TICL植入矫正高度近视合并散光的临床疗效

TICL for high myopia with astigrnatism

目的研究矫正散光的有晶状体眼后房型人丁品状体（toricimplantablecontactlens，TICL）矫正高度近视合并散光的有效性及可预测性。方法对22例（31只眼）高度近视患者行TICL植入术，术前散光度数为（-1．50～4．75）D之间。记录术前及术后1、3个月的裸眼视力、最佳矫正视力、屈光度、眼压、角膜内皮细胞密度等。结果所有患者成功植入TICL，手术前后裸眼视力（Log．MAR）分别为1．16±0．31、0．23±0．17、0．25±0．18，手术前后最佳矫正视力（LogMAR）分别为0．26±0．17、0．13±0．13、0．12±0．13，差异有统计学意义（P〈0．01）；植入TICL预计矫正等效球镜度数与术后1个月实际矫正度数一致（r=0．938，P=0．000），预计矫正等效球镜度数与术后3个月实际矫正度数一致（r=-0．946，P=0．000）；植入TICL预计矫正散光度数与术后1个月实际矫正散光度数J0一致（r=-0．526，P=0．002），与术后3个月实际矫正散光度数J0一致（r=-0．542，P=0．002）。预计矫正散光度数与术后1个月实际矫正散光度数J0，一致（r=-0．710，P=0．000），与术后3个月实际矫正散光度数J45一致（r=-0．878，P=0．000）。手术前后角膜内皮细胞密度分别为（2933．65±263．07）、（2899．35±256．84）、（2877．13±274．55）个/mm2，差异无统计学意义。结论TICL矫正高度近视合并散光有较好的有效性及可预测性，长期疗效有待进一步观察。

Objective To evaluate the efficacy and safety of posterior chamber phakic intraocu- lar lens toric implantable contact lens （TICL） for the correction high myopia with a astigmatism. Methods Posterior chamber phakic toric intraocular lens implantation was performed in 31 eyes of 22 patients with high myopia with a astigmatism. The patients with a astigmatism （-1.50 - -4.75）D. The clinical examinations included uncorrected visual acuity （UCVA）, best corrected visual acuity （BCVA）, astigmatism power, intraocular pressure and cornea endothelial cell density before and after surgery. Results TICL were implanted successfully in all the operative eyes. The average UCVA was 1.16±0.31, 0.23±0.17, 0.25±0.18 at preoperative and postoperative 1 month, 3 months respective- ly. The average BCVA was 0.26±0.17, 0.13±0.13, 0.12±0.13 at preoperative and postoperative 1 month, 3 months respectively, showed a significant difference （P 〈0.01）. At 1 month the expected correction of spherical equivalent degree corresponded with actual （r =-0.938, P =0.000）, also at 3 months （r =-0.946, P=0.000）; At 1 month the expected correction of astigmatism degree J0 corre- sponded with actual （r =-0.526, P =0.002）, also at 3 months （r =-0.542, P =0.002）. At 1 month the expected correction of astigmatism degree J45 corresponded with actual （r =-0.710, P =0.000）, also at 3 months （r =-0.878, P =0.000）. The average cornea endothelial cell density was （2933.65＋263.07） cells/mm2 before operation and （2899.35±256.84）, （2877.13±274.55） cells/mm2 at 1 month, 3 months after operation, showed no significant difference. Conclusions TICL implantation for high myopia with a astigmatism is predictable, safe and effective. A long term evaluation of effectiveness and safety for this phakic IOL should be performed.