Clinical Effect Analysis of Posterior Chamber Intraocular Lens Implantation for Correcting High Myopia and Astigmatism

Objective:To explore the corrective effect of posterior chamber intraocular lens implantation with phakic eyes in the treatment of high myopia and astigmatism.Methods:From May 2023,the hospital began to collect the case data of diagnosis and treatment of high myopia and astigmatism.By May 2024,310 cases were included,all of which were treated with posterior chamber intraocular lens implantation.The visual acuity,astigmatism and axial position of the intraocular lens were observed before and after treatment.Results:At different time points after the operation,the patient’s vision was significantly improved compared with that before the operation(P<0.05),and the vision level was equal to or greater than the best-corrected vision before the operation.At different time points after the operation,the average rotation of the intraocular lens was less than 5 degrees.Astigmatism was significantly lower than that before the operation(P<0.05).After the operation,the intraocular pressure increased in 11 cases,accounting for 3.55%,with no adverse complications such as lens turbidity,glare and obvious halo occurring.Conclusion:The posterior chamber intraocular lens implantation with phakic eyes has an ideal correction effect in the treatment of high myopia and astigmatism,which can effectively improve the vision level of patients and reduce the degree of astigmatism,and has high effectiveness and safety.

Comparison of Artisan iris-claw intraocular lens implantation and posterior chamber intraocular lens sulcus fixation for aphakic eyes

AIM:To compare the efficacy and complications of Artisan iris-claw intraocular lens(IOL)implantation and posterior chamber IOL sulcus fixation for the treatment of aphakic eyes without capsular support after vitrectomy.METHODS:A prospective study of 45 cases was conducted.Forty-five eyes without sufficient lens capsule support following pars plana vitrectomy(PPV)combined lens extraction were divided into two groups.Group A:25 eyes received Artisan iris-claw IOL implantation.Group B:20 eyes received posterior chamber IOL sulcus fixation.The corrected distance visual acuity(CDVA)and intraocular pressure(IOP),corneal endothelial cell loss rate,surgical time and complications were compared between the two groups.Pigment changes of trabecular meshwork and anterior chamber depths were measured at each time point in Artisan group.RESULTS:The mean surgical time of Artisan group was significantly shorter(P【0.05).No statistically significant difference in endothelial cell loss rate was noted between two groups at any time point(P】0.05).CDVA of Artian group was better than that of the sulcus fixation group 1d after surgery(P【0.05)and there was no statistically significant difference 1 and 3mo after surgery(P】0.05).Mean IOP showed no significant differences between groups before and after surgery.The postoperative complications of Artisan group were anterior uveitis,iris depigmentation,pupillary distortion and spontaneous lens dislocation.The complications of sulcus fixation group include choroidal detachment,intraocular haemorrhage,tilt of IOL optic part and retinal detachment.CONCLUSION:Secondary Artisan IOL implantation canbe performed less invasively and in a shorter surgical time period with earlier visual recovery after surgery compared to transscleral suturing fixation of an IOL.This technique is an effective and safe procedure.It is a promising option for the treatment of aphakic eyes without capsular support after vitrectomy.

Long-term vision-threatening complications of phakic intraocular lens implantation for high myopia

AIMTo report the long-term vision-threatening complications in patients who underwent phakic intraocular lens (pIOLs) implantation for high myopia.

