高度近视有晶状体眼后房型人工矫正晶状体植入术后视觉质量的临床评价

Clinical evaluation of visual quality following implantation of posterior chamber phakic intraocular corrective lens for high myopia

背景有晶状体眼后房型人工矫正晶状体（ICL）植入术是矫正高度近视的手术方法之一，与准分子激光角膜原位磨镶术（LASIK）不同的是，该术式保留了角膜与晶状体像差固有的匹配关系，但术后视觉质量是患者和医师较为关注的问题。目的探讨ICL植入术矫正高度近视术后视觉质量的变化。方法对高度近视患者42例84眼行ICL植入术，于术后1d、1个月和6个月复查裸眼视力、最佳矫正视力（BCVA）、屈光状态、波前像差、对比敏感度以及调节力并与术前进行比较。结果采用前瞻性病例观察试验设计。本组患者术前视力均〈0．3，术后各随访时问点裸眼视力和BCVA均〉0．3，明显好于术前。术后各时间点间视力增加的眼数差异无统计学意义（x2=10．70，P〉0．05）。本组患者术前平均等效球径屈光度为（-15．384-1．03）D，术后1d平均等效球镜屈光度为（＋0．55±0．06）D，术后1个月平均等效球镜屈光度为（-1．22±0．09）D，术后6个月平均等效球镜屈光度为（-0．68±0．06）D，各时间点比较等效球镜屈光度的差异有统计学意义（F=16559．90，P〈0．01）；术眼术前平均波前总像差为11．00±0．25，术后6个月平均总像差为2．21±0．56，其中术前和术后6个月高阶像差分别为0．43±0．05和0．47±0．04，差异无统计学意义（t=1．65，P=0．10）。明视和暗视状态下术后各空间频率的对比敏感度和眩光敏感度与术前比较均有增高，手术前后各时间点的对比敏感度和眩光敏感度差异有统计学意义（P〈0．05）；术后1个月和6个月时屈光度〈-16D组术眼调节力较术前明显增加（术前：2．75±1．20，术后1个月：5．75±1．44；术后6个月：6．00±1．52），差异均有统计学意义（F=1597．70，P〈0．05）；而屈光度〉-16D组手术前后调节力的变化差异无统计学意义（F=2．67，P〉0．05）。结论ICL植入术矫正高度近视后患者的视觉质量较术前明显改善，但远期疗效及安全性尚需进一步观察。

Background hnplantation of phakic posterior chamber intraocular corrective lens （ICL） is a new choice for correction of high myopia. Different from laser assisted in situ keratomileusis, implantation of phakic posterior chamber ICL will allow the good imaging quality because it remaines the matched relationship between cornea and lens. But its visual quality after operation is concerned by patient and ophthalmologists. Objective This study was to observe the effectiveness of implantation of posterior chamber phakic ICL on visual quality in patients with high myopia. Methods Eighty-four high myopia eyes of 42 patients accepted implantation of posterior chamber phakic ICL and follow-up of 6-month duration. The visual acuity, refractive status, wavefront, contrast sensitivity and accommodation were examined and compared before and after surgery. This clinical study complied with Declaration of Helsinki. The written informed consent was obtained from each patient before operation. Results A prospective observational trial design was used. The uncorrected visual acuity and best corrected visual acuity after operation were better than preoperative ones in all of the patients. The eye numbers of 〉0.3 were increased after operation in eomparison with before operation with a stable result among 1 day, 1 month and 6 months after surgery （X2 = 10.70, P〉0.05 ）. Spherical equivalent refraction was （ -15.38±1.03 ） D before surgery and （ ＋0.55±0.06 ） at 1 day, （-1.22±0.09） D at 1 month and （ -0.68±0.06 ） D after 6 months, showing a significant difference among them （ F = 16 559.90, P 〈 0.05 ）. Total aberrations and higher-order aberrations were 11.00±0.25 and 0.43±0.05 before surgery,the wavefront aberrations were 2.21±0.56 and 0.47±0.04 at 6 months after surgery with significant difference（t = 1.65, P = 0. 10）. Each spatial frequency contrast sensitivity and glare sensitivity on photopic and scotopic conditions in postoperation were higher compared with the preoperative （ P〈0.05）. The accommodation in 1 month and 6 months after surgery was greater than that of preoperative in the patients 〈-16 D （preoperation：2.75±1.20 ;postoperation 1 month：5.75±1.44, postoperation 6 months：6.00±1.52） （P〈0.05） ,however,in the 〉-16 D group, no considerably change in accommodation was seen after surgery （ F= 1597.70, P〈0.05 ）. No significant difference was found in accommodation between before and after surgery in 〉-16 D group （F= 2.67, P〉0. 05 ）. Conclusions Visual quality of high myopia is obviously improved after implantation of posterior chamber phakic ICL,but its long-term outcome is need to further study.