屈光性晶状体置换手术治疗高度近视眼的长期疗效观察

Refractive lens exchange surgery for high myopia:a long term follow-up

目的:通过对高度近视眼透明晶状体摘除人工晶状体植入手术后长期疗效观察,评价该疗法的远期效果及安全性。方法:利用非随机的系列病例回顾性研究,对在两年间接受高度近视眼透明晶状体摘除人工晶状体植入的67例(125眼)患者进行了长达6a的随访研究。所有患者均接受了以矫正高度近视眼为目的透明晶状体超声乳化摘除及低读数或负度数人工晶状体囊袋内植入手术。在术后第1,3,6a,分别观察其视力、屈光度、角膜内皮、后发性白内障及视网膜并发症等方面的变化情况。结果:所有手术没有医源性事故发生;接受手术时患者的平均年龄为42.8岁;术前平均近视屈光度为-15.65D。术后6a随访,较术前自戴眶架眼镜矫正视力提高的占75.7%,没有变化的占10.4%,低于术前自戴眶架眼镜矫正视力的占12.2%。44%有后发性白内障发生,需行Nd∶YAG激光后囊膜切开或后囊膜切除手术;1.6%分别在术后5mo和16mo发生视网膜脱离。术后1a角膜内皮丢失率为1.9%,3a为3.2%,6a为5.9%。结论:有术前全面细致的眼部检查、评估和娴熟的超声乳化手术技术的掌控,透明晶状体摘除手术治疗高度近视眼是安全和疗效满意的。

AIM： To evaluate the long-term efficacy and safety of clear lens extraction and intraocular lens （IOL） implantation in patients with high myopia treated for refractive indications. METHODS： This retrospective nonrandomized case series study comprised 125 eyes of 67 consecutive myopic patients who had surgery because of refractive indications during a two-year period. The follow-up was as long as 6 years. In each case, phacoemulsification was performed and an IOL was implanted in the capsular bag. Patients were observed on 1, 3 and 6 year-interval. The main outcome measures were preoperative and postoperative spherical equivalent （SE）, the incidence of posterior capsule opacification （PCO）, and the incidence of retinal complications. RESULTS： The surgery was uneventful in all operated eyes. The mean patient age at surgery was 42.8 years; the mean preoperative SE was -15.65 Diopters （D）. In the sixth postoperative year, 75. 7% of the patients＇ visual acuity （VA） was better than preoperative corrected VA, 10.4% remained unchanged, and 12.2% was lower than preoperative corrected VA. 44% had PCO and further treatment was needed. 1. 6% had postoperative retinal detachment. The endothelial loss was 1.9%, 3.2% and 5.9% in the first, third and sixth postoperative years respectively. CONCLUSION ： With a careful preoperative ophthalmologic evaluation and skillful surgical techniques, patients who have clear lens exchange surgery for correction of high myopia have a chance of obtaining satisfactory visual results with a few complications.