有晶状体眼散光矫治型后房型人工晶状体植入矫治超高度近视并散光的临床观察

Toric Implantable Collamer Lens for extreme high myopic astigmatism

背景近年来随着屈光手术的不断进步，有晶状体眼人工晶状体植入手术在矫治超高度近视、散光、远视等方面逐步体现出其特有的优越性，其安全性、有效性在临床上越来越受到关注。目的观察有晶状体眼散光矫治型后房型人工晶状体（TICL）植入治疗超高度近视并散光的有效性、稳定性及安全性。方法回顾性系列病例研究。观察分析2008年5月-2009年2月经手术治疗的超高度近视并散光患者27例33眼的病例资料，均在眼球周围阻滞麻醉下经3mm颞侧透明角膜切口植入TICL，随访18个月，随访内容包括术前及术后1d，1周，2周，1、3、6、12、18个月的裸眼远近视力、最佳矫正视力、裂隙灯显微镜检查、TICL轴向、屈光度数、眼压、角膜内皮细胞分析等。结果术后96．97％眼裸眼视力等于或高于术前最佳矫正视力，术后球镜度数均在一1．00～＋0．25D，柱镜度数均在-1．00～0D，TICL轴向偏差在10°以内者占93．94％（31／33），手术前后眼压及角膜内皮细胞计数的差异均无统计学意义（眼压：F=3．350，P=5．490；角膜内皮细胞计数：t=1．835，P=0．082），术后1眼出现须手术调整的散光轴向旋转，1眼因TICL直径较大，发生术后高眼压，行TICL置换后眼压恢复正常，目前尚无白内障发生。结论TICL植入矫治超高度近视并散光具有有效性、安全性及稳定性。

Background In recent years,with the contiunous progress of the refractive surgery,the operation skill of phakic intraocular lens （PIOL）implantation for correcting extreme high myopia, astigmatism, farsightedness have made greater progression, and its security, effectiveness in clinical attract much more attention. Objective This study was to evaluate the efficacy,safety and stability of Torie Implantable Collamer Lens（TICL） for extreme high myopic astigmatism. Methods This retrospective case series included 33 eyes of 27 patients from May 2008 to February 2009. A TICL was intraoeularly implanted via a 3 mm clear corneal incision after paraocular anesthesia. Patients were examined preoperatively and followed-up at 1 day, 1 week, 1 month, 3, 6, 12 and 18 months postoperatively. The examinations included uncorrected visual acuity, best corrected visual acuity （BCVA） , slit lamp examination, refraction, intraocular pressure, endothelial cell morphometry, etc. The written informed consent was obtained from each patient before any medical procedure. Results The uncorrected visual acuity in 96.97% eyes was equal or improved after operation in comparison with BCVA of preoperation. The spherical refraction was within - 1.00 D-＋0. 25 D. The cylinder refraction was within -1.00 D-0 D. The axial deviation of TICL within 10 degree was 93.94% （31/33 ）. No significant differences were found in the intraocular pressure and endothelial cell morphometry between preoperation and postoperation （ intraocular pressure ： F= 3.35, P = 5.49 ; endothelial cell morphometry ： t = 1. 835,P= 0. 082）. The visual acuity and refraction were stable during the follow-up. Astigmatic axial rotation required surgical intervention on one eye. One eye occurred high intraocular pressure because of bigger TICL diameter. The intraocular pressure returned to normal after TICL was exchanged. No cataract occurred during the follow-up duration. Conclusion TICL implantation appears to be an effective,safe and reliable method for extreme high myopic astizmatism.