Artisan屈光性人工晶状体植入术后迟发性偏心观察

Clinical observation of late-onset decentration of Artisan Phakic intraocular lens for correction of high myopia

目的分析Artisan屈光性人工晶状体（PIOL）植入术后远期随访人工晶状体在眼内位置及其偏心发生情况，以提高PIOL在眼内长期正位率及眼内稳定性。方法回顾性研究。高度近视患者行PIOL植入术后随访3年以上（平均4．5年）患者20例40只眼，按手术方法不同分为植入PIOL正位组和偏上组，对比术前术后视力、屈光度等临床指标，裂隙灯观察PIOL在前房位置，眼前段照相后测量PIOL在眼内位置，PIOL植入术后远期眼内偏心情况，及对角膜内皮细胞计数的影响。结果术后三年以上观察，34只眼裸眼视力t〉0．5，占87．18％。所有术眼（100％）最佳矫正视力I〉0．5。平均等效球镜屈光度为-0．34D（0．1．25D）。术中植入PIOL光学中心位于瞳孔正中位共30只眼平均观察4．8年（4～6．25年），随诊时16只眼发生PIOL下移，其中6只眼下移明显；平均下移（0．52±0．12）mm，10只眼发生轻度下移，平均下移（0．22±0．12）mm；3例4只眼发生PIOL不全脱位，其中3只眼发生于眼部外伤后，1只眼发生于分娩后；10只眼PIOL眼内位置无明显改变。术中植入PIOL光学中心位于瞳孔中央轻度偏上10只眼[PIOL光学中心位于瞳孔中央偏上方平均（0．38±0．10）mm，平均观察3．4年（3～4年]，目前正位5只眼，保持轻度偏上5只眼，平均偏上（0．26±0．13）mm。角膜内皮细胞密度（ECD）在PIOL术后居中组、轻度偏上组和轻度偏下组安全稳定，明显下移及脱位患者ECD均有不同程度下降。结论PIOL植入术矫正高度近视效果良好，长期随访发现部分病例发生偏心，伴角膜内皮细胞不同程度的下降，术中固定PIOL稍微偏上可能可以对抗术后重力对PIOL的长期作用，从而提高PIOL的长期正位率，减少术后并发症的发生，提高手术安全性。

Objective To analyze the occurrence of late-onset decentration of Artisan Phakic in- traocular lens （PIOL） implanted for correction of high myopia, to increase the long-term rate of nor- motopia and stability by modification of surgery skills. Methods A more than 3 years （average 4.5 years） retrospective follow-up study. Forty eyes of 20 patients underwent Artisan PIOL implantation for the correction of high myopia. The patients were divided into 2 group base on the difference of surgery method. Group 1 was PIOL implanted in the centre of pupil, Group 2 was PIOL implanted up the centre of pupil. The clinic data （included visual acuity, refraction, PIOL position） of the pre-operation and post-operation were compared, the occurrence of late-onset decentration and the in- fluence on endothelial cell density （ECD） were observed. Results After more than 3 years follow up, 34 eyes （87.18%） reached an uncorrected visual acuity （UCVA） of 0.5 or better, 40 eyes （100%） kept a best spectacle-corrected visual acuity （BSCVA） of 0.5 or better. The mean spherical equiva-lent （SE） was -0.34 diopters. There were 30 eyes PIOL had implanted in the center of pupil, more than half of eyes （16 eyes） were found down located position, obvious down located in 6 eyes （mean 0.52±0.12mm）, and a little down located in 10 eyes （mean 0.22±0.12mm）, in 4 eyes of 3 pa- tients PIOL dislocated form iris, In other 10 eyes PIOL located at the right position while fol- lowed-up （mean followed up 4.8 years）. There were 10 eyes PIOL had implanted a little up located relative to the pupil （mean up the center 0.38±0.10mm）, the PIOL at the right position in 5 eyes while another 5 eyes kept a relative up position of the pupil （mean up the center 0.26±0.13mm）, mean followed up 3.4 years. In the group of PIOL located at the right position, a little upper loca tion and a little down location of pupil, the ECD showed safe and stabile, but in the eye PIOL clearly down located of pupil and dislocated of iris, the ECD had decreased in different level. Conclusions Artisan PIOL is well for the correction of high myopia. Late-onset decentration has been observed by long-term follow-up, and followed the decrease of the ECD. Located the Artisan PIOL at a relative upper position of the pupil might anti-gravity induced lower location and kept the PIOL at the perfect position in long term, which can reduce the happening of complication, in- crease the safety.