Posterior chamber phakic intraocular lens implantation for high myopia

AIM:To evaluate the efficacy,safety and stability of posterior chamber phakic intraocular lens implantation for the correction of high myopia.METHODS:Retrospective case review of 82 eyes(43patients)undergoing implantable Coliamer lens(ICL)placement by a single surgeon(Xiao-Wei Gao)to correct preoperative mean spherical equivalents between-9.00diopter(D)and-23.00D.Main outcome measures included uncorrected visual acuity(UCVA),refraction,best spectacle-corrected visual acuity(BSCVA),endothelial cell density(ECD),intraocular pressure(IOP),lens transparency,postoperative uveitis.Visante anterior segment optical coherence tomography(AS-OCT)was used to measure anterior chamber depth(ACD)and the position of ICL.RESULTS:Mean follow-up was 6.54±3.26 months(range 3-12 months).Predictability of the manifest spherical equivalent(SE)refraction to within±1.OOD was achieved in 88%of eyes and±0.50D in 72.5%of eyes.The mean postoperative manifest SE refraction was-1.85±0.72D,with 96.34%of eyes maintaining or gaining≥1 line(s)of BSCVA.The mean 3-month postoperative ECD decreased but had no statistically difference compared with the preoperative ECD.Of the 7 eyes(8.54%)with a mild transient increase in intraocular pressure(up to 30mmHg),none required a second surgical procedure or prolonged topical medication.There was no loss of lens transparency.Pigmented precipitates were observed in 5 eyes(6.09%).The mean preoperative ACD measured with AS-OCT was 3.28±0.14mm,three months after surgery,the mean ACD was2.45±0.22mm.Anterior chamber depth showed astatistically significant reduction.One eye(1.22%)had ICL spontaneous rotation,81 eyes(98.78%)of the lens remained correctly centered.CONCLUSION:The implantation of ICL is an effective surgical option for the management of high myopia.But its long time effect and safety still need more time to prove.

Phakic posterior chamber intraocular lens for unilateral high myopic amblyopia in Chinese pediatric patients

AIM： To assess the outcomes of posterior chamber implantable collamer lens （ICL） implantation in Chinese pediatric patients with unilateral high myopic amblyopia.METHODS： Eleven eyes of 11 amblyopic patients aged 11.02±3.34y underwent ICL （model V4, Staar Surgical Inc.） implantation to treat unilateral anisometropia were studied. Visual acuity, cycloplegic refraction, contrast sensitivity, stereopsis, intraocular pressure （IOP）, vaulting, corneal endothelial cell count and complications were evaluated. Patients completed follow-up at 3d, 1, 3mo and the last follow-up time （mean 8.18±2.82mo） after surgery.RESULTS： The mean myopic anisometropia was -13.70±3.25 D preoperatively and ＋0.69±2.63 D at 8mo postoperatively. The logMAR corrected distance visual acuity （CDVA） of the amblyopic eye was 1.51±0.72 preoperatively and 0.75±0.40 at 8mo postoperatively. The logMAR CDVA at 3d, 1, 3 and 8mo postoperatively improved by a mean of 0.64, 1.55, 1.82 and 2.64 lines and gained more than 2 lines accounted for 18%, 45%, 45%, 64%, respectively. The contrast sensitivity of 0.5, 1 and 2 cpd in amblyopic eyes was significantly increased after surgery. No patient had near stereopsis recovery. The vaulting at 3 and 8mo was significantly lower than that at 1mo postoperatively. No other intraoperative or postoperative complications were observed, except an acute pupillary block glaucoma happened in a patient at two weeks postoperatively.CONCLUSION： This short-term results indicate that ICL implantation can be a promising alternative therapy for high myopic anisometropic amblyopia in pediatric patients who have failed with conventional treatments and not suitable to corneal refraction surgery.

Visual performance after implantation of two types of phakic foldable intraocular lenses for correction of high myopia

AIM: To compare Visian lens(model V4 c) and Artiflex lens regarding quality(contrast sensitivity) and quantity(efficacy, predictability, safety and stability) of vision in correcting high myopia with recording and analysis of complications. METHODS: The comparative prospective study included 39 eyes of 23 patients with high myopia, 19 eyes had Visian lens implantation(model V4 c) and 20 eyes had Artiflex lens implantation. The inclusion criteria were high myopia(higher than 6.0 D) and stable refraction(<0.5 D change over one year). Outcomes included assessment of safety and efficacy indices, predictability, stability, contrast sensitivity and analysis of complications at postoperative 1 d, 1 wk and 1, 3, 6 and 12 mo. Selection of the type of phakic intraocular lens for patients was based on surgeons' preferences, which was no specific selection criteria. RESULTS: After 12 mo of follow up, difference in uncorrected and corrected distant visual acuity(CDVA) between both groups was statistically insignificant(UDVA for VisianV4 c and Artiflex lens were 0.33±0.2 logMAR and 0.37±0.2 logMAR respectively, P=0.59, CDVA for VisianV4 c and Artiflex lens were 0.155±0.1 logMAR and 0.147± 0.1 logMAR respectively, P=0.87). The efficacy index was 1.25 for VisianV4 c lens and 0.8 for Artiflex lens, 78.9% of eyes were within one diopter spherical equivalent in Visian V4 c lens group compared to 70% in the Artiflex lens group. No eye lost lines of CVDA proving a good safety index for both lenses(safety index was 1.67 for VisianV4 c lens and 1.34 for Artiflex lens). Difference in contrast sensitivity between both groups was statistically insignificant(P=0.15, 0.88, 0.27, 0.32 and 0.82 at five spatial frequencies). CONCLUSION: Both Visian ICL V4 c and Artiflex lensesare safe and effective with stable and predictable refraction and they have comparable contrast sensitivity outcomes with no vision threatening complications.

