无黏弹剂下V4c ICL植入矫正高度近视疗效的观察

Observation on the effect of V4c ICL implantation without using viscoelastic agent in high myopia patients

目的观察无黏弹剂下有晶状体眼后房型人工晶状体(V4c ICL)植入术矫正高度近视的临床疗效。方法前瞻性病例研究。选取2018年8月至2019年8月在我院就诊的高度近视患者30例(60只眼)进行日间手术,术中未使用黏弹剂进行V4c ICL植入。术后观察2 h、4 h、24 h、1周眼压,对比术前和术后两组患者的裸眼视力(UCVA)、角膜内皮细胞计数、客观散射指数(OSI)、调制传递函数截止频率(MTF cut off)、总体波前像差、全眼的高阶像差、球差、彗差、三叶草,并观察手术相关的并发症。结果术后眼压2 h时有3例患者眼压>35 mmHg,最高眼压43 mmHg,表面麻醉下辅助切口放液后观察到术后4 h眼压正常,术后4 h时所有患者眼压均正常离院,24 h、1周复诊时所有患者眼压均正常。术后1 d裸眼视力≥0.8者57只眼(95%),裸眼视力≥1.0者52只眼(86%);术后1周裸眼视力≥1.0者56只眼(93%),裸眼视力≥术前矫正视力者57只眼(95%)。角膜内皮细胞计数术后1 d略有降低,术前和术后组间差异无统计学意义(P>0.05)。术后OSI、MTF cut off均优于术前,与术前比较差异有统计学意义(P<0.05)。术后1 d和1周的全眼总体波前像差比术前明显降低,差异有统计学意义(P<0.05);全眼高阶像差、全眼总彗差、全眼的三叶草和全眼总球差较术前有不同程度的升高,差异有统计学意义(P<0.05);无黏弹剂下V4c ICL植入矫正高度近视无手术相关并发症发生。结论无黏弹剂下V4c ICL植入矫正高度近视术后早期高眼压发生率低、且眼压升高幅度低、视力恢复快,角膜内皮细胞计数无明显减少,手术步骤减少,手术时间缩短,患者手术感受轻松、视觉质量早期得到明显改善,手术安全有效。

Objective To observe the clinical effect of V4c implantable collamer lens(V4c ICL)implantation without using viscoelastics in the treatment of high myopia patients.Methods Prospective case study.A total of 30 patients(60 eyes)with high myopia who were treated with V4c ICL implantation without using viscoelastic agent in our hospital from August 2018 to August 2019 were selected.The intraocular pressure was observed at 2h,4h,24h and 1w after surgery,and the uncorrected visual acuity(UCVA),corneal endothelial cell count,objective scattering index(OSI),modulation transfer function cut off frequency(MTF cut-off),total high-order phase difference,total wavefront aberration,coma and trefoil of the two groups at both before and after surgery were examined,as well as the surgical complications.Results At two hours after surgery,3 patients had high intraocular pressure(>35 mmHg),and the highest was 43 mmHg.After auxiliary incision drainage with topical anesthesia,the intraocular pressure returned to normal at 4h after the treatment,and all patients had normal intraocular pressure at the 1d and 1w follow-up visit.The UCVA was≥0.8 in 57 eyes(95%)and≥1.0 in 52 eyes(86%)at 1d after the surgery.At 1 week after the surgery,the UCVA was≥1.0 in 56 eyes(93%),and was better than the preoperative visual acuity in 57 eyes(95%).The corneal endothelial cell count decreased slightly at 1 day after the operation,and there was no significant between-group difference(P>0.05).The postsurgical OSI and MTF cut-off were better than those before the operation,and the differences were statistically significant(P<0.05).The total wavefront aberrations of the whole eye at 1 day and 1 week after the operation were significantly lower than before the operation,and the difference was statistically significant(P<0.05).The higher-order aberration,total spherical aberration,total coma aberration,total trefoil aberration of the whole eye ncreased in different degrees compared with those before the operation,and the differences were statistically significant(P<0.05)(P<0.05).No surgical complications was observed.Conclusions The V4c ICL implantation without using viscoelastics to correct high myopia has a stable intraocular pressure,the amplitude of intraocular pressure increase is low,and the vision recovers quickly,the number of corneal endothelial cells is not significantly decreased.The reduced operation steps result in shorter operation time,the patients feel relaxed during the operation and the visual quality significantly improves in the early stage.Overall the operation is safe and effective.