三种有晶状体眼IOL植入矫正高度近视的临床评价

Three kinds of phakic intraocular lens for correction of high myopia

目的评价3种有晶状体眼IOL植入矫正高度近视的有效性、安全性和稳定性。方法选取2003年12月至2009年12月就诊高度近视患者110例（208只眼），平均年龄31岁，其中59例（113只眼）行房角支撑型IOL植入术，29例（53只眼）行虹膜夹持型IOL植入术，21例（41只眼）行后房型IOL植入术，平均随访时间分别为54个月（3～72个月）、15．7个月（3—24个月）和7．2个月（3—15个月）。定义安全性指数为术后平均BSCVA与术前平均BSCVA的比值，定义有效性指数为术后平均UCVA与术前平均BSCVA的比值。对手术前后角膜内皮细胞计数比较采用配对t检验。结果术后3个月和1年时有效性指数均大于1。只有植入房角支撑型IOL的患者随访至术后5年，有效性指数下降为0．85，但仍有16％的患眼裸眼视力≥1．0，85％的患眼1〉0．5。所有患者术后的随访过程中，安全性指数始终大于1。植入房角支撑型IOL的患者随访术后5年时，46％的患眼实际屈光度数与预期矫正度数在±0．50D以内，68％的患眼实际屈光度数与预期矫正度数在±1．00D以内。植入虹膜夹持型IOL的患者随访至术后1年时，78％的患眼实际屈光度数与预期矫正度数在±0．50D以内，100％的患眼的实际屈光度数与预期矫正度数在±1．00D以内。植入后房型IOL的患者随访至术后3个月时，95％的实际屈光度数与预期矫正度数在±0．50D以内，100％的实际屈光度数与预期矫正度数在±1．00D以内。房角支撑型IOL植入术后5年时角膜内皮细胞计数的减少与术前相比具有统计学意义（t=9．769，P=0．000），而植入虹膜夹持型IOL的患者在术后1年和植入后房型IOL的患者在术后3个月时的角膜内皮细胞计数与术前相比无统计学意义（t=1．180，0．583；P=0．249，0．566）。术后1个月内分别有16只眼出现高眼压，局部应用降眼压眼液后恢复正常。植入房角支撑型IOL的患者术后最主要的并发症是瞳孔失圆，虹膜夹持组为夹持处虹膜色素的脱失，植入后房型IOL的患者为自然晶状体的混浊。结论有晶状体眼IOL植入治疗高度近视早期预测性好、安全，但手术长期并发症的发生需要引起关注。

Objective To evaluate the efficacy, safety and stability of three kinds of phakic intraocular lens implantation for the correction of high myopia. Methods This study included 208 eyes of 110 patients with a mean age of 31 years（21-55） from December 2005 to December 2009. Angle-supported lens（ Phakic 6H, OII） were inserted into 113 eyes, iris-fixated lens（ Artisan, OPHTEC） were inserted into 53 eyes and implantable contact lens （ICL） （V4, STAAR）were inserted into d l eyes. The average follow-up time of the three groups were 54. 0 months（3-72 months）, 15.7 months（3-24 months） and 7.2 months（3-15 months） respectively. Results At 3 months and 12 months, the efficacy indexes of the three groups were all above 1.00. Only the angle-supported group was followed up to 72 months postoperatively when the efficacy index dropped to 0. 85, but still UCVA was 1.0 （20/20） or better in 16% eyes and 0. 5 （20/40） or better in 85% eyes. The safety indexes of the three groups were always above 1.00 during the follow up. In the angle-supported group, 46% eyes were within ±0. 50 D of the desired refraction and 68% eyes were within ± 1.00 D at 5 years postoperatively. In the iris-fixated group, 78% eyes were within ±0. 50 D of the desired refraction and 100% eyes were within ± 1.00 D at 1 years postoperatively. In the ICL group, 95% eyes were within ± 0. 50 D of the desired refraction and 100% eyes were within ± 1.00 D at 3 months postoperatively. No statistically significant differences were found between preoperative and 3-month postoperative endothelial cell density in the ICL group. Also, there was no statistically significant reduction in endothelial cell density at 1 years in the iris-fixated group. However, when preoperative and 5-year postoperative measurements were compared in the angle-supported group, the total decrease in cell density is statistically significant（ t = 9. 769, P = 0. 000）. 16 eyes developed high lOP within 1 month postoperatively which resolved after intervention. In the three groups （ angle-supported, iris-fixated and ICL） , the most common complications were pupil ovalization, iris atrophy plus pigment dispersion and lens opacification respectively. Conclusion Although phakie IOL implantation is predictable and safe for treatment of high myopia in short-term, the long-term complications should be concerned and treated well.