Posterior chamber phakic intraocular lens for the correction of high myopic anisometropic amblyopia in adults

This study aims to evaluate the clinical results of posterior chamber implantable collamer lens（ICL） implantation in adults with high myopic anisometropic amblyopia. Thirteen patients aged 27.04±7.24 y（range 19.2 to 42.5） were studied. ICL implantation was performed in 13 amblyopic eyes. The mean myopic anisometropia was significantly dropped from-10.70±3.02 D preoperatively to ＋0.09±1.67 D at 1 mo postoperatively. The logMAR CDVA at 3 d, 1, 3 and mean 9 mo postoperatively improved by a mean of 1.69, 2.50, 3.01 and 3.00 lines and gained more than 2 lines accounted for 23.08%（3 eyes）, 41.67%（5 eyes）, 63.63%（7 eyes） and 55.56%（5 eyes）, respectively. The contrast sensitivity of amblyopic eyes was significantly increased after surgery. Four patients partially recovered near stereopsis（400＂ to 100＂）. There was no severe complications were observed. ICL implantation alone can improve vision, contrast sensitivity, and partial restoration of binocular vision in adult patients with high myopic anisometropia.

AcrySof phakic angle-supported intraocular lens for the correction of high to extremely high myopia:one-year follow-up results

AIM: To assess the safety, efficacy and predictability of the AcrySof phakic angle-supported intraocular lens (IOL) (Alcon Inc., U.S.A.) for correction of high-to-extremely high myopia in adults. METHODS: In this prospective study performed in Tianjin Medical University Eye Center & College of Optometry, Tianjin, China, 25 eyes of 13 patients were implanted with AcrySof phakic angle-supported IOLs and followed for 1 year postoperatively. Preoperative manifest refractive sphere was (-12.08 +/- 2.44) diopters (D) and cylinder was (-1.35 +/- 0.62)D. Visual acuity, predictability and stability of manifest refraction spherical equivalent (MRSE), adverse events, and endothelial cell density were analyzed during 1-year of follow-up. RESULTS: After 1 year of follow-up, no eyes lost 1 line (best spectacle-corrected visual acuity)BSCVA; an uncorrected visual acuity (UCVA) of 20/20 or better was achieved in 60% of eyes; 100% had an UCVA of 20/40 or better; a BSCVA of 20/30 or better was achieved by 100% of eyes; 84% had a BSCVA of 20/20 or better. The overall mean percentage change in endothelial cell density 1 year after surgery was (-0.27 +/- 3.60)%. Two eyes (8%) had increased intraocular pressure (IOP) on the day of surgery. No pupil ovalization, pupillary block, or retinal detachment events were observed. CONCLUSION: After 1 year of follow-up, the implantation of AcrySof phakic angle-supported IOL is proved to be safe, effective and predictable with minimal complications in patients with high-to-extremely high myopia. Due to the limitation of visiting time, long-term of clinical investigation is necessary to verify the safety and efficacy of this IOL.

Short and long-term outcomes of angle supported phakic intraocular lens implantation in high myopic eyes

This cohort study included 36 eyes of 21 patients with high myopia treated with angle supported phakic intraocular lens（p IOL）.Endothelial cell density（ECD） at baseline,6 mo and 3 y were 3017±296,2775±265 and 2558±299 cells/mm^2 respectively.ECD loss at 6 mo was 7.2% and annual ECD loss was 3% over 36 mo.Corrected distance visual acuity at 36 mo was 0.4 log MAR or better in 32（88.9%） eyes.Intraocular pressure did not change（P=0.9）.No eyes developed cataract,retinal detachment or pupillary distortion.Angle supported p IOL gives good visual outcome.Endothelial cell loss should be monitored.

