有晶状体眼人工晶状体植入术治疗超高度近视10年随访分析

A ten-year follow-up analysis of phakic intraocular lens implantation in very high myopic eye

目的探讨有晶状体眼人工晶状体(phakic IOL)植入术治疗超高度近视的长期预测性和安全性。方法对7例12只超高度近视眼植入phakic IOL,随访10年。比较术前术后裸眼视力、最佳矫正视力、屈光度、眼压和角膜内皮细胞计数等。结果术前平均屈光度(-16.12±3.21)D;平均最佳矫正视力0.68±0.36。术后1年平均裸眼视力0.71±0.25,最佳矫正视力0.83±0.31,残余屈光度(-0.50±-0.43)D;术后10年,平均裸眼视力0.32±0.12,最佳矫正视力0.50±0.24,残余屈光度(-2.50±-0.62)D。术前、术后1年和术后10年角膜内皮细胞计数分别为(2988±230)、(2837±225)、(1639±201)个/mm2;术前、术后1年和术后10年眼压分别为(16.87±2.32)、(17.12±2.45)、(18.60±3.24)mmHg。术后10年时瞳孔变形2眼;人工晶状体偏位2眼;继发性青光眼2眼;虹膜根部离断和萎缩2眼;白内障3眼;黄斑变性2眼。结论PhakicIOL植入术治疗超高度近视早期预测性好、安全,但手术长期并发症特别是角膜内皮细胞减少、白内障和继发性青光眼的发生需要引起关注。

Objective It is difficult for surgeon to perform LASIK surgery on thin cornea with very high myopia.This study was to investigate the stability,predictability and safety of angle-supported phakic intraocular lens （phakic IOL） implantation for treatment of very high myopia.MethodsAnterior chamber angle-supported phakic IOL （NuVita MA20） implantation was performed on 12 high myopic eyes of 7 patients with the follow-up time for ten years.Anterior segment changes,uncorrected visual acuity （UCVA）,best corrected visual acuity（BCVA）,refraction,intraocular pressure（IOP）,corneal endothelium preoperatively and postoperatively were clinically observed in the 12 eyes.ResultsThe mean preoperative diopter was （-16.12±3.21） D and BCVA was 0.68±0.36.After one year of surgery,the mean UCVA was 0.71±0.25,the mean BCVA was 0.83±0.31 and the mean residual refraction was （-0.50±0.43）D.After ten years of surgery,the mean UCVA was 0.32±0.12,and the mean BCVA was 0.50±0.24 and the mean residual refraction was （-2.50±0.62）D.The mean corneal endothelial count was 2988±230/mm2,2837±225/mm2 and 1639±201/mm2 respectively and the IOP was （16.87±2.32）mmHg,（17.12±2.45）mmHg and （18.60±3.24）mmHg respectively before,after one and ten years of surgery.Oval pupils in 2 eyes,decentered phakic IOL in 2 eyes,secondary glaucoma in 2 eyes,atrophy and dissection of iris roots in 2 eyes,cataract in 3 eyes and macular degeneration in 2 eyes were observed at ten years of follow-up.ConclusionAlthough phakic IOL implantation is predictable and safe for treatment of very high myopia in short-term,the long-term complications should be concerned especially for diminution of endothelial cell,formation of cataract and occurrence of glaucoma.