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.

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.

Comparison of postoperative optical quality according to the degree of decentering of V4c implantable collamer lens

AIM：To evaluate the clinical outcomes of V4 c implantable collamer lens（Hole ICL） implantation with regard to the optical quality assessed according to different degrees of decentering.METHODS：This included 49 eyes that received conventional ICL and 94 eyes that received Hole ICL.The eyes that received Hole ICL were divided into three groups according to the degree of decentering：group 1,central hole within 1 hole diameter（HD） from the pupil center;group 2,central hole within 1 HD to 2 HD;and group 3,central hole within 2 HD to 3 HD.Visual acuity（VA）,intraocular pressure（IOP）,and spherical equivalent（SE） values were assessed at 1wk,1 and 3mo after surgery.The ocular modulation transfer function,Strehl ratio,objective scattering index,and higher order aberrations（HOAs） were measured for 4-mm pupils at 3mo after surgery.RESULTS：There were no significant differences in VA,IOP,and SE among the conventional and Hole ICL groups.With regard to HOAs,values for coma and spherical aberrations showed no differences.The total HOA and trefoil values were significantly higher in group 2 than in group 1（P=0.02,0.03,respectively）.There were no significant differences among groups with regard to other optical quality parameter at 3mo after surgery.CONCLUSION：Our results suggest that Hole ICL implantation provides satisfactory visual quality that is equivalent to that provided by conventional ICL,regardless of the presence of central hole and degree of decentering.

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.

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.

In vivo optical quality of posterior-chamber phakic implantable collamer lenses with a central port

Background:The aim of this review is to summarize the optical quality results in patients following the implantation of the V4c implantable collamer lens with a central port(ICL,STAAR Surgical Inc.).Main text:A literature search in several databases was carried out to identify those publications,both prospective,retrospective and/or comparative with other refractive surgery procedures,reporting optical outcomes of patients who were implanted with the V4c ICL model.A total of 17 clinical studies published between 2012 and 2021 were included in this review.A detailed analysis of the available data was performed including number of eyes,follow-up and preoperative spherical equivalent.Specifically,the review focused on several optical parameters including higher-order aberrations(HOAs),modulation transfer function(MTF)cut-off frequency and Strehl ratio.This review encompassed a total of 817 eyes measured using different optical devices based on Hartmann-Shack,retinal image quality measurement and ray-tracing technologies at different follow-ups.Conclusions:The outcomes found in this review lead us to conclude that the ICL V4c model provides good optical quality,by means of different metrics,when implanted.

In vivo optical quality of posterior-chamber phakic implantable collamer lenses with a central port

Background: The aim of this review is to summarize the optical quality results in patients following theimplantation of the V4c implantable collamer lens with a central port (ICL, STAAR Surgical Inc.).Main text: A literature search in several databases was carried out to identify those publications, both prospective,retrospective and/or comparative with other refractive surgery procedures, reporting optical outcomes of patientswho were implanted with the V4c ICL model. A total of 17 clinical studies published between 2012 and 2021 wereincluded in this review. A detailed analysis of the available data was performed including number of eyes, follow-upand preoperative spherical equivalent. Specifically, the review focused on several optical parameters includinghigher-order aberrations (HOAs), modulation transfer function (MTF) cut-off frequency and Strehl ratio. This reviewencompassed a total of 817 eyes measured using different optical devices based on Hartmann-Shack, retinal imagequality measurement and ray-tracing technologies at different follow-ups.Conclusions: The outcomes found in this review lead us to conclude that the ICL V4c model provides good opticalquality, by means of different metrics, when implanted.

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.

Five‑year outcomes of EVO implantable collamer lens implantation for the correction of high myopia and super high myopia

Background:To evaluate the long-term safety,efficacy,predictability,and stability of implantable collamer lens with a central hole(EVO ICL)implantation for correcting high myopia(HM)and super high myopia(SHM).Methods:This prospective study evaluated 83 eyes of 46 patients who were divided into groups based on their spherical equivalent refractive error(SE):HM group(−12 D≤SE<−6 D)and SHM group(SE<−12 D).They were followed up for 5 years after ICL implantation;assessments of uncorrected distance visual acuity(UDVA),corrected distance visual acuity(CDVA),manifest refractive error,axial length,intraocular pressure,corneal endothelial cell density,and vault were conducted,and a questionnaire was administered.ResuIts:At 5 years postoperatively,the safety indices of the HM and SHM groups were 1.03±0.10 and 1.32±0.39,and the efficacy indices were 0.83±0.25 and 0.86±0.32,respectively.In the HM group,60.47%and 79.07%of the eyes were within±0.50 D and±1.00 D of the attempted correction,while it was achieved for 22.50%and 47.50%of the eyes in the SHM group,respectively.The SE of the HM group decreased from−9.72±1.41 D preoperatively to 0.04±0.39 D 1 month postoperatively and−0.67±0.57 D 5 years postoperatively,while in the SHM group,it decreased from−15.78±3.06 D preoperatively to−0.69±0.97 D 1 month postoperatively and−1.74±1.19 D 5 years postoperatively.Conclusion:EVO ICL implantation is safe,effective,and predictable for correcting HM and SHM.CDVA improved more after surgery for SHM,but the growth of axial length still needs attention.