Effect of incision types for Artisan phakic intraocular lens implantation on ocular higher order aberrations

AIM： To evaluate the effect of incision types for Artisan phakic intraocular lens （PIOL） implantation on ocular higher-order aberrations （HOAs）.METHODS： A retrospective review was conducted of the patients who had undergone Artisan PIOL implantation for the correction of myopia and followed up for at least 6mo. Patients are classified into 2 groups considering the incision type： cornea group with patients undergone clear corneal incision; sclera group with patients undergone sclera tunnel incision. All patients with postoperative astigmatism of under 1 diopter （D） were included to minimize the effect of residual astigmatism on postoperative HOAs. Visual acuity, special equivalents, astigmatism, predictability （±1 D from target refraction）, HOAs （coma, trefoil, spherical aberration）, and corneal endothelial counts were analyzed preoperatively and 6mo postoperatively.RESULTS： At the postoperative 6mo, all patients of both groups achieved uncorrected visual acuity of 16/20 or better, and significantly decreased the spherical equivalents compared with preoperative values. The predictability of refractive correction was 96% in the former, and 94% in the latter. Unlike the sclera group, preoperative astigmatism decreased significantly in cornea group at postoperative 6mo. The HOAs increased significantly at postoperative 6mo compared to the preoperative values in both groups, and the root mean square （RMS） total and trefoil wavefront aberration of cornea group were significantly higher than those of sclera group.CONCLUSION： Although corneal incision significantly reduces preexisting astigmatism, the postoperative 6mo of total RMS and trefoil aberration change may deteriorate the visual quality after Artisan PIOL implantation.

Macular hole following phakic intraocular lens implantation:A case report

BACKGROUND Phakic intraocular lens(pIOL)implantation has been commonly prescribed and is considered as a safe and effective option for correcting high myopia.However,it is associated with multiple complications.CASE SUMMARY This report describes a case of full-thickness macular hole(MH)in a patient with a history of bilateral pIOL implantation for the correction of myopia of–12.00 diopters in both eyes 7 mo ago.The MH closed after pars plana vitrectomy with internal limiting membrane removal and the best-corrected visual acuity improved to 20/40 in the left eye.CONCLUSION In rare cases,MH can occur following pIOL.In this present case report,we analyzed the formation process of MH following the surgery and emphasized that it is important to inform highly myopic patients about the risk of MH occurrence while being aware of the symptoms of this complication.

Iris Repair after Long-Term Complications of Angle-Supported Phakic Intraocular Lenses

We report the case of a high myopic patient who had been implanted with angle-supported phakic intraocular lenses (pIOL) in 1990 and who subsequently and gradually developed complications in both eyes including endothelial cell loss, chronic glaucoma, cataract, pupil ovalization and severe iris atrophy. The patient was impaired by photophobia, glare, halo, loss in visual acuity and concerned about the cosmetically deforming aspect of her eyes. Cataract surgery was performed after explantation of the pIOL followed by combined implantation of a standard IOL in the capsular bag and a Dr Schmidt artificial iris in the sulcus. There were no intraoperative and postoperative complications except slight bilateral corneal oedema which resolved completely within 1 month after surgery. Uncorrected and corrected visual acuity improved progressively to reach 0.3 and 0.6 at the last follow-up visit (±1 year), respectively. The patient was very satisfied with the functional and aesthetical outcomes.

Rhegmatogenous retinal detachment after intraocular lens implantation in high myopia:A case report and literature review

Objective:To observe the changes of diagnosis and treatment of a patient with rhegmatogenous retinal detachment(RRD)after phakic intraocular lens implantation in high myopia,and analyze its mechanism and treatment combined with the literature.Methods:To report a case of rhegmatogenous retinal detachment(RRD)after phakic intraocular lens implantation.Result:Two months after the patient underwent scleral cerclage+pad pressing+vitrectomy+silicone oil filling,the fundus color photos showed that the vitreous cavity was filled with silicone oil,the fundus retina was flat,the cerclage ridge was obvious,and a large number of old laser spots.After the silicone oil in the eye was removed,the eye examination:the naked visual acuity of the left eye was 0.12,the corrected visual acuity was-3.25ds/-1.50dc*180=0.4,the intraocular pressure was 19mmHg,the ring ridge was seen in the fundus after mydriasis,a large number of old laser spots and flat retina;The OCT showed that the macular structure of the left eye was complete and there was no subretinal fluid.Conclusion:Scleral cerclage+padding+vitrectomy+silicone oil filling is an effective treatment for retinal detachment(RD)after PIOL.

