有晶状体眼后房型人工晶状体植入矫正高度近视的观察

Clinical research of phakic posterior chamber intraocular lens implantation for high myopia

目的评价有晶状体眼后房型人工晶状体植入术治疗高度近视的有效性、安全性及稳定性。方法后房型人工晶状体植入术治疗高度近视患者26例（40只眼），随访术前及术后1天、1周及1、6、12个月，随访内容包括裸眼视力、最佳矫正视力、屈光度数、裂隙灯显微镜检查、眼压、角膜内皮计数、Pentaeam、光学相干断层成像等，观察屈光状态及术后并发症。结果所有手术均顺利进行，所有患者裸眼视力均有明显提高，40只眼术前裸眼视力和最好矫正视力分别为0．05±0．02，0．61±0．28；术后分别提高为0．62±0．17，0．62±0．31，术后裸眼视力均明显好于术前（P〈0．05）。术前平均屈光度为（-18．95±4．73）D，术后1个月平均屈光度为（-0．76±0．75）D。术前角膜内皮细胞数（2917．42±208．36）个／mm^2，术后1个月角膜内皮细胞为（2797．03±210．25）个／mm^2。术前平均眼压为（16．65±4．75）mmHg，术后第一天眼压为（15．47±4．36）mmHg。通过Pentaeam观察术前前房深度（3．25±0．27）mm，而术后1月复查减少到（2．97±0．19）mm，两者相比较差异具有统计学意义（P〈0．05），而以后随访中前房深度没有明显差异。40只眼均未发生瞳孔阻滞性青光眼、晶状体前囊下混浊等并发症。结论有晶状体眼后房型人工晶状体植人术对高度近视的治疗是一种有效的方法，具有有效性、稳定性及矫正效果好等优点，但需要有更长时间的随访。

Objective To evaluate the efficacy and safety of the surgical correction of high myopia using a phakic posterior chamber intraocular lens. Methods Forty eyes of 26 patients with high myopia who accepted surgery treatment. Each eye was examined before and after surgery one day, one week, one month, six months and twelve months. The examination included visual acuity, refraction, tonometry, Pentaeam, anterior chamber depth, horizontal corneal diameter （white to white）, and posterior segment evaluation after indirect ophthalmolscope examination. Results All eyes of preoperative uncorrected visual acuity and best-corrected visual acuity （BCVA） were 0.05±0.02, 0.61±0.28 respectively and postoperative were 0.62±0.17, 0.62±0.31 respectively. The mean preoperative SE was （-18.95±4.73）D and postoperative SE was （-1.50±0.75）D. The mean preoperative ECD was （2917.42±208.36）/mm2 and postoperative ECD was （2797.03±210.25）/mm2. The mean preoperative IOP was （16.65±4.75）mmHg and postoperative IOP at first day was （15.47±4.36）mmHg. Pentacam showed that preoperative ACD was （3.25±0.27）mm and postoperative ACD reduced to （2.97±0.19）mm. Conclusions The phakic IOLs is an effective treatment for the correction of high myopia and has significant advantages such as reversibility, immediate correction, stability, and relative simplicity. However, long-term studies are necessary to assess the potential risks.