有晶状体眼后房型人工晶状体植入术对高度近视眼调节功能影响的临床观察

The effects of posterior chamber intraocular lens implantation on accommodative function in high myopia

目的探讨有晶状体眼后房型人工晶状体植入术对不同年龄高度近视眼患者调节功能的影响。方法回顾性队列研究。对2017年1月至2018年12月在陆军军医大学第一附属医院眼科行有晶状体眼后房型人工晶状体植入术、随访资料完整的高度近视眼患者进行研究,共75例(150只眼),其中男性23例,女性52例,年龄(28.99±7.26)岁。按照年龄分为两组:低龄组(18~34岁)40例(80只眼),高龄组(35~48岁)35例(70只眼)。对患者术前及术后1、3、6、12个月的裸眼远视力(UCVA)、最佳矫正视力(BCVA)、裸眼近视力(UNVA)、等效球镜度数、调节幅度、负相对调节(NRA)、正相对调节(PRA)、单眼和双眼调节灵敏度(AF)、调节反应、远近水平隐斜、调节性集合与调节比值(AC/A)以及视觉满意度问卷调查评分等指标进行统计与分析,比较不同年龄组上述指标的变化及差异性。对两组患者手术前后各时间点的指标采用重复测量方差分析进行比较,有统计学意义者再行最小显著性差异法两两比较;两组间的数据比较采用独立样本t检验,组内手术前后数据比较采用配对t检验;率的比较用卡方检验及Fisher确切检验。结果术前和术后12个月低龄组调节幅度分别为(8.88±2.27)和(9.51±1.34)D,高龄组分别为(7.67±2.36)和(6.56±2.63)D,两组调节幅度随时间变化趋势不同(F=15.044,P<0.05),同一时间比较两组的调节幅度差异有统计学意义(F=47.678,P<0.05),高龄组调节幅度在各时间点均显著低于低龄组。两组间NRA比较,术前及术后低龄组NRA均优于高龄组,差异具有统计学意义(F=13.459,P<0.05),两组内NRA随时间变化差异无统计学意义(F=1.788,P=0.141)。PRA术前及术后两组差异均无统计学意义(F=1.447,P=0.233),各组随时间亦无显著性变化(F=1.762,P=0.146)。两组单眼及双眼AF比较,随时间变化差异均有统计学意义(F=34.296,21.839,P<0.05),两组单眼AF及双眼AF术后12个月均较术前显著性提高。各时间点低龄组单、双眼AF均优于高龄组,差异均有统计学意义(F=80.327,43.08,P<0.05)。两组调节反应比较,高龄组由术前(0.12±0.32)D增加到术后12个月(0.38±0.49)D,差异有统计学意义(F=4.752,P<0.05);而低龄组内术前术后变化差异无统计学意义(F=2.110,P=0.151)。AC/A术前及术后两组间差异无统计学意义(F=0.389,P=0.505),术后组内随时间变化差异亦无统计学意义(F=1.049,P=0.309)。结论高度近视眼患者有晶状体眼后房型人工晶状体植入术后视力、调节幅度及AF都有显著提高,术后调节功能显著改善,视觉满意度高;低龄患者的提高优于高龄患者。

Objective To investigate the effects of implantable Collamer lens(ICL)with a central hole on the accommodative function of patients with high myopia at different ages after implantation.Methods A retrospective cohort study was conducted on 75 patients(150 eyes,23 men and 52 women)with high myopia who underwent ICL implantation in Department of Ophthalmology of First Affiliated Hospital of Army Medical University from January 2017 to December 2018.The age was(28.99±7.26)years(range,18-48 years).Forty patients(80 eyes)aged 18-34 years were included in the younger group and 35 patients(70 eyes)aged 35-48 years were included in the elderly group.To compare the changes and differences of accommodative function between the two groups,the uncorrected visual acuity,best corrected visual acuity,spherical equivalent error,amplitude of accommodation(AMP),negative relative accommodation(NRA),positive relative accommodation,single and both eyes′accommodation of facility(AF),fused cross cylinder,near and far distance horizontal phoria,accommodative convergence/accommodation and visual satisfaction questionnaire before surgery and at 1,3,6 and 12 months after surgery were analyzed.ANOVA for repeated design,LSD,unpaired sample t-test,Paired t-test,Chi-square test and Fisher′s exact test were used for data analyses.Results At each time point before and after operation,there were significant differences between the two groups in the AMP(F=16.511,P<0.05).The AMP of the younger group increased from(8.88±2.27)D at baseline to(9.51±1.34)D at 12 months,while it was decreased in the elderly group from(7.67±2.36)D at baseline to(6.56±2.63)D at 12 months.The trend of changes was significantly different(F=15.044,P<0.05).The AMP of the elderly group was significantly lower than that of the younger group at all time points(F=47.678,P<0.05).The NRA of the younger group was better than that of the elderly group(F=13.459,P<0.05),but the NRA had no significant changes in both groups postoperatively(F=1.788,P=0.141).We could not find any significant changes of positive relative accommodation between two groups(F=1.447,P=0.233).The monocular and binocular AF of two groups was increased significantly after surgery(F=34.296,21.839,P<0.05).The AF of the younger group was better than that of the elderly group(F=80.327,43.08,P<0.05).The fused cross cylinder was improved from baseline(0.12±0.32)D to(0.38±0.49)D at 12 months(F=4.752,P<0.05),while the difference was not found in the younger group(F=2.110,P=0.151).We could not find any significant changes of accommodative convergence/accommodation between two groups(F=0.389,P=0.505)or in each group(F=1.049,P=0.309)preoperatively and at 1,3,6 and 12 months after surgery.Conclusions ICL implantation is effective in the treatment of high myopia.The visual acuity,AMP,monocular and binocular AF may increase obviously.Big improvements in the accommodative function and high satisfaction of vision can be achieved,especially in younger patients.