Y-Shaped Intra-Scleral Fixated Lens versus Retro-Pupillary Iris Claw Lens in the Treatment of Aphakia

Background: Many reasons can lead to an aphakia without adequate capsular support for implantation of a posterior chamber intraocular lens (IOL), such as intraoperative unintentional rupture of posterior capsule during phacoemulsification, planned intracapsular cataract extraction, ocular trauma and lens dislocation due to congenital and acquired causes. Purpose: To compare Y-shaped intra-scleral fixation of a posterior chamber IOL with retro pupillary fixation of an iris-claw intraocular lens (IOL) for Aphakic eyes without sufficient capsular support as respects safety, visual recovery and complications of both methods. Patients and Methods: One hundred Aphakic eyes were arbitrarily distributed between two groups. Group A included 50 eyes treated with retropupillary fixation of iris claw lens and group B included 50 eyes treated with Y-shaped intra-scleral fixation technique. Preoperative, intraoperative and postoperative data were analysed including best corrected visual acuity (BCVA), intraocular pressure (IOP), surgical time, intraoperative problems, IOL malposition and postoperative complications. Following up on patients was carried out for at least six months. Results: The mean duration of surgery was 21 ± 5.3 min in group A and was 53.4 ± 6.9 min in group B (p-value 0.05). IOL tilt was found in 0 (0%) eyes in group A and in 5 (10%) eyes in group B (p 0.05). Conclusion: The results of our study indicated that both methods are satisfactory in correcting aphakia without sufficient capsular support as regards postoperative best corrected visual acuity (BCVA);however the surgical technique of retropupillary iris claw lens is easier, shorter, with low intra- and postoperative complications and safer than those used for intra-scleral fixation of IOL. But for eyes which lack both iris and capsular support, a scleral fixation of a posterior chamber IOL remains the only option.

高度近视有晶状体眼后房型人工晶状体植入术后患者视力恢复的影响因素

目的 探讨高度近视有晶状体眼后房型人工晶状体(ICL)植入术后患者视力恢复的影响因素。方法 前瞻性研究。选取2021年5月至2023年3月郑州大学第二附属医院收治的210例(420眼)行ICL植入术的高度近视患者作为研究对象。根据术后3个月视力恢复情况将患者分为恢复良好组(最佳矫正视力恢复≥0.3 D)、恢复不良组(最佳矫正视力恢复<0.3 D)。比较两组患者基线资料,采用Logistic回归分析影响患者视力恢复的因素,采用受试者工作特征曲线(ROC)分析Logistic回归模型对高度近视患者ICL植入术后视力恢复不良的预测价值。结果 术后3个月,恢复良好组的患者共149例298眼,恢复不良组的患者共61例122眼。两组患者性别、年龄、近视年限、体重指数、学业情况比较,差异均无统计学意义(均为P>0.05)。恢复不良组患者角膜散光度<1.30 D占比(55.74%)、角膜屈光度<45 D占比(59.02%)、匹茨堡睡眠质量指数(PSQI)<7分占比(63.93%)、中央平均曲率半径[(7.82±0.27) mm],均低于恢复良好组[83.89%、81.88%、85.91%及(7.90±0.24)mm],角膜前表面中央扁平子午线曲率(k1)[(43.27±1.43)D]、角膜前表面陡峭子午线曲率(k2)[(44.84±1.53)D]、拱高[(628.49±67.28)μm]均高于恢复良好组[(42.73±1.42)D、(44.12±1.47)D、(417.56±80.14)μm],差异均有统计学意义(均为P<0.05)。Logistic回归分析结果显示,角膜散光度、角膜屈光度、k1、k2、拱高、睡眠PSQI评分均为高度近视患者ICL植入术后患者视力恢复不良的独立影响因素(均为P<0.05)。ROC曲线分析显示,Logistic回归模型预测高度近视患者ICL植入术后视力恢复不良的ROC曲线下面积为0.938(95%CI:0.896~0.966),敏感度为83.61%,特异度为91.95%(P<0.05)。结论 角膜散光度、角膜屈光度、k1、k2、拱高、睡眠PSQI评分等均可影响高度近视ICL植入术后患者视力恢复,基于上述因素构建的Logistic回归模型对ICL植入术后患者视力恢复有较高预测价值。

