垂直设计的散光型有晶状体眼后房型人工晶状体植入矫正近视复合散光的临床观察

Clinical Observation on Correction of Myopia and Astigmatism with Vertical Implantation of Toric Posterior Chamber Intraocular Lens in Phakic Eyes

目的:探讨散光型有晶状体眼后房型环曲面人工晶状体(TICL)垂直位植入术治疗近视复合散光的有效性与安全性。方法:选取2020年8月~2021年8月在福州东南眼科医院(金山新院)行散光型有晶状体眼后房型人工晶状体TICL植入术的近视患者28例(49眼),平均年龄(26.93±5.74)岁。根据术前检查,选择特定大小的TICL转换散光轴向并定制垂直位植入。对比观察所有患者在术前、术后1年随访裸眼视力、最佳矫正视力、眼压、角膜内皮细胞计数、术后拱高等。计算术后1个月和1年的安全性指数和有效性指数。结果:术前和术后1年裸眼视力比较,视力均显著提高,差异有统计学意义(t=-44.33;P<0.001),术前最佳矫正视力与术后1年裸眼视力比较差异有统计学意义(t=-8.41;P<0.001)。术前和术后1年眼压差异无统计学意义(t=0.11;P>0.05)。术前、术后1年角膜内皮细胞计数差异有统计学意义(t=11.46;P<0.001)。术后1年44眼(89.80%)拱高在250~750μm。术后随访,未发现高眼压、晶体混浊等,尚未发现黄斑出血、视网膜脱离等其他并发症。结论:根据超声生物显微镜检查结果评估筛选后选择进行的垂直位定向TICL设计和植入,具有良好的安全性、有效性和可预测性。

Objective:To investigate the efficacy and safety of vertical implantation of posterior chamber intraocular lens(TICL)with astigmatism in the treatment of myopia combined with astigmatism.Methods:From August 2020 to August 2021,astigmatic lens posterior chamber intraocular lens(TICL)implantation was performed in Fuzhou Southeast Eye Hospital(Jinshan New Hospital)28 patients(49 eyes)were myopic,with an average age of(26.93±5.74)years.Based on the preoperative examination,the TICL of a specific size was selected to convert the astigmatic axis and customize the vertical placement.Naked eye visual acuity,best corrected visual acuity,intraocular pressure,corneal endothelial cell count,and postoperative arch height were compared in all patients before and 1 year after surgery.The safety index and effectiveness index were calculated at 1 month and 1 year after operation.Results:The naked eye visual acuity was significantly improved before operation and 1 year after operation,and the difference was statistically significant(t=-44.33;P<0.001),the best corrected visual acuity before surgery was significantly different from that 1 year after surgery(t=-8.41;P<0.001).There was no significant difference in intraocular pressure between preoperative and postoperative 1 year(t=0.11;P>0.05).The difference of corneal endothelial cell count between preoperative and postoperative 1 year was statistically significant(t=11.46;P<0.001).The arch height of 44 eyes(89.80%)was 250-750μm 1 year after surgery.Postoperative follow-up showed no high intraocular pressure or crystal opacity.No other complications such as macular hemorrhage and retinal detachment have been found.Conclusion:According to ultrasonic biological display microscopy results evaluated the selection of vertical position oriented TICL design and implantation after screening with good safety,efficacy and predictability.