有孔和无孔眼内镜植入术后房角改变的对比研究

Comparative study of angle changes after implantable collamer lens with or without center hole implantatione

目的比较无孔(V4)和有孔(V4c)型眼内镜(ICL)植入术后房角的差异。设计回顾性病例系列。研究对象2014年2月到2015年9月在北京同仁医院接受V4或V4c型ICL植入术,且术后3个月接受Visante前节OCT检查的高度近视患者60例(60眼)。方法回顾性分析V4植入组(40例)和V4c植入组(20例)患者右眼的术前眼压、等效球镜、突到突距离、中央前房深度、房角数据以及术后3个月时眼压、房角数据、角膜内皮到ICL距离和拱高。对两组患者手术前、后的房角数据以及两组患者术前的前节及房角数据和术后房角数据分别进行分析比较。主要指标眼压和房角数据,包括:500μm和750μm房角开放距离(AOD)、500μm和750μm小梁虹膜面积(TISA)和巩膜突角度(SSA)。结果 V4组和V4c组患者术前的眼压、等效球镜、突到突距离、中央前房深度、房角数据无统计学差异(P均>0.05);两组患者术后的眼压、角膜内皮到ICL距离、拱高和房角数据无统计学差异(P均>0.05)。与术前相比,V4组和V4c组术后房角均显著变窄(P均<0.01),SSA分别减少了43%~47%和39%~40%,但两组患者术后的眼压同术前相比均无差异(P均>0.05)。结论 V4和V4c型ICL植入术后,患者的前房角均显著变窄,且房角狭窄程度相似。由于V4植入术前的预防性虹膜周切和V4c的中央圆孔设计,两种ICL植入术后均未引起眼压升高。

Objective To compare the difference of anterior chamber angle of high myopia patients who received V4 or V4c implantable collamer lens （ICL） implantation. Design Retrospective case series. Participants 60 patients （60 eyes） with high myopia who received V4 or V4c ICL implantation and Visante anterior segment OCT examination 3 months postoperation in Beijing Tongren Hospital from February 2014 to September 2015. Methods The intraocular pressure （IOP）, spherical equivalent, spur to spur distance, central anterior chamber depth, angle data preoperation and IOP, corneal endothelium to ICL distance, vault and angle data postoperation were retrospectively analyzed. The preoperative and postoperative angle data and the anterior segment data were compared between V4 group and V4c group. Main Outcome Measures IOP and angle data, including 500 μm and 750 μm angle open distance （AOD）, 500 μm and 750 μm trabecular-iris space area （TISA） and scleral spur angle （SSA）. Results There was no significant difference between the two groups in terms of IOP, spherical equivalent, spur to spur distance, central anterior chamber depth and angle data preoperatively （P〉0.05）. The IOP, corneal endothelium to ICL distance, vault and angle data were not statistically different between the two groups postoperatively （P〉0.05）. In V4 group and V4c group, postoperative anterior chamber angle was significantly narrowed （P〈0.01）, and SSA decreased by 43%~47% and 39%~40% respectively compared to the preoperation. Conclusion After V4 and V4c ICL implantation, the anterior chamber angle was significantly narrowed, and the angle parameters were similar between the two groups. Because of the prophylactic iridotomy of V4 and the central hole design of V4c, no significant IOP elevation was observed after ICL implantation.