中央孔型有晶状体眼后房型人工晶状体植入术后缩瞳和散瞳状态下眼压的临床观察

目的观察散瞳或缩瞳对中央孔型有晶状体眼后房型人工晶状体(ICL V4c)植入术术后眼压的影响。方法前瞻性病例对照研究。选取2021年9~12月于武汉普瑞眼科医院屈光专科行ICL V4c植入术患者102例(102只眼),随机分为缩瞳组48例(48只眼)和散瞳组54例(54只眼)。两组患者术后分别使用相应的药物建立缩瞳、散瞳模型,分别于术前、术后2 h、术后4 h、术后1 d、术后1周、术后1个月检测并记录患者眼压,眼压异常者行相关降眼压处理。结果术后2 h,两组患者的眼压均较术前显著升高(P<0.05),术后4 h、1 d、1周、1个月时两组患者眼压呈现回落趋势,且均与术前眼压的差异无统计学意义(P>0.05)。每个观测时间点两组间患者的眼压差异均无统计学意义(均P>0.05)。术后早期眼压异常者比例分布散瞳组与缩瞳组差异无统计学意义(P>0.05)。结论散瞳或缩瞳对ICL V4c植入术患者术后早期的眼压无明显控制作用。

Corneal refractive surgery and phakic intraocular lens for treatment of amblyopia caused by high myopia or anisometropia in children

Objective A systematic review of literature was performed to compare various visual function parameters including the final visual acuity outcome and/or adverse events between corneal refractive surgery （CLRS） and phakic intraocular lens implantation （p-IOLi） in the treatment of refractive amblyopic children.Data sources Two reviewers independently searched the PubMed,EMBASE,and Controlled Trials Register databases for publications from 1991 to 2013.Study selection There were 25 articles,including 597 patients and 682 eyes,was included in CLRS group.Among them,21 articles reported the use of CLRS in the treatment of myopic anisometropia for 318 patients （13 photorefractive keratectomy or laser epithelial keratomileusis and eight laser in situ keratomileusis）.And 11 articles had the results of CLRS in treating hyperopic anisometropic amblyopia children.Eleven articles reported the effect of p-IOLi for treating high myopia or anisometropic amblyopia,including 61 patients （75 eyes）.Age,pre-and postoperation best-corrected vision acuity （BCVA）,and spherical equivalent （SE） were compared in CLRS and p-IOLi groups.Results The average age of CLRS group and p-IOLi group has no statistically significant difference.The SE in CLRS group for myopic anisometropia amblyopia patients was （-10.13±2.73） diopters （D） and for hyperopic anisometropia amblyopia patients was （5.58±1.28） D.In p-IOLi group the SE was （-14.01±1.93） D.BCVA was improved significantly in both groups,and even better in p-IOLi group.Refractive errors were corrected in both groups,but there was no clinically significant difference in final SE between each group.More than one-half of the children had improved binocular fusion and stereopsis function in both groups.Conclusions Both CLRS group and p-IOLi group showed their advantage in treating refractive amblyopia in children.In comparing p-IOLi with CLRS for treatment of refractive amblyopia,no statistically significant difference in final BCVA was observed.

A novel ophthalmic viscosurgical devicefree phakic intraocular lens implantation makes myopic surgery safer

