依镜PRL植入术矫正超高度近视的临床疗效观察

Observation the clinical efficacy of PRL implantation for correction of ultra high myopia

目的:观察依镜有晶状体眼后房屈光晶体(phakic refractive lens,PRL)植入术矫正超高度近视的疗效和安全性。方法:纳入自2018年1月—2020年9月在深圳市眼科医院行依镜PRL植入术的超高度近视患者共24例39眼,进行自身对照研究。其中,男8例13眼,女16例26眼,平均年龄(31.15±6.33)岁。观察术后屈光度、视力[裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)]、眼压、角膜内皮细胞计数、拱高、手术并发症等指标。结果:中位随访时间为5.5(3.0,11.0)月。屈光度从术前(-22.29±4.96)D降低至术后(-0.28±1.01)D(t=24.421,P<0.001),其中术后球镜度数±0.5 D占28眼(82.4%),±1.0 D占31眼(91.2%)。LogMAR UCVA从术前1.40(1.30,1.70)改善至术后(0.28±0.20)D,LogMAR BCVA由术前0.40(0.22,0.70)改善至术后0.15(0.00,0.30),差异均有统计学意义(均P<0.001)。术后BCVA较术前提高3.00(1.00,5.00)行,所有患者均无BCVA丢失。术前、术后1 d、末次随访眼压值比较差异有统计学意义(F=8.779,P=0.012),其中术后1 d较术前眼压增高(Z=-3.401,P=0.001),而末次随访较术后1 d眼压降低(Z=-2.685,P=0.007),末次随访与术前眼压之间比较差异无统计学意义(Z=-0.894,P=0.371)。角膜内皮细胞计数从术前(2782.20±296.30)个/mm^(2)降低至术后(2472.54±394.32)个/mm^(2)(t=-5.437,P<0.001),平均丢失角膜内皮细胞数11.2%。末次随访33眼平均拱高值为(379.00±283.27)μm,其中0~250μm占12眼(36.4%),250~750μm占19眼(57.6%),大于750μm占2眼(6%)。21眼PRL术后3个月拱高值为(269.81±194.67)μm,较术后1个月拱高值(373.62±195.75)μm降低(t=-2.917,P=0.009)。术后并发症包括激素性青光眼(1例2眼)、PRL光学面裂痕(1眼)、黄斑出血(1眼)、PRL偏位(2例3眼)。结论:对于超高度近视患者,依镜PRL植入术是一种可供选择的安全、有效的眼内屈光手术方式,但其远期疗效及安全性仍需更长时间和更大样本量进一步观察。

Objective:To assess the efficacy and safety of phakic refractive lens(PRL)implantation for the correction of ultra-high myopia.Methods:This self-controlled case series study included 39 eyes of 24 patients with ultra-high myopia who underwent PRL implantation at Shenzhen Eye Hospital between January 2018 and September 2020.The study comprised 13 eyes in 8 males and 26 eyes in 16 females,with a mean age of(31.15±6.33)years.Postoperative parameters,including refraction,visual acuity(UCVA,BCVA),intraocular pressure,corneal endothelial cell count,vault,and surgical complication were observed.Results:The median follow-up time was 5.5(3,11)months.The refraction significantly decreased from preoperative(-22.29±4.96)D to postoperative(-0.28±1.01)D(t=24.421,P<0.001).Postoperatively,82.4%of eyes achieved a spherical degree within±0.5 D,and 91.2%within±1.0 D.LogMAR UCVA significantly improved from 1.40(1.30,1.70)preoperatively to(0.28±0.20)postoperatively.LogMAR BCVA significantly improved from 0.40(0.22,0.70)preoperatively to 0.15(0.00,0.30)postoperatively(P<0.001 for all).Postoperative BCVA improved by 3.00(1.00,5.00)lines compared with preoperative BCVA,with no instances of BCVA loss in any patient.Intraocular pressure values showed significant differences among preoperative,1 day postoperative and last follow up(F=8.779,P=0.012).Intraocular pressure increased significantly 1 day after surgery compared to before surgery(Z=-3.401,P=0.001),but decreased significantly at the last follow-up compared to 1 day postoperatively(Z=-2.685,P=0.007),with no significant difference in intraocular pressure between preoperative and last follow-up(Z=-0.894,P=0.371).Corneal endothelial cell count decreased significantly from preoperative(2782.20±296.30)/mm^(2) to postoperative(2472.54±394.32)/mm^(2)(t=-5.437,P<0.001),with a mean loss of 11.2%.The average vault at the last follow-up was(379.00±283.27)μm,of which 0~250μm in 12 eyes(36.4%),250~750μm in 19 eyes(57.6%),and>750μm in 2 eyes(6%).In 21 eyes,the vault at 3 months postoperative(269.81±194.67)μm was significantly lower than that at 1 month postoperative(373.62±195.75)μm(t=-2.917,P=0.009).Postoperative complications included steroid-induced glaucoma(2 eyes in 1 case),PRL optical surface crack(1 eye),macular hemorrhage(1 eye),and PRL decentration(3 eyes in 2 cases).Conclusions:PRL implantation is a safe and effective intraocular refractive surgery for ultra-high myopic patients.Nonetheless,it should be neccessary to observe for long-term efficacy and saff lens;high myopia.