AC-PIOL联合AK矫正超高度近视伴中高度散光

Astigmatic keratotomy combined with anterior chamber angle-fixated phakic IOL for the correction of high myopia with high astigmatism

目的评估有晶状体眼前房房角支撑型人工晶状体植入(AC-PIOL)联合散光性角膜切开术(AK)治疗超高度近视合并中高度散光的安全性、有效性、可预测性。方法超高度轴性近视合并中高度散光行AC-PIOL的住院患者45例(70只眼),其中未联合AK者(非AK组)19例(25只眼),联合AK者(AK组)26例(45只眼)。检查裸眼远视力、最佳矫正视力、屈光状态、眼压、裂隙灯显微镜检查、眼底检查、角膜地形图。结果两组患者术后裸眼视力、最佳矫正视力与术前相比均有显著性差异(P均<0.001);AK组患者术后散光度明显低于非AK组患者,两组间比较有显著性差异(P<0.01);AK组术后裸眼视力与术前相比的提高量明显高于非AK组患者,两组间比较有显著性差异(P<0.05)。结论 AC-PIOL术可显著提高裸眼远视力、最佳矫正视力,预测性较好,是治疗超高度近视有效的方法;联合AK术治疗合并存在的中高度散光,可有效地降低术后散光,进一步提高术后裸眼视力。

Objective To evaluate the safety,efficacy and predictability of anterior chamber angle-fixated phakic intraocular lens combined with arcuate keratotomy for the correction of high myopia with high astigmatism. Methods All patients having anterior chamber angle-fixated phakic IOL implantation to correct high myopia,including 19 cases （25 eyes） without AK（group non-AK） and 26 cases （45 eyes） together with AK（group AK）.Examination for all the patients included uncorrected visual acuity （UCVA）,best corrected visual acuity （BCVA）,near visual acuity （NVA）,refraction,intraocular pressure （IOP）,slit-lamp findings,dilated fundus examination and cornea topography. Results There were statistically significant changes in UCVA,BCVA and magnitude of astigmatism after phakic IOL implantation in both groups（P0.001）; the postoperative magnitude of astigmatism in group AK was much lower than group non-AK,and there was statistically significant change between two groups（P0.01）; the improvement of UCVA and the change of astigmatism magnitude were statistically significant between two groups（P0.01）.Conclusion The implantation of anterior chamber angle-fixated intraocular lens reduced high myopia safely,effectively and predictably.The combination of arcuate keratotomy can reduced the magnitude of astigmatism,improve the postoperative uncorrected visual acuity.