有晶状体眼人工晶状体Phakic 6植入术后五年的临床安全性分析

Five years safety analysis of the implantation of Phakic 6 in high myopia

目的研究房角支撑型有晶状体眼人工晶状体Phakic 6植入眼内的5年安全性。设计回顾性病例系列。研究对象2004年12月至2005年12月在北京同仁医院进行Phakic 6植入术的10例(20眼)-12 D以上的高度近视患者。方法根据术前测量的角膜缘白到白(W-W)距离及术前的屈光检查来确定所植入的Phakic 6的型号。对上述患者手术后随访5年,检查视力、屈光度、眼压、房角镜及超声生物显微镜。主要指标视力、眼压、Phakic 6距相邻组织的距离、角膜内皮计数、房角镜下人工晶状体襻的位置及术后并发症。结果 10例患者中9例患者术后5～6年的裸眼视力较术前裸眼视力提高5～7行,最佳矫正视力均较术前提高1～3行。眼压平均(15.7±3.5)mm Hg。人工晶状体光学部前表面距角膜内皮的距离为(2.386±0.241)mm,光学部后表面与自身晶状体之间的距离为(0.693±0.124)mm,光学部边缘的最高点与周边角膜内皮的距离为(1.571±0.174)mm。2例患者(2眼)角膜内皮细胞计数较术前丢失大于1000个/mm2。1例(1眼)Phakic 6晶状体襻插入周切孔中,1例(1眼)视网膜脱离,3例(4眼)人工晶状体前房内旋转,1例(1眼)散瞳后瞳孔不能自然恢复正常。未发生前房内旋转的Phakic 6襻均位于房角;发生前房内旋转的Phakic 6襻均位于虹膜根部以内的虹膜面上,即所植入Phakic 6长度偏短。结论随访5年的结果显示,Phakic 6植入能有效提高高度近视者的视力,但对角膜内皮细胞有一定程度的损伤,后者与其在前房内的旋转有关。术前准确测量角膜缘白-白距离对于减少Phakic6术后前房内旋转有重要意义。

Objective To analyze the 5 years safety of implantation Phakic 6 in high myopia. Design Retrospective case series. Participants 20 eyes of 10 cases implanted Phakic 6 for high myopia in Beijing Tongren hospital from Dec 2004 to Dec 2005. Method We selected the type of Phakic 6 according to the distance of white to white and the refractive power. After implantation of Phakic 6 in high myopia eyes 5 years, the visual acuity, refraction, intraocular pressure （IOP）, slit lamp and ultrasound hiomicroscopy （UBM） were measured. Main Outcome Measures Visual acuity, refraction, intraocular pressure, corneal endothelium count, the distance between Phakic 6 to corneal and lens, and complications. Results Five years later, uncorrected visual acuity improved 5 to 7 lines than pre-operation, corrected visual acuity improved 1 to 3 lines than pre-operation except 1 case （1 eye）, in which retina detachment occurred. The mean IOP was 15.7±3.5 mm Hg. 2 cases （2 eyes） showed corneal endothelium count decreased more than 1000/mm2. The mean distance between anterior surface of optic to endothelinm was 2.386±0.241 mm. The mean distance between posterior surface of optic to lens was 0.693±0.124 mm, and the mean distance between optic edge to peripheral endothelium was 1.571±0.174 mm. The complications included as following： the loop of Phakic 6 inserted into irisectomy hole in 1 case （1 eye）, retina detachment occurred in 1 case （1 eye） three years after surgery, Phakic 6 rotated in anierior chamber 3 years after surgery in 3 cases （4 eyes）, the pupil couldn＇t recover to normal after mydriasis in 1 case （1 eye）. The loop of stable Phakic 6 located at chamber angle, and the loop of rotated Phakic 6 located inside of chamber angle, so the type was shorter than it should be. Conclusion Implantation of Phakic 6 can improve the visual acuity in high myopia effectively. But it may also damage corneal endothelium in some cases. The precision measurement of W-W before surgery is the key for guarantee the stable of Phakic6 in anterior chamber and for the prevention of corneal endothelium damage.