高度近视有晶状体眼后房型人工晶状体植入术后眼前节解剖变化

Anatomical changes of anterior segment after phakic collamer implantation

目的 分析高度近视眼患者植入有晶状体眼后房型人工晶状体（Visian ICL V4）术后眼前节解剖结构的变化.方法 本研究入选行有晶状体眼人工晶状体植入术的高度近视患者93例（175眼）,平均年龄（30.52 ±7.00）岁（18～48岁）,其中119眼接受ICL植入术,46眼接受Toric-ICL植入术.比较术前和术后1周前房容积（ACV）、前房深度（ACD）、房角角度（ACA）（3：00 ～9：00位方向）变化、ICL光学区后表面到晶状体前囊膜中央距离（拱高）、角膜-晶状体间距、虹膜-晶状体间距、人工晶状体等效球镜（pIOL SE）等各参数间的关系.结果 术前、术后1周ACV分别为（200.29±31.76） mm3及（116.49±21.88） mm3,ACV减少（t=48.456,P=0.000）.术前、术后ACD由（3.17 ±0.23） mm减少到（2.89±0.33） mm（t=12.237,P=0.000）,术前、术后房角由（36.40 ±4.90）°减少到（23.44 ±5.07）°（t=31.131,P=0.000）;术后ACV和术后ACD与术后ACA呈现正相关（分别为r=0.637,P=0.000;r=0.393,P=0.000）.术后的角膜-晶状体间距较术前增加（0.40 ±0.31） mm（t=-16.935,P=0.000）,其与拱高呈正相关（r=0.446,P=0.000）.多因素回归分析,拱高与角膜-晶状体间距比值、手术前后的瞳孔变化率是独立的手术前后角膜-晶状体间距变化的影响因素（分别是P =0.001和P=0.048）.结论 ICL植入术后,虹膜平面抬升,使前房容积变小和房角变窄.

Objective To evaluate the anatomical changes of anterior segment after posterior chamber phakic intraocular lens （Visian ICL V4,Implantable Collamer Lenses V4） implantation for high myopic eyes.Methods One hundred and seventy-five eyes of 93 patients who underwent myopic inplantable collamer lens （ICL） implantation were recruited [aged （30.52 ± 7.0） yearing,range from 18 to 48 years].One hundred and nineteen eyes underwent conventional ICL implantation and 46 eyes underwent Toric-ICL implantation.Preoperative and postoperative （one week） anterior chamber volume （ACV）,anterior chamber depth （ACD）,anterior chamber angle （ACA） （scan from 3：00 ～ 9：00）,the distance between central posterior surface of the ICL and anterior surface of the crystalline lens （vault）,cornea-lens distance,iris-lens distance,and spherical equivalent of phakic intraocular lens （pIOL SE） were recorded and analyzed.Results The mean ACV decreased from （200.29 ± 31.76） mm3 preoperatively to （116.49 ± 21.88） mm3 one week postoperatively （t =48.456,P =0.000）.The ACD decreased from （3.17 ±0.23） mm （preoperatively） to （2.89 ±0.33） mm （1 week postoperatively） （t =12.237,P =0.000）.The anterior chamber angle decreased from （36.40 ± 4.90）° （preoperatively） to （23.44 ± 5.07）° （1 week postoperatively） （t =31.131,P =0.000）.Postoperative ACA was positively correlated with postoperative ACV（r =0.637,P =0.000） and postoperative ACD（r =0.393,P =0.000）.Postoperative corneal-lens distance were greater than preoperative cornea-lens distance [mean difference （0.40 ± 0.31） mm,P =0.000].Positive correlation was observed between corneal-lens distance and vault （r =0.446,P =0.000）.Stepwise regression analysis showed that the ratio of vault to cornea-lens distance and the change rate of preoperative and postoperative pupil diameter were two independent predictors of the changes of corneallens distance.（P =0.001,0.048 respectively）.Conclusions ICLs implantation could decrease the size of ACV and narrow the anterior chamber angles.