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.

Lenstar在可植入性眼内接触镜植入术中的应用

目的 评估Lenstar LS900在可植入性眼内接触镜（ICL）植入术中的应用.方法 回顾性系列病例分析.分析2012年1月-2013年6月在西安市眼科医院接受ICL植入的高度近视患者的临床资料,对术前及术后视力（logMAR）、眼压、角膜内皮细胞计数进行比较,并于术后行UBM检查分析术后ICL拱高、距巩膜突500 μm房角开放距离（AOD 500）,观察虹膜前表面形态.对数据采用配对t检验、重复测量的方差分析、Pearson相关分析进行检验.结果 共27例患者（54眼）纳入该项研究.术后所有患者裸眼视力（logMAR） （0.06±0.05）均较术前（1.22±0.33）有明显的提高（t=25.306,P＜0.01）,与术前最佳矫正视力（logMAR） （0.06±0.05）差异无统计学意义（t=-0.640,P＞0.05）.术后等效球镜度为（-0.21±0.10）D,较术前的（-9.34±1.97）D显著降低（t=34.304,P＜0.01）.术后眼压为（14.93±2.12）mmHg,与术前的（13.82±1.83）mmHg比较差异无统计学意义（t=1.851,P＞0.05）.术后3个月时内皮细胞丢失率为（2.69±2.16）％.术后3个月72％患眼的ICL拱高在理想范围内.所有患者在随访期间均未出现白内障.结论 Lenstar LS900在ICL植入术中的应用是安全、有效的,术后可获得精确的预期屈光度,且术后绝大部分患者ICL拱高均在理想范围内.

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。

稳定型圆锥角膜患者植入新型Phakic角膜接触镜的视觉效果分析

目的:评估可植入式Phakic角膜接触镜治疗稳定型圆锥角膜患者的疗效、安全性、稳定性和可预测性。方法:共14例患者采用植入式Phakic角膜接触镜(IPCL)矫正屈光不正,测量了未矫正视力、最佳矫正视力、离焦曲线、对比敏感度、屈光度及可能的副作用。评估结果超过6mo。结果:平均等效球镜度(SE)和散光在术后6mo末次检查时由术前-6.94±2.79 DS和-4.24±1.42 DC分别变为术后-0.23±0.43 DS和-1.05±0.49 DC。术前平均Snellen视力为0.18±0.10。6mo内未矫正视力和最佳矫正视力平均值分别为0.13±0.10和0.05±0.15。平均安全指数为1.11。所有眼视力均无降低,其中22眼视力提高超过1行。20眼(71.4%)屈光度在0.50 D以内,27眼(96.42%)在±1.00 D以内。术后1wk至6mo,屈光度变化为-0.23±0.43(范围:-1.00至+0.75)。6mo内角膜内皮细胞(ECL)丢失率小于5%。术后6mo眼压(IOP)为11.32±2.28 mmHg。结论:Toric植入式Phakic角膜接触镜在矫正与稳定圆锥角膜相关的近视和近视散光方面具有有效性、安全性和可预测性。

有晶状体眼后房型人工晶状体植入术矫正中低度近视

目的:观察有晶状体眼后房型人工晶状体(ICL)植入术矫正中低度近视的临床效果。方法:回顾性研究。纳入我院ICL植入术矫正的中低度近视患者48例85眼,观察术后1 a裸眼视力(LogMAR)、最佳矫正视力(LogMAR)、屈光状态、眼压、拱高与角膜内皮细胞计数等的变化情况。结果:术后12 mo,患者裸眼视力-0.10(-0.20,-0.10)、有效性指数为1.07±0.13、最佳矫正视力-0.10(-0.20,-0.10)、安全性指数为1.10±0.14。实际矫正屈光度与预期矫正屈光度差值在±0.50 D范围占91%(77/85),差值在±1.00 D范围占100%(85/85)。术后12 mo时拱高为501.16±210.46μm。术前,术后6、12 mo的角膜内皮细胞密度比较无差异(F=1.050,P=0.352)。所有患者术后随访期间无前囊下混浊、白内障、瞳孔阻滞或其他威胁视力的并发症。结论:ICL植入术矫正中低度近视具有良好的有效性、安全性与可预测性。

