房角支撑型前房人工晶体植入术治疗高度近视的初步观察

A Preliminary Study on Implantation with Angle-supported Phakic Anterior Chamber Intraocular Lens for the Correction of Severe Myopia

目的探讨有晶体眼房角支撑型前房人工晶体植入治疗高度近视的有效性、预测性和安全性。方法 2004年6月—2007年4月接受前房人工晶体植入术治疗超高度近视的患者11例(15只眼)。测量手术前后患眼的视力、屈光状态等参数,观察角膜、瞳孔、人工晶体情况,并进行比较分析。术后随访2.7～5.6年。结果 15只眼均成功植入前房型人工晶体。平均裸眼视力术前(0.06±0.03)与术后3年(0.58±0.26)比较有统计学意义(t=-7.602,P<0.01);平均最佳矫正视力术前(0.54±0.18)与术后3年(0.74±0.26)比较有统计学意义(Z=-2.214,P<0.05);平均等效球镜度数术前(-16.75±3.66)D与术后3年(-0.38±0.87)D比较有统计学意义(t=-16.840,P<0.01);平均角膜内皮细胞计数术前(2 934±455)个/mm2与术后3年(2 485±812)个/mm2比较无统计学意义(t=1.869,P>0.05)。术后出现晶体光学中心稍偏移,晶体后表面周边条带状虹膜色素播散,及瞳孔稍变形,但对视力均无明显影响。手术的预测性指数为-0.023,有效性指数为1.08,安全性指数为1.37。结论本组术后裸眼视力提高,生活质量明显改善,并发症相对较少。该手术预测性好、安全、有效,是高度近视矫正可供选择的方法之一。

Objective To explore the effectiveness, predictability, and safety of the implantation of angle-supported Phakic anterior chamber intraocular lens（PAC-IOL） for the correction of severe myopia. Methods In this retrospective study, 11 eases（15 eyes）with severe myopia were implanted with Phakic 6H2 PAC-IOL. The visual acuity, refraction and other biological parameters were accurately measured. The situations of corneal,pupil,PAC-IOL were monitored and compared. Results All of 15 eyes wereimplanted successfully and have been followed-up for 2.7 years to 5.6 years. The mean pre-operative and post-operative uncorrected visual acuity （UCVA）was （0.06±0.03） and （0. 58±0.26） respectively. There were significant difference between pre-and 3-year post-operative mean uncorrected visual acuity （UCVA）（t=-7. 602, P〈0.01）. The mean best corrected visual acuity （BCVA） was （0.54~0.18） pre-operatively and （0.74!0.26） post-operatively. There were significant difference between pre- and 3- year post-operative mean corrected visual acuity（Z=-2. 214,P〈0.05）. The mean preoperative spheri- cal equivalent degree was （-16.75±3.66） D, which was significantly different from the 3-year post-oper- ative mean spherical equivalent degree （-0.38±0.87） D （t=--16. 840, P〈0.01）. The mean pre-oper- ative corneal endothelial cell count （2 934±455） mm2 was not significantly different from 3-year post-oper- ative mean corneal endothelial cell count （2 485±812） mm^2 （t=l. 869, P〉0.05） . Complications, such as lens optical center slightly offset, crystal around the surface of banded iris pigment dispersion and oval- shaped pupil deformation have been observed. However, these complications had no significant effect on vision. The predictability index of operation was -0. 023;the effectiveness index was 1.08, and the safe- ty index was 1.37. Oonclusion This group of angle-supported PAC-IOL treatment of severe myopia pa- tients acquires higher postoperative visual acuity and the quality of life is significantly improved. The op- eration had few complications. Implantation of angle-supported PAC-IOL may be one of the options a- vailable for correction of severe myopia with good predictability, efficacy and safety.