中央孔型有晶状体眼后房型人工晶状体矫正中高度近视眼的远期效果研究

Long term results of central hole type posterior chamber intraocular lens in the correction of moderate to high myopia

目的评估中央孔型有晶状体眼后房型人工晶状体(pIOL)植入术矫正中高度近视眼的远期安全性、有效性、预测性及稳定性。方法回顾性病例系列研究。收集2015年于复旦大学附属眼耳鼻喉科医院行中央孔型pIOL植入术,且完成术后5年随访的患者资料共50例(95只眼),其中男性15例,女性35例;年龄(29.27±7.81)岁。随访裸眼视力、矫正视力、屈光度数、眼轴长度、眼压、角膜内皮细胞计数、拱高及并发症至术后5年,计算术后1个月和5年的安全性指数(术后矫正视力/术前矫正视力)和有效性指数(术后裸眼视力/术前矫正视力)。采用配对t检验、重复度量单因素方差分析及Pearson相关分析进行统计学分析。结果患者术前、术后1个月及5年等效球镜度数分别为(-12.16±3.04)、(-0.19±0.55)、(-1.14±0.84)D。术后1个月及5年的安全性指数分别为1.24±0.27和1.13±0.27,有效性指数分别为1.14±0.25和0.87±0.26。术后1个月时,76只眼(80.00%)实际矫正度数在预期矫正度数±0.50 D及以内,92只眼(96.84%)在±1.00 D及以内。术后眼压与术前相比差异无统计学意义(F=2.607,P=0.175)。术后5年内皮细胞平均丢失率为3.87%(t=27.411,P<0.001),拱高平均下降106.32μm(t=6.596,P<0.001)。结论植入中央孔型pIOL用于矫正中高度近视眼具有较好的远期安全性、有效性、预测性及稳定性。中央孔的存在可维持眼压的长期稳定,对避免前囊膜下混浊有一定作用。

Objective To evaluate the long-term safety,effectiveness,predictability and stability of ICL V4c implantation for moderate to high myopia.Methods In this retrospective case series study,95 eyes from 50 patients with moderate to severe myopia who were treated in 2015 underwent central hole type posterior chamber intraocular lens(ICL V4c)implantation at Eye&ENT Hospital of Fudan University.The patients were followed up for a period of five years,during which we assessed various parameters including uncorrected visual acuity(UDVA),corrected visual acuity(CDVA),refractive error,axial length,intraocular pressure,endothelial cell density(ECD),vault,and complications.We used the paired t-test and repeated measures one-way ANOVA in SPSS statistical software to analyze the data.Results The mean spherical equivalent refraction(SE)decreased significantly from(-12.16±3.04)D preoperatively to(-0.19±0.55)D at one month and(-1.14±0.84)D at five years postoperatively.The safety indices(postoperative CDVA/preoperative CDVA)were 1.24±0.27 and 1.13±0.27,respectively,and the efficacy indices(postoperative UDVA/preoperative CDVA)were 1.14±0.25 and 0.87±0.26 at one month and five years postoperatively.At one month after surgery,80.00%of the eyes were within±0.50 D of the expected correction,and 96.84%were within±1.00 D.There was no significant difference in IOP between preoperative and postoperative measurements.The rate of ECD was 3.87%,and the vault decreased by 106.32μm at five years postoperatively.Conclusion ICL V4c implantation is safe and effective with good predictability and stability for long term.