有晶状体眼后房型人工晶状体植入联合角膜激光手术矫正超高度近视的临床观察

Clinical observation of posterior chamber intraocular lens implantation combined with corneal laser surgery for correction of super high myopia

目的观察有晶状体眼后房型人工晶状体（ICL）植入联合角膜激光手术矫正超高度近视的有效性、安全性、可预测性。方法前瞻性研究。选择拟在重庆爱尔眼科医院进行ICL植入术的等效球镜（SE）≥-16．0D的患者共7例13只眼。先行ICL手术矫正大部分屈光不正，〉13个月后，再行角膜激光手术矫正剩余屈光不正。比较ICL术前与角膜激光术后1d，I周，1个月，≥8个月时，视力、晶体拱高、眼压，角膜内皮细胞计数等指标。结果患者术眼联合手术前平均最佳矫正视力（BCVA）为（4．63±0．29），联合手术后1个月裸眼视力（UCVA）为（4．75±0．19），其中联合手术后1个月UCVA达到术前BCVA的术眼占84．62％（11／13）。联合手术后1个月UCVA与联合手术前BCVA比较，提高1行的眼数为3只眼，提高3行及以上的眼数为4只眼，占全部眼数的53．85％（7／13）。联合手术有效性指数和安全性指数分别为102．81％，103．24％。联合手术术后1个月UCVA≥4．7的为8只眼（61．54％，8／13）。联合手术后1个月残余屈光度≤±1.0D为9只眼，≤±0.5D为5只眼，占比为81．82％（9／11）。联合术后1个月校正眼压、前房深度、前房容积较联合术前比较均降低，差异有统计学意义（P〈0．05）。ICL术后1周、1个月、3个月、≥8个月拱高比较，差异无统计学意义（P〉0．05）。联合术后角膜内皮细胞数较联合手术前降低，观察期间角膜内皮细胞计数均〉2000个／mm^2。术后随访期间，1例1只眼出现孔源性视网膜脱离，1例2只眼有夜间眩光／光晕，1例1只眼有干眼症状，未发现感染、晶状体脱位、青光眼、白内障等术后并发症。结论有晶状体眼后房型人工晶状体植入联合角膜激光手术矫正超高度近视，在短期观察中安全、有效及可预测。

Objective To observe the efficacy, safety and predictability of implantable collamer lens （ICL） implantation combined with corneal laser surgery to correct super high myopia. Methods Prospective study. A total of 7 patients （13 eyes） with SE （equivalent spherical refraction）≥-16.0D were selected. First, ICL surgery was done to correct most of the refractive errors, 3 months later, secondary corneal laser surgery to correct the remaining refractive error. Results The best corrected visual acuity （BCVA） was （4.63±0.29） before the surgery. Postoperative uncorrected visual acuity （UCVA） was （4.75±0.19）, UCVA of 11 eyes achieved level of preoperative BCVA （84.62%, 11/13）. Compared with BCVA before combined surgery, a gain of 1 line of UCVA was seen in 3 eyes, a gain of 3 lines and above of UCVA was seen in 4 eyes （53.85%, 7/13）. Efficacy ratio and safety ratio of the operative was 102.81% and 103.24%, respectively. One month after combined surgery, the UCVA over 4.7 was 8 eyes, accounting for 61.54%. The residual refraction within ±1.0D of emmetropia was 9 eyes and within ±0.5D was 5 eyes （81.82%, 9/11）. The intraocular pressure, anterior chamber depth and anterior chamber volume were significantly lower than that before operation （P 〈0.05）. Comparison of one week, one month, three months and over eight months of vault after ICL, the difference was not statistically significant （P 〉0.05）. The number of corneal endothelial cells after combined surgery was lower than that before combined surgery. The corneal endothelial cell density was 〉2000/mm^2 at last examination. Complications related to infection, lens dislocation, glaucoma, cataract was not observed. But 1 eye of 1 person suffered rhegmatogenous retinal detachment, 2 eyes of 1 person with night glare and halo, 1 person had dry eye symptoms. Conclusions Implantable collarner lens （ICL） implantation combined with corneal laser surgery is a safe, effective and predictable method to correct super high myopia in short-term after combined surgeries.