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。

ICL植入术治疗高度近视术后早期眼前节形态的变化分析

目的探讨有晶体状眼后房型人工晶状体(ICL)植入术治疗高度近视术后早期眼前节形态的变化情况。方法选取60例(113眼)高度近视患者,均接受ICL植入术治疗。对比患者治疗前后裸眼视力、最佳矫正视力变化情况,眼前节形态变化情况[角膜厚度(CCT)、角膜曲率(K值)、中央前房深度(ACD)],角膜像差变化情况[角膜高阶像差(CHOA)、角膜低阶像差(CLOA)、角膜总像差(CTA)]。结果治疗后30 d、90 d、半年的裸眼视力、最佳矫正视力均优于治疗前(P<0.05)。治疗前及治疗后30 d、90 d、半年,角膜厚度分别为(532.50±25.40)、(532.54±23.17)、(534.64±22.55)、(532.97±24.10)μm,角膜曲率分别为(43.80±0.89)、(43.55±0.92)、(43.55±0.97)、(43.43±1.03)D,中央前房深度分别为(3.22±0.14)、(3.06±0.17)、(3.06±0.14)、(3.09±0.11)mm。与治疗前对比,治疗后30 d、90 d、半年的角膜曲率、中央前房深度均有所减小(P<0.05);治疗前后各个阶段,角膜厚度对比均无明显差异(P>0.05)。治疗后30 d、90 d、半年的CHOA均大于治疗前(P<0.05);治疗后30 d、90 d、半年的CLOA、CTA与治疗前对比均无明显差异(P>0.05)。结论高度近视患者应用ICL植入术治疗,患者的最佳矫正视力、裸眼视力均有所改善,角膜曲率变小、中央前房深度变浅、前房角变窄,患者术后早期眼前节形态良好,且较小影响角膜,安全性较高,可促进患者术后早日康复。

圆锥角膜屈光重建

圆锥角膜是一种进行性、严重影响青少年视力的疾病。圆锥角膜常造成高度近视、不规则散光,部分患者晚期角膜出现明显瘢痕,视力明显下降。在圆锥角膜的诊疗过程中,圆锥角膜屈光重建是临床关注的重点。经过多年的研究与探索,多种治疗方法在不同病程阶段中(非进展期、进展期、晚期)为圆锥角膜患者进行屈光重建,使其获得良好的视功能。文章主要针对不同时期圆锥角膜屈光重建的方案进行综述,分析国内外各治疗方案的利弊,总结不同治疗方式的特点,以期为圆锥角膜诊疗工作提供理论参考及新的治疗思路。

Pentacam辅助有晶状体眼后房型人工晶状体植入术治疗超高度近视的疗效观察

背景有晶状体眼人工晶状体（IOL）植入术是一种安全、有效地矫正高度近视的手术方法。Petacam辅助观察手术后IOL在眼内的位置，为评估手术安全性提供了良好途径。目的探讨有晶状体眼后房型可植入式角膜接触镜（1cL）植入术治疗高度近视的疗效及安全性。方法回顾性分析2009年3月至2012年9月行ICL植入术的高度近视患者18例25眼的近期疗效，患眼术前平均等效球镜度为（-17．52±1．73）D，平均柱镜度为（-0．75±0．28）D，术后随访6～32个月。均采用标准对数视力表行术前术后裸眼视力及最佳矫正视力（BCVA）检查，将小数视力换算成最小分辨角对数（10gMAR）视力，同时测定术前及术后术眼的等效球镜度和眼压，用角膜内皮计检测结膜内皮细胞的形态和数目变化，采用Pentacam眼前节分析系统观察手术前后前房深度、前房角度、术后ICL拱高的变化。采用SPSS19．0统计学软件进行分析，2个组间上述指标的差异用配对t检验进行比较。结果本组25眼均成功植入ICL，术后6个月裸眼视力为0．26±0．15，明显高于术前的1．47±0．26，差异有统计学意义（t=21．71，P=0．00）。术后6个月术眼的等效球镜度明显低于术前，角膜内皮细胞计数明显少于术前，角膜内皮六角形细胞的比例明显低于术前，差异均有统计学意义（等效球镜度：t=-48．60，P=0．00；角膜内皮细胞计数：t=13．07，P=0．00；角膜内皮六角细胞：t=10．79，P〈0．05）；术后6个月前房角度为（25．02±4．77）°，较术前的（38．43±4．04）。减小，差异有统计学意义（￡=15．32，P=0．00）；而术后6个月术眼的眼压和前房深度与术前比较差异均无统计学意义（眼压：t=-1．57，P=0．13；前房深度：t=1．46，P=0．16）。术后6个月ICL拱高为（542．17±39．46）μm，明显低于术后1周时的（363．33±44．37）μm，差异有统计学意义（t=20．86，P=0．00）。2例2眼术后出现轻度眩光，所有术眼观察期内均未发现晶状体混浊。结论ICL保留了生理性调节，对于高度近视眼的矫治安全、有效，但术后应检测角膜内皮细胞的变化。

