 month,6 and 18 months. Results In the 1st month after PSR surgery,the best corrected vision acuity was significantly improved in comparison with before PSR surgery（ P 〈 0. 05 ） ,and that in the lst,6th and 18th month after ACPIOL surgey was evidently increased in comparison with before PSR surgery and the 1st month of PSR surgery （ P 〈 0. 05 ）. The mean spherical equivalent was lower significantly after PSR surgery than that prior to PSR surgery （ P 〈 0. 05 ） ,but no statistical change was found among 1,6,18 months after ACPIOL（ P 〉 0.05 ）. No significant change was found in axial lenth on various periods （ F = 0. 002 ,P =0. 903）. Conclusion Implanting ACPIOL after PSR is an effective, feasible and safe approach to treatment of pathological myopia with a stable refractive outcome. Future study to assess safety and risks of complications is required by long-term follow-up.