ICL-V4c植入术治疗超高度近视临床效果

Effect of ICL-V4c Implantation in Treatment of Ultra-High Myopia

目的:观察新型中央孔型后房型人工晶状体(ICL-V4c)植入术治疗-10 D以上超高度近视的安全性和有效性,并探讨视力提高情况(△LogMAR)与术前球镜度(SD)之间的关系。方法:回顾性研究。选取2016年12月至2020年1月于北京同仁医院行ICL-V4c植入术治疗超高度近视患者802例(1380眼),术前SD-23.50~-6.00(-11.54±3.59)D。根据患者术前SD将患者分为A组(-10 D<SD≤-6 D)、B组(-23.5 D≤SD≤-10 D),B组按照组距3 D分为B1(-13 D<SD≤-10 D)、B2(-16 D<SD≤-13 D)、B3(-19 D<SD≤-16 D)、B4(-22 D<SD≤-19 D)、B5(-23.5 D≤SD≤-22 D)共5个亚组。使用Kruskal-Wallis检验及卡方检验分析比较各组患者术前和术后1周、2个月的视力、眼压及视力提高情况。结果:B组患者SD术后得到明显改善(P<0.001),最佳矫正视力(BCVA)得到明显提高(P<0.001);2组患者手术的安全指数和有效指数平均值均>1。△LogMAR和组别之间存在相关性(P<0.001);B3、B4组患者术后△LogMAR明显高于A、B1、B2组(调整后均P<0.001)。B组患者术后眼压高于A组(P<0.001),且术后高眼压的比例更高(P=0.008)。结论:ICL-V4c植入术治疗SD≤-10 D以上的超高度近视是安全、有效的,远期效果需进一步观察;治疗-22~-16 D的超高度近视患者术后收益高于>-16~-6 D的患者。

Objective:To observe the safety and effectiveness of ICL-V4c implantation in the treatment of ultra-high myopia over-10 D,and to explore the relationship and rules between the improvement of vision(△LogMAR)and preoperative spherical diopter(SD).Methods:This was a retrospective study.Eight hundred and two patients(1380 eyes)with ultra-high myopia were treated by ICL-V4c implantation in Beijing Tongren Hospital from December 2016 to January 2020.The preoperative SD was-23.50 D≤SD≤-6.00 D(mean-11.54±3.59 D).The patients were divided into group A(-10 D<SD≤-6 D)and group B(-23.5 D≤SD≤-10 D)according to their preoperative SD.Group B was further divided into five sub groups:B1(-13 D<SD≤-10 D),B2(-16 D<SD≤-13 D),B3(-19 D<SD≤-16 D),B4(-22 D<SD≤-19 D)and B5(-23.5 D≤SD≤-22 D).The preoperative and postoperative visual acuity at 1 week and 2 months and improvement in visual acuity and intraocular pressure of the patients were analyzed by Kruskal-Wallis test and Chi-square test.Results:The postoperative SD and best corrected visual acuity(BCVA)of patients in group B were significantly improved(P<0.001).Both mean safety and effectivity indices were>1.There was a significant correlation between△LogMAR and group(P<0.001).△LogMAR in the B3 and B4 groups was significantly higher than that in A,B1 and B2 groups(adjusted,P<0.001).The intraocular pressure(IOP)in group B was higher than that in group A(P<0.001),and the proportion of postoperative high IOP was higher(P=0.008).Conclusions:ICL implantation is safe and effective for patients with ultra-high myopia over-10 D,but the long-term effect needs further explorations.The improvement of BCVA in patients with-22 D≤SD≤-16 D was higher than that of patients with-16 D<SD≤-6 D.