ICL联合Trans-PRK治疗超高度近视患者的疗效及对角膜内皮细胞密度的影响

Effect of ICL combined with Trans-PRK on corneal endothelial cell density in patients with high myopia

目的:探索可植入式隐形眼镜(implantablecollamerlense,ICL)联合经角膜上皮激光角膜切削术(laser keratectomy via corneal epithelium,Trans-PRK)治疗超高度近视患者的疗效及对角膜内皮细胞密度(corneal endothelial cell density)的影响。方法:分析研究本院眼科2014年3月~2017年3月期间收治的超高度近视患者,在接受ICL植入术后6个月仍残留近视并再次接受Trans-PRK治疗,病例数为30例52眼。术后对患者进行随访,于术前、ICL植入术后6个月、Trans-PRK术后6个月观察裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)、屈光度(dioptre,D)、眼压(intraocular pressure)、ICL拱高(arch height)、前房容积(anterior chamber volume)、前房深度(anterior chamber depth)以及角膜内皮细胞数变化情况,以此评价手术的有效性及安全性。结果: ICL植入术后6个月、Trans-PRK术后6个月术眼UCVA、BCVA均明显高于术前( P =0.000),且Trans-PRK术后6个月术眼UCVA明显高于ICL植入术后6个月( P <0.05);所有患者术后均未出现眼压增高的情况,术前、ICL植入术后6个月及Trans-PRK术后6个月术眼眼压差异无统计学意义( P >0.05),Trans-PRK术后6个月术眼ICL拱高稍低于ICL植入术后6个月,但差异无统计学意义( P >0.05);ICL植入术后6个月、Trans-PRK术后6个月术眼前房容积、前房深度均明显小于术前( P =0.000),且Trans-PRK术后6个月前房深度明显低于ICL植入术后6个月( P <0.05);ICL植入术后6个月术眼角膜内皮细胞数略少于术前,差异不具有统计学意义( P >0.05),Trans-PRK术后6个月角膜内皮细胞数较ICL植入术后6个月有所回升,接近术前水平。结论: Trans-PRK治疗可有效改善高度近视ICL植入术后残留近视患者眼球的屈光度,对角膜内皮细胞密度影响小,显著提升视力水平,提升视力水平,达到预期手术效果,且操作安全,值得临床推广。

Objective: To explore the efficacy of ICL combined with Trans-PRK in the treatment of high myopia and its effect on corneal endothelial cell density. Methods : A prospective analysis was performed on the patients with ultra-high myopia admitted to the ophthalmology department of our hospital from March 2014 to March 2017.Six months after ICL implantation,the patients still had myopia and received trans-prk treatment again.The number of cases was 30 and 52 eyes.Patients were followed up postoperatively.The uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA) and Dioptre (Dioptre) were observed preoperatively,6 months after ICL implantation and 6 months after Trans PRK.D) Intraocular pressure,Arch height,Anterior chamber volume,Anterior chamber depth,and corneal endothelial cell count changes in order to assess the procedure's effectiveness and safety. Results: UCVA,BCVA and refractive index of the eyes were significantly higher 6 months after the implantation of ICL and 6 months after the trans-prk than before ( P =0.000),and UCVA of the eyes 6 months after the trans-prk was significantly higher than that 6 months after the implantation of ICL ( P <0.05).There was no increase in intraocular pressure in all patients after surgery.There was no significant difference in intraocular pressure before surgery,6 months after ICL implantation and 6 months after trans-prk ( P >0.05).Both anterior chamber volume and anterior chamber depth were significantly lower 6 months after ICL implantation and 6 months after trans-prk than before ( P =0.000),and anterior chamber depth was significantly lower 6 months after trans-prk than after ICL implantation ( P <0.05).The number of corneal endothelial cells 6 months after ICL implantation was slightly less than that before surgery,but it was not statistically significant ( P >0.05).The number of corneal endothelial cells 6 months after trans-prk was higher than that after ICL implantation and close to the preoperative level. Conclusion: Trans-prk can effectively improve the eye diopter of patients with high myopia and residual myopia after ICL implantation.It has little effect on the density of corneal endothelial cells,significantly improves the level of vision,improves the level of vision,achieves the expected operation effect,and the operation is safe,which is worthy of clinical promotion.