一种新型晶状体调位器在无黏弹剂眼内镜植入术中的应用

Application of a new type crystal adjuster on viscoelastics free implantable collamer lens implantation

目的 观察比较应用黏弹剂与不用黏弹剂而应用新型晶状体调位器行眼内镜(ICL)植入手术的临床疗效。设计回顾性病例系列。研究对象选择在湖州爱尔眼科医院接受ICL植入手术的患者81例(142眼)。方法根据手术方式不同,将患者分成两组:黏弹剂组(72眼)和无黏弹剂组(70眼)。术前、术后2、4、6小时、1天、1周、1、3、6个月测量两组患者的眼压;术前、术后1天、1周、1、3、6个月测量角膜内皮细胞计数、角膜内皮细胞六角型细胞的比例、拱高、裸眼视力(UCVA);术中记录患者的手术时间。比较两组患者术中及术后上述指标的差异。主要指标手术时间、角膜内皮细胞计数、角膜内皮细胞六角型细胞的比例、拱高、UCVA、眼压。结果无黏弹剂组和黏弹剂组的手术时间分别为(9.91±1.75)分钟和(18.90±8.93)分钟(t=-7.658,P<0.01);两组间术后UCVA和术后的拱高比较均无显著差异。术后2、4小时,无黏弹剂组和黏弹剂组的眼压分别为(15.61±3.24)mmHg、(14.41±3.38)mmHg和(20.68±5.33)mmHg、(18.26±4.71)mmHg(P均<0.001);术后6小时,无黏弹剂组和黏弹剂组的眼压分别为(14.48±3.54)mmHg和(16.59±4.05)mmHg(P=0.003)。两组术后的角膜内皮细胞计数均无显著差异。结论新型晶状体调位器辅助的不用黏弹剂的ICL植入手术是安全有效的,其简化了手术流程,可减少黏弹剂所导致的高眼压。

Objective To observe the clinical efficacy of viscoelastic free implantable collamer lens(ICL)implantation assisted with a new type crystal adjuster.Design Retrospective case series.Participants 142 eyes of eighty-one patients who have done ICL V4C lens implanted surgery in Huzhou Aier Eye Hospital.Methods 142 eyes were divided into two groups:group of applied with viscoelastic(viscoelastic group,72 eyes),and group of applied without viscoelastic(viscoelastic free group,70 eyes).Intraocular pressure was measured before operation,and 2,4,6 hours,1 day,1 week,1,3,6 months after operation;corneal endothelial cell count,corneal endothelial hexagonal cell ratio,vault height,and uncorrected visual acuity(UCVA)were measured before operation,and 1 week,1,3,6 months after operation.The operation time were recorded during the operation.The differences of the above indicators during and after the operation were compared between the two groups.Main Outcome Measures Operation time,corneal endothelial cell count,corneal endothelial cell hexagonal cell ratio,vault height,UCVA,and intraocular pressure.Results The operation time of the viscoelastic free group and the viscoelastic group was 9.91±1.75 minutes and 18.90±8.93 minutes,respectively(t=-7.658,P<0.01).There was no significant difference in postoperative UCVA and postoperative vault height between the two groups.At 2,4 hours after operation,the intraocular pressures of the viscoelastic free group and the viscoelastic group was(15.61±3.24)mmHg,(14.41±3.38)mmHg and(20.68±5.33)mmHg,(18.26±4.71)mmHg,respectively(All P<0.001);at 6 hours after operation,the intraocular pressures of the viscoelastic free group and the viscoelastic group was(14.48±3.54)mmHg and(16.59±4.05)mmHg,respectively(P=0.003).There was no significant difference in corneal endothelial cell counts between the two groups postoperatively.Conclusion The ICL implantation without viscoelastic agent assisted by the new lens positioner is safe and effective.It simplifies the process of surgery and reduces the high intraocular pressure caused by viscoelastics.