非球面人工晶状体置换治疗高度近视的效果分析

Clinical efficacy of aspherical lens exchange for high myopic eye

目的探讨非球面人工晶状体置换矫治中老年高度近视患者的有效性和安全性。方法 2012年3月至2014年5月就诊于郑州市第二人民医院的高度近视患者57例(110只眼)行超声乳化晶状体摘除联合人工晶状体植入术。患者年龄47~70岁,平均(57.87±13.83)岁。近视屈光度数-6.0^-21.5 D,平均(-15.08±8.17)D,术前最佳矫正远视力0.12~0.63,植入单片式非球面人工晶状体(Rayner IOL),随访1 a,观察手术前后的最佳矫正视力、屈光状态、角膜内皮细胞计数、眼压、前房、IOL位置和眼底情况以及并发症并进行比较。结果 99眼裸眼视力提高,13眼(11.8%)裸眼视力提高至≥0.5;102眼(92.7%)最佳矫正视力较术前提高,53眼(48.1%)最佳矫正视力≥0.5。术眼术后平均近视屈光度为(-2.25±1.77)D,12眼(10.9%)后囊膜混浊行YAG激光切开、1例因并发视网膜脱离行玻璃体切除联合硅油注入术。结论超声乳化晶状体置换术矫治高度近视眼具有良好的安全性,有效性及可预测性,但对于高度近视患者,眼底病变是影响预后的主要因素,术前应仔细检查眼底情况,术后长期随防,注意并发症的发生。

Objective To discuss the effectiveness and safety of the replacement of intraocular lens（ IOL） for the middle-aged and old patients with high myopia. Methods A total of 57 patients（ 110 eyes） with high myopia who had underwent phacoemulsification and IOL implantment from March of 2012 to May of 2014 were retrospectively analyzed. The age of patients was47 ~ 70 years old,average（ 57. 87 ± 13. 83） years old. The myopia diopter number was- 6. 0 ^- 21. 5 D,average（- 17. 08 ±8. 17） D. The best corrected distance visual acuity was 0. 12 ~ 0. 63 before operation. All eyes were replaced by monolithic aspherical IOL（ Rayner IOL） and followed up for one year. The best corrected visual acuity,refractive status,corneal endothelial cell,intraocular pressure,anterior chamber,the position of IOL,fundus situation and complications were compared before and after operation. Results The naked vision of 99 eyes（ 90. 0%） was improved. The naked vision of 13 eyes（ 11. 8%） was improved to 0. 5,even better than 0. 5. The best corrected vision of 102 eyes（ 92. 7%） was improved,the best corrected vision of 53eyes（ 48. 1%） was improved to 0. 5,even better than 0. 5. The average refractive degree was（- 2. 25 ± 1. 77） D. 12 eyes（ 10. 9%） of the lens posterior capsular opacity had underwent YAG laser. 1 eye of retina detachment had underwent vitrectomy and silicone oil tamponade. Conclusion Phacoemulsification and IOL implantment had good safety,effectiveness and predictability.But for the patients with high myopia,the fundus disease is an important factor to effect the operative prognosis. The condition of fundus must be carefully checked before operation with a long- term follow- up after operation,and notice the complications.