ICL植入术矫正超高度近视的临床效果观察

目的:评估有晶状体眼后房型人工晶状体(ICL)矫正超高度近视的疗效及安全性。方法:对超高度近视患者20例40眼接受普通型ICL或散光型后房型人工晶状体(TICL)治疗,术前屈光度球镜-10.0～-18.0D,柱镜-0.25～-3.00D,等效球镜-15.32D,术后随访12mo,观察指标包括UCVA,BCVA、角膜地形图、主观和客观验光、角膜内皮细胞计数、眼压测量、裂隙灯检查。结果:术后12mo,裸眼视力≥0.8者占80.0%(32眼)。30.0%(12眼)的术眼BCVA较术前提高1行,15.0%(6眼)的术眼BCVA较术前提高2行。术后12mo术眼屈光度在±0.50D者达70.0%(28眼)。术前患者平均眼压为16±2.8mmHg,术后6mo平均眼压为17±3.4mmHg,术前术后相比较差异无显著性(t=0.518,P=0.776),术前患者角膜内皮细胞计数平均为2823±243.6个/mm2,术后6mo平均为2709±273.2个/mm2,术前术后比较无显著性差异(t=0.794,P=0.422)。未发生继发性青光眼、视网膜脱离及并发性白内障。结论:ICL植入术矫正超高度近视具有良好的疗效和安全性,远期效果有待进一步观察。

TICL植入术在矫治圆锥角膜深板层角膜移植术后屈光不正中的临床应用

背景圆锥角膜患者行深板层角膜移植术（DALK）后的屈光不正常导致术后裸眼视力不佳，尤其是高度散光。这样的屈光不正虽可通过佩戴框架眼镜或行角膜屈光手术矫正，但术后视觉质量差或因角膜厚度不足等难以实施角膜屈光手术。研究证实环曲面后房型有晶状体眼人工晶状体（TICL）植入术对屈光不正，尤其是高度散光有较好的矫正作用，但其在DALK术后的应用研究较少。目的探讨TICL植人术矫治DALK术后的屈光不正，特别是高度散光的有效性和安全性。方法采用自身对照系列病例观察法，纳入2011年8月至2012年3月在南京大学医学院附属鼓楼医院眼科中心圆锥角膜DALK术后18个月以上且拆线3个月以上的屈光不正患者8例8眼，其球镜度数为0- -7．5D，柱镜度数为-2．5- -6．0D。所有患者均行TICL植入术，分别于术前、术后1周、术后3个月、6个月、1年和2年检测术眼裸眼视力、最佳矫正视力（BCVA）。采用CV-3000综合验光仪进行验光；采用OCULYZERⅡ测定角膜散光、角膜厚度及前房深度；采用ST3000P角膜内皮细胞计数仪检测角膜内皮细胞数（ECD）；采用Goldman压平眼压计测量眼压，比较术前及术后不同时间点的眼压检测结果。观察TICL植入术术中或术后的并发症，评价手术的安全性。结果术后6个月，所有术眼的UCVA及BCVA均好于术前，术后球镜度数和柱镜度数较术前均有不同程度降低，术后球镜度为-0．5- -1．0D，柱镜度为-0．5- -2．0D。术眼术前及术后1周、6个月、1年和2年的ECD分别为（2520．2±307．2）、（2496．2±306．2）、（2469．6±304．5）、（2432．0±305．4）和（2383．4±309．4）个／mm2，眼压分别为（14．57±3．75）、（16．62±4．21）、（16．57±3．56）、（15．66±3．37）和（15．13±3．48）mmHg，总体比较差异均无统计学意义（F=0．375，P=0．825；F=9．871，P=0．394）；术前及术后2年术眼的前房深度分别为（3．15±0．03）和（3．12±0．03）mm，差异无统计学意义（t=1．56，P=0．16）。术后6个月所有术眼TICL轴位偏差均小于10°且趋于稳定。所有术眼术中及术后均未发生严重并发症。结论TICL植入术可用于圆锥角膜DALK源性高度散光的矫正，其临床疗效可靠，安全性好。