ICL或TICL植入术临床矫治高度近视

Clinical observation on implantation of ICL/TICL for correction of high myopia

目的探索有晶状体眼后房型人工晶体(ICL或TICL)植入术矫正高度近视的有效性和安全性。方法选择高度近视8例15眼,平均年龄(25.56±3.2)岁,经术前检查后符合入选标准,屈光状态稳定1年以上。14眼矫正视力≥0.8,1眼:0.6。11眼行ICL植入,4眼行TICL植入。术前2周行YAG激光虹膜周边切除术(10∶30和1∶30位)或于术中在12点位行虹膜周切术。术后检查屈光度、角膜、前房、眼压、人工晶体等情况。结果 15眼中14眼术后裸眼远视力等于或大于术前最佳矫正视力(93.33%),术后1 d裸眼远视力≥1.0者10眼(66.7%),0.5～0.8者4眼(26.7%),0.4者1眼(6.67%);随访6个月时矫正视力,12眼≥1.0,2眼为0.8,1眼为0.6。4眼TICL植入经随访6个月,散光轴偏差均<10°。本组8例未发现前囊下晶体局限性混浊。术后角膜内皮细胞计数及前房深度未见明显变化。结论有晶状体眼后房型人工晶体植入预测性好,视力恢复迅速,无回退,无严重并发症,适用屈光度范围广,特别适用于不适合LASIK手术的高度近视患者,但严格掌握手术适应证和高超的手术技巧及术后的密切观察是手术成功的关键。

Objective To observe and investigate the efficacy and safety of implantation of implantable contact lens（ICL）/toric implantable contact lens（TICL） for the correction of high myopia. Methods Fifty eyes of 8 patients with -8.5--15.5 diopters of myopia were included in this study, among what II eyes were treated with ICL implantation,and 4 with TICL. All the patients were followed-up for I year. The follow-up examination included visual acuity, refraction, intraocular pressure, cornea, anterior chamber depth, intraocular lens and so on. Results After operation, naked vision of 14 eyes （93.33%） was the same as or better than the pre-operatlve best vision. On the first day after operation, there were I0 eyes （66.7%） got naked vision increased to 1.0 or even better, with 4 eyes （26.7%） to 0.5-0.8, I eye （6.67%） to 0.4.After 6 months, there were 12 eyes got naked vision increased to 1.0 or even better, 2 eyes to 0.8, 1 eye to 0.6. There were 4 eyes happened increased intraoeular pressure at early days after operation, the intraocular pressure became normal soon after active treatment. The astigmatism axis deviations of the 4 eyes which were treated with TICL implantation were all less than 10~. After operation, there was no limited lens opacities of anterior suhcapsular, and the anterior chamber depth intraoeular pressure and corneal endothelium counting before and after the operation had no significant difference. Conclusion The phakic posterior chamber ICL/TICL implantation for correct high myopia is a predictable method which can increase vision rapidly, with no regression and serious complication. It is a suitable treatment method for high myopia, especially for patients who was not suitable to receive LASIK, with a wide range of diopters. The key to successful operation includes excellent skins, close observation after operation and strictly mastering the operation indication.