Purpose:To assess the efficacy and safety of a novel ophthalmic viscosurgical device-free(OVD-free)method for posterior chamber phakic intraocular lens(PIOL)implantation in myopic eyes.Methods:In this retrospective cohort study,the medical records of myopic eyes that underwent PIOL(Implantable Collamer Lens,ICL)implantation for myopia correction at the Eye Hospital of Wenzhou Medical University between May 2015 and March 2017 were reviewed.A total of 49 eyes with complete data that met follow up requirements(2 h,1 day,1 week,3 months postoperatively)were recruited.Based on the surgical techniques used,the eyes were divided into the OVD-free method group and the standard method group.The clinical data,including intraocular pressure(IOP),corrected distance visual acuity(CDVA)and spherical equivalent(SE),at each follow-up were collected for comparison.Endothelial cell loss and complications were also investigated.Results:Twenty-one eyes received the standard method,and 28 eyes received the OVD-free method.A rise in IOP>22 mmHg at 2 h was noted in 14 eyes(66.7%)in the standard group and none(0%)in the OVD-free group(p<0.001).The rise in IOP from baseline was significantly higher at 2 h in the standard group(10.5±5.2 mmHg vs.2.2±3.3 mmHg,difference:8.3,95%CI 5.8 to 10.8;p<0.001).There was a significant difference in the time course of LogMAR CDVA changes between the two groups(p=0.047).The LogMAR CDVA was significantly better in the OVD-free method group compared to the standard group at 1 day(−0.076,95%CI−0.134 to−0.018;p=0.012),1 week(−0.071,95%CI−0.135 to−0.007;p=0.03),but not at 3 months(−0.046,95%CI−0.107 to 0.015;p=0.134).There was no significant difference in the time course of SE changes between the two groups(p=0.471;p=0.705).In the OVD-free group,mean endothelial cell loss was 4.6%at 3 months(2522±281 vs.2407±226 cells/mm^(2),difference:-115,95%CI−295 to 65;p=0.187).No complications were reported in both groups except for the early IOP elevation in the standard group during the observation period.Conclusions:The OVD-free method is safe and efficient for ICL implantation.It can be a safer method of ICL implantation compared to the standard method in that it completely eliminates ophthalmic viscoelastic devicesrelated complications without causing additional complications.

Phakic 6H型有晶状体眼前房型人工晶状体植入矫正高度近视术后角膜内皮细胞密度临床观察

目的观察Phakic 6H型有晶状体眼前房型人工晶状体(ACP-IOL)植入矫正高度近视手术后远期角膜内皮细胞密度,并评价手术的安全性。方法收集2001年9月—2006年3月间行Phakic 6H型ACP-IOL植入术矫正高度近视患者共170例(283眼),经连续随访,对最终行ACP-IOL取出的7例(7眼)患者的临床资料进行回顾性分析。使用SP-2000P型角膜内皮显微镜定期测量角膜中央、上方、下方、颞侧及鼻侧5个方位的角膜内皮细胞密度。结果 7例患者平均随访时间为5年,6例平均角膜内皮细胞丢失数为2 105个/mm2,平均丢失率为73.71%(1例因角膜失代偿无法测量出内皮细胞密度)。4例行ACP-IOL取出+透明晶状体摘除+后房型人工晶状体(IOL)植入,1例行ACP-IOL取出+超声乳化白内障吸除+后房型IOL植入,2例行ACP-IOL取出。结论 Phakic 6H型ACP-IOL对角膜内皮的远期影响可致角膜内皮功能临界失代偿甚至失代偿,发现角膜内皮功能处于临界失代偿或内皮有明显损伤时须尽快取出ACP-IOL。

Comparison of preoperative simulated and postoperative real safety distances using anterior segment OCT in patients with phakic IOL according to iris configuration

AIM:To compare the simulated safe distance(SSD)preoperatively versus real safe distance(RSD)postoperatively in patients with iris-claw phakic intraocular lens(p IOL)implantation according to iris configuration.METHODS:Totally 60 eyes of 60 patients underwent p IOL implantation for surgical correction of myopia.Anterior chamber depth(ACD)was measured with the IOLMaster 700,and nasal and temporal safety distances(SD)were measured pre-and postoperatively using Anterior Segment Visante-OCT.SD was defined as a line measured between the edge of the optic or its simulated image to the endothelium.Eyes were divided into 3 groups:convex,concave,and plane according to preoperatory iris configuration.Statistical analysis was performed using the R program,for the comparison of independent groups and multiple comparisons,the Kruskal-Wallis test and the Dunn test were used respectively.RESULTS:Mean difference between nasal preoperative SSD and postoperative RSD was-0.36±0.38,-0.29±0.48,and-0.18±0.30 mm in the concave,convex,and plane group,respectively.Mean difference between temporal SSD and RSD was-0.36±0.37,-0.14±0.38,and-0.24±0.33 mm in the concave,convex,and plane group,respectively.There were statistically significant differences between SSD and RSS for both nasal and temporal sides in the concave and plane group(P<0.002).CONCLUSION:Preoperative SSD and postoperative RSD for iris-claw p IOL shows significant differences in patients with concave and plane iris.