虹膜固定型人工晶状体植入矫正高度近视的疗效

The results of iris-fixated intraocular lens implantation for high myopia

目的探讨虹膜固定型人工晶状体（10L）植入术矫正高度近视的近中期安全性、有效性以及术后的视觉质量。方法前瞻性临床研究。双眼植入虹膜固定型10L患者89例，屈光度范围-6．00-24．00D。观察术前、术后3个月患者的裸眼视力（UCVA）、最佳矫正视力（BCVA）、角膜内皮计数、眼压（10P），以及3、4、5mm瞳孑L直径下像差均方根（RMS）值、调制传递函数（MTF）值。术前术后各指标变化采用配对￡检验进行比较。结果178眼均一次性成功植入虹膜固定型IOL，术后随访2-48个月。术后裸眼视力达到或超过术前最佳矫正视力者占80％，且两者差异有统计学意义（t=6．187，P=0．003）。术后残余屈光度（-0-36±0．53）D。患者术后眼压与术前相比差异无统计学意义。术后角膜内皮计数较术前稍有下降，差异有统计学意义（f=2．690，B=0．01）。术后高阶像差与术前相比差异无统计学意义，所有瞳孔直径下的术后MTF值较术前稍有提高f5mm瞳孔直径下的高频空间除外），且差异有统计学意义（P〈0．05）。结论虹膜固定型10L植入术矫正高度近视安全有效．具有可逆性、可预测性等优点．并能够提供较好的术后视觉质量。但是虹膜固定型10L对角膜内皮、晶状体、虹膜的远期影响还需进一步观察。

Objective To evaluate the safety, efficiency and visual quality of phakic iris-fixated intraoeular lens for the correction of high myopia. Methods In this prospective study, 178 eyes of 89 patients with myopia from -6.00 to -24.00 diopters （D） underwent implantation of Verisyse phakic intraocular lenses （PIOLs）. Best corrected visual acuity （BCVA）, uncorrected visual acuity （UCVA）, corneal endothelial cell density, intraoeular pressure （IOP）, were recorded preoperatively and postoperatively, as well as root mean square （RMS） value of aberration, modulation transfer function （MTF） with 3, 4 and 5 mm pupil sizes. Data were analyzed using SPSS 17.0 statistical software. Presurgery versus postsurgery changes within the group were analyzed using a paired t test. Results All the 178 eyes were implanted successfully with Verisyse PIOLs and followed up for 2 to 48 months. The proportion of UCVA of postoperation reached or exceeded BCVA of preoperation was 80%, and there was significant difference between them （t=6.187, P=0.003）. And the residual refraction was （-0.36±0.53）D. The mean lOP of postoperation was not different from preoperation. The mean corneal endothelial cell density of postoperation was slightly lower than preoperation and the difference was statistically significant （t=2.690, P=0.01）. There was no difference between higher-order aberrations of postoperation and preoperation. The MTF values of postoperation were slightly higher than preoperation with all pupil sizes （excluding high spatial frequency with 5 mm pupil size） （P〈0.05）. Conclusion Implantation of the Verisyse PIOLs for the correction of high myopias resulted in a safe, efficient, predictable, and accurate refractive outcome. And the optical quality is excellent. However, longer-term data are needed to evaluate the impact of the lens on the endothelium, the crystalline lens, and the iris.