有晶状体眼人工晶状体植入术后二次手术的临床特征分析

Clinical Characteristics of Secondary Operation after Phakic Implantable Collamer Lens Implantation

目的:探究有晶状体眼人工晶状体(ICL)植入术后需再次行人工晶状体调位、更换或取出术等二次手术的原因,分析其临床特点和术后效果。方法:系列病例研究。收集2017年7月至2020年12月在郑州爱尔眼科医院行ICL(V4c)植入术后行人工晶状体调位、更换或取出术的屈光不正患者73例(74眼),其中需调位47眼、更换26眼、取出1眼,术后定期复查,观察记录裸眼视力(UCVA)、拱高和角膜内皮细胞计数(ECD)等指标。以单纯ICL植入术眼68眼作为对照组,ICL植入后行调位术眼47眼为调位组,ICL植入后行更换术眼26眼为更换组。采用独立样本t检验比较因拱高过高与拱高过低行二次手术处理患者的拱高变化量;采用单因素方差分析比较调位组、更换组与对照组在术后1个月的UCVA、有效性指数、安全性指数及ECD减少量的差异;采用卡方检验比较单纯球镜矫正型和复曲面型ICL植入术后的更换率。结果:ICL植入术后进行ICL调位、更换或取出的原因有拱高异常、复曲面型ICL旋转和ICL位置异常。因拱高异常行ICL调位或更换59眼,拱高过高者通过调位或更换小一号尺寸的ICL后均获得理想拱高,而拱高过低的病例相对复杂,且拱高过高者行ICL调位或更换的平均拱高变化量大于拱高过低者,差异有统计学意义(t=4.72,P<0.001)。复曲面型ICL植入术后发生轴向旋转且视觉质量欠佳14眼,其中12眼行调位后取得稳定、良好的效果,2眼调位后顽固性旋转,通过更换手术方式才解决。术后1个月,调位组、更换组与对照组的UCVA、有效性指数、安全性指数及ECD减少量比较差异均无统计学意义。单纯球镜矫正型ICL植入术后更换率小于复曲面型ICL(分别为1.6%、3.5%),差异有统计学意义(χ^(2)=4.04,P=0.045)。1眼ICL植入术后出现ICL位置异常、瞳孔区拱高上下差异大,行ICL取出+晶状体超声乳化吸除+囊袋内人工晶状体植入术,术后效果理想。结论:拱高异常为ICL植入术后调位、更换或取出的最主要原因,拱高过高者行ICL调位或更换后的平均拱高变化量大于拱高过低者,且更具规律性;复曲面型ICL旋转经调位后多数病例可获得满意结果;ICL调位术和更换术相较于单纯植入术具有相当的安全性和术后效果。

Objective:To explore the causes of secondary operations such as phakic implantable collamer lens(ICL)reposition,exchange or explantation after ICL implantation,further more to analyze its clinical characteristics and outcomes.Methods:In this case serial study,74 eyes of 73 patients with ametropia who underwent ICL reposition,exchange or explantation in Zhengzhou Aier Eye Hospital from July 2017 to December 2020 were collected,composed of 47 eyes with ICL reposition,26 eyes with ICL exchange and 1 eye with ICL explantation.All patients were followed up with the examination including uncorrected visual acuity(UCVA),vault and corneal endothelial density(ECD).Sixty-eight eyes with simple implantation were used as the control group,meanwhile 47 eyes with ICL reposition and 26 eyes with ICL exchange were defined as the reposition group and exchange group respectively.Independent sample t-test was used to compare the vault changes between excessive vault and insufficient vault.One way ANOVA was used to compare the differences of UCVA,effectiveness index,safety index and ECD reduction among the reposition group,exchange group and the control group.The exchange rates of ICL and TICL were compared by Chi-square test.Results:The causes of ICL reposition,exchange or explantation include abnormal vault,TICL rotation and abnormal ICL position.Fifty-nine eyes underwent ICL reposition or exchange due to abnormal vault,of which eyes with excessive vault achieved ideal vault through reposition or smaller ICL exchange,while eyes with insufficient vault were relatively complex.In addition,the average vault changes of ICL reposition or exchange in those with excessive vault was greater than that in those with insufficient vault(t=4.72,P<0.001).There were 14 eyes with visual acuity decreasing due to TICL rotation,of which 12 eyes had stable and good results after TICL reposition,and 2 eyes got unsatisfactory results after reposition treated by ICL exchange finally.There were no significant difference in UCVA,effectiveness index,safety index and ECD reduction among the reposition group,exchange group and the control group.The exchange rate of ICL(1.6%)was lower than that of TICL(3.5%),and the difference was statistically significant(χ^(2)=4.04,P=0.045).For 1 eye whose ICL position was abnormal and vault varied greatly from top to bottom in pupil area,ICL removal+phacoemulsification+intraocular lens implantation brought satisfactory results.Conclusion:Abnormal vault is the main reason of ICL reposition,exchange or explantation.The average vault changes of ICL reposition or exchange in those with excessive vault was greater than that in those with insufficient vault,and shown better regularity.After reposition of TICL rotation,satisfactory results can be obtained in most cases.Compared with simple implantation,ICL reposition or exchange have considerable safety and outcomes.