有晶状体眼后房型人工晶状体植入术矫正高度近视的临床观察

Clinical study of phakic posterior collamer lens implantation for treating high myopia

目的 观察有晶状体眼后房型人工晶状体（PPC-ICL）植入术矫正高度近视的有效性、安全性和视觉质量.方法 前瞻性研究.选择拟行PPC-ICL植入的患者28例（50眼）,其中男10例（14眼）,女18例（36眼）,平均球镜度（-8.26±2.15）D,等效球镜度（SE）（-9.88±2.39）D,其中36眼接受了散光型PPC-ICL植入.术前与术后6个月分别进行视力、波前像差检测;术后6个月进行视觉质量问卷评分.采用配对t检验进行统计分析.结果 术前、术后1d、术后1周、术后6个月UCVA（标准对数视力表）分别为3.82±0.08、4.76±0.26、5.02±0.13、5.03±0.10.术后6个月UCVA较术前增加（t=72.88,P＜0.05）.术后6个月UCVA与术前BCVA相比等于、提高1行、提高2行及以上分别为16眼、26眼、4眼,占全部眼数的92％.术后6个月残余度数在±0.50 D以内的眼数占96％.术前全眼总高阶像差、球差、彗差、三叶草均方根（RMS）值分别为（0.309±0.098）、（-0.008±0.111）、（0.197±0.103）、（0.142±0.076） μm;术后6个月分别为（0.320±0.152）、（-0.114±0.117）、（0.026±0.534）、（0.204±0.122） μm.术后全眼总高阶像差与球差较术前有增加但差异无统计学意义,全眼彗差较术前减少（t=-3.454,P＜0.05）,全眼三叶草像差较术前增加（t=2.556,P＜0.05）.在视觉质量问卷方面：全部28例（50眼）均对白天远视力和手术整体效果表示满意,其他视觉质量评分由高到低依次为（分数越高越满意）：白天骑车/开车容易度、白天近视力、夜间视力、电脑、近距离阅读、夜间骑车/开车容易度、视物疲劳、光晕、眩光、眼干.结论 PPC-ICL植入术是矫正高度近视的一种安全有效的手术方法,患者术后UCVA明显提高,彗差减少,与术前比较有更好的视觉质量.

Objective To observe the efficacy,safety and visual quality of phakic posterior chamber intraocular lens implantable collamer lens （PPC-ICL） for correcting high myopia.Methods In a prospective study of 50 eyes of 28 patients （14 eyes of 10 males and 36 eyes of 18 females） with an average spherical refractive error of-8.26±2.15 D and a spherical equivalent （SE） of-9.88± 2.39 D.Thirty-six eyes were implanted with toric ICLs.The following indicators were compared：preoperative and postoperative uncorrected visual acuity （UCVA）,best corrected visual acuity （BCVA）,validity and safety analysis of the ICL surgeries,preoperative and 6 month postoperative wavefront aberrations,analysis of relevant indicators,and visual quality questionnaire scores six months after surgery.All patients were followed up for more than 6 months.Data were analyzed using a matched t test.Results Preoperative UCVA （logarithm visual table,5 vision） and 1 day,1 week and 6 months after surgery were 3.82±0.08,4.76±0.26,5.02±0.13 and 5.03±0.10.Visual acuity 6 months after surgery improved compared to preoperative acuity （t=72.88,P＜0.05）.Compared to preoperative BCVA,UCVA 6 months after surgery equal to,increased 1 row,2 rows and above for 16,26,4 patients,respectively,which accounted for 92％ of the total number of eyes.The amount of residual diopters after 6 months of PPC-ICL implant was less than ±0.50 D,accounting for 96％.Preoperative higher-order wavefront aberrations,spherical aberrations,coma,and trefoil were 0.309±0.098 μm,-0.008±0.111 μm,0.197±0.103 μm,and 0.142±0.076 μm; and after surgery were 0.320±0.152 μ m,-0.114±0.117 μm,0.026±0.534 μm,and 0.204±0.122 μm.Total higher-order aberrations and spherical aberrations increased,but the difference was not statistically significant.Coma was reduced （t=-3.454,P＜0.05）,and trefoil increased （t=2.556,P＜0.05）.The results of the visual quality questionnaire showed that all 28 patients （50 eyes） were satisfied with the surgery; other scores in descending order （the higher the score,the greater the satisfaction） were dav cycling/driving ease,near vision,night vision,computer,close reading,night cycling/driving ease,visual fatigue,halos,glare,dry eye.Conclusion ICL implants are a safe and effective surgical method for correcting high myopia,and all patients were satisfied with the surgery.The UCVA after surgery was obviously higher than the BCVA before surgery.Moreover,the procedure can also decrease coma,which can result in better visual quality.