植入负度数后房型人工晶状体对眼内组织稳定性的影响

Implantation of negative-power posterior chamber intraocular lenses affects the stability of eye tissues

背景:白内障合并超高度近视眼的患者手术摘除白内障后,多数学者主张植入人工晶状体。目的:观察超声乳化白内障吸出联合负度数人工晶状植入治疗超高度近视合并白内障的效果。设计、时间及地点:回顾性分析,于2006-10/2007-10在潍坊医学院附属医院眼科中心完成。对象:选取本院同期收治的行超声乳化白内障吸除负度数人工晶状体植入术患者28例(50只眼),均为超高度近视眼合并白内障,术前矫正视力<0.1共45只眼,0.1~0.15共5只眼。Sensar AR40e疏水性丙烯酸酯折叠式人工晶状体为AMO公司产品。方法:术前常规检查眼轴长度、测量角膜曲率,以第3代理论公式(Sanders-Retzlaff-KraffT,SRK-T)计算人工晶状体屈光度数,实际植入人工晶状体的屈光度数为测量度数增加+1.00^+3.50D。眼表面麻醉,11~12点钟方位角膜缘后1.0mm处做宽3.0mm的角巩膜隧道切口,直径5.0mm连续环形撕囊,使用超声乳化仪吸除晶状体核,囊袋内植入屈光度数为-1.00^-10.00D人工晶状体。术后随访3~12个月。主要观察指标:术后最佳矫正视力、屈光度数偏差值及并发症。结果:术前平均眼轴长度为(32.19±2.31)mm。术后最佳矫正视力≥0.2共43只眼(86.0%),≥0.5共23只眼(46.0%);屈光度数偏差值<±1.00D共25只眼(50.0%),<±2.00D共44只眼(88.0%)。术中仅1只眼晶状体后囊膜破裂。随访3个月时,1眼晶状体后囊轻度浑浊,术眼无视网膜和脉络膜脱离。随访12个月时,5眼晶状体后囊轻度浑浊,术眼无视网膜和脉络膜脱离。结论:超声乳化白内障吸除后植入负度数后房型人工晶状体既可以增加眼内组织的稳定性,防止发生视网膜脱离,又可同时进行屈光矫正。

BACKGROUND： Most cataract patients combined with extreme myopia were implanted with prosthetic lens after removing cataract. OBJECTIVE： To evaluate the clinical effects of phacoemulsification and implantation of negative-power posterior chamber intraocular lenses （IOL） in patients with extreme myopia and cataract. DESIGN, TIME AND SETTING： The retrospective analysis experiment was performed at the Eye Center, Affiliated Hospital, Weifang Medical College from October 2006 to October 2007. PARTICIPANTS： Totally 28 cataract patients combined with extreme myopia （50 eyes） received phacoemulsification and implantation of negative-power IOL. There were preoperative rectification sight 〈 0.1 in 45 eyes, and 0,1-0.15 in 5 eyes. Sensar AR40e intraocular lens was obtained from AMO. METHODS： Axial length and corneal curvature were measured before surgery, Diopter （D） was calculated by Sanders-Retzlaff-Kraff T （Third edition）. Practical diopter （D） was the measured diopter plus ＋ 1.00-＋3.50 D. After anesthesia of eye surface, a 3,0 mm width incision was made on the comeosclera at 11-12 o＇clock position 1.0 mm behind limbus cornea, A diameter of 5.0 mm continuous circular capsulorhexis was conducted. Lens nucleus was absorbed by phacoemulsification, Prosthetic lens with diopter （D） of - 1.00-- 10.00 D were implanted into the sac, A follow-up was performed for 3-12 months after surgery. MAIN OUTCOME MEASURES： Postoperative visual acuity, refractive error and complications were recorded. RESULTS： The mean preoperative axial length was （32.19±2.31） mm. Best corrected visual acuity achieved 0.2 or better in 43 eyes （86.0%） and 0.5 or better in 23 eyes （46,0%）, Of the 50 eyes, 25 eyes （50.0%） were within 1.00 diopter （D） of refractive error and 44 eyes （88.0%） were within an error of 2.00 D. Only 1 eye had posterior capsule rupture. At month 3, 1 eye developed posterior capsule opacification. No retinal or choroidal detachment was detected, At month 12, 5 eyes developed posterior capsule opacification, No retinal or choroidal detachment was seen. CONCLUSION： It is safe and effective for phacoemulsification and implantation of negative-power Sensar AR40e IOL in patients with extreme myopia and cataract, Negative power Sensar AR40e IOL can especially improve the stability of the tissue in eyeball, prevent the occurrence of retinal detachment. Meanwhile it can correct the refractive errors,