Safety and visual outcomes following posterior chamber phakic intraocular lens bilensectomy

Background:To evaluate the safety,efficacy,refractive outcomes and causes for bilensectomy(phakic intraocular lens–pIOL–explantation with cataract surgery and pseudophakic intraocular lens implantation)in patients previously implanted with posterior chamber pIOLs.Methods:This multi-center retrospective study included 87 eyes of 55 patients who underwent bilensectomy for posterior chamber pIOL with a follow up time of 12 months.The uncorrected and best corrected distance visual acuities(UDVA,CDVA),endothelial cell density before and after bilensectomy were assessed,as well as the cause of bilensectomy and intra or postoperative complications.Results:There was a statistically significant improvement in uncorrected and best corrected visual acuities after bilensectomy(p=0.00).The main reason for bilensectomy was cataract development(93.1%of the cases),followed by miscalculation of lens size,and corneal edema.The endothelial cell count remained stable without a statistically significant change after surgery(p=0.67).The refractive efficacy index was 0.8,none of the patients lost lines of CDVA after surgery,73%of the patients were within±1 D(spherical equivalent)of the target refraction.Intraoperative complications were one posterior capsule rupture with the intraocular lens(IOL)implanted in the sulcus,and 3 eyes required the use of pupil expanders for adequate pupil dilation.Postoperatively,one eye developed retinal detachment.The three pIOLs models explanted were the Implantable Collamer Lens(ICL),Implantable Phakic Contact Lens(IPCL)and the Phakic Refractive Lens(PRL).Conclusions:Good safety and visual outcomes were observed 1 year after bilensectomy for posterior chamber phakic intraocular lenses(PC pIOLs).There were few intra and postoperative complications and there was no significant endothelial cell loss after the bilensectomy procedure.

Safety and visual outcomes following posterior chamber phakic intraocular lens bilensectomy

Background:To evaluate the safety,efficacy,refractive outcomes and causes for bilensectomy[phakic intraocular lens(plOL)explantation with cataract surgery and pseudophakic intraocular lens(IOL)implantation]in patients previously implanted with posterior chamber plOLs(PC plOLs).Methods:This multi-center retrospective study included 87 eyes of 55 patients who underwent bilensectomy for PC plOL with a follow-up time of 12 months.The uncorrected and corrected distance visual acuities(UDVA,CDVA),endothelial cell density before and after bilensectomy were assessed,as well as the cause of bilensectomy and intra or postoperative complications.Results:There was a statistically significant improvement in UDVA and CDVA after bilensectomy(P=0.00).The main reason for bilensectomy was cataract development(93.1%of the cases),followed by miscalculation of lens size,and corneal edema.The endothelial cell count remained stable without a statistically significant change after surgery(P=0.67).The refractive efficacy index was 0.8,none of the patients lost lines of CDVA after surgery,73%of the patients were within±1.0D(spherical equivalent)of the target refraction.Intraoperative complications were one posterior capsule rupture with the IOL implanted in the sulcus,and three eyes required the use of pupil expanders for adequate pupil dilation.Postoperatively,one eye developed retinal detachment.The three plOLs models explanted were the implantable collamer lens(ICL);implantable phakic contact lens(IPCL)and the phakic refractive lens(PRL).Conclusions:Good safety and visual outcomes were observed one year after bilensectomy for PC plOLs.There were few intra and postoperative complications and there was no significant endothelial cell loss after the bilensectomy procedure.

优化ICL V4c植入术的临床研究进展

随着有晶状体眼后房型人工晶状体植入术的发展及可植入式接触镜(ICL)的不断改进,ICL V4c植入术目前已经成为矫正中高度近视的主流术式之一。术后拱高是评价手术安全性的重要指标,在常规ICL V4c植入手术的基础上,如何优化手术以获得更理想的拱高是近年来学者们研究的热点。本文以术前检查、术中手术设计以及术后随访为中心,总结分析优化ICL V4c植入手术的方案,为提高手术安全性提供帮助。

低剂量卡巴胆碱在有晶状体眼后房型人工晶状体植入术中应用的有效性和安全性

背景 质量分数0.01%卡巴胆碱注射液是M胆碱受体和神经节及骨骼肌N胆碱受体激动剂，在眼科用于白内障和晶状体手术中缩小瞳孔和开放周边虹膜切开口，增加房水引流，但其经前房注射后容易引起全身和局部胆碱样反应，而低质量浓度卡巴胆碱前房注射后是否具有较好的效果及较低的胆碱样反应的发生率尚不清楚。目的 比较0.01%卡巴胆碱与0.005%卡巴胆碱注射液在有晶状体眼后房型人工晶状体（ICL）植入术中前房注射后的疗效及安全性。方法 纳入2014年9月至2015年9月在第三军医大学大坪医院拟行ICL植入术的患者76例152眼，患者双眼均接受ICL植入术及激光虹膜周边切开术，手术间隔时间为1 d，术中右眼均用0.01%卡巴胆碱原液行前房注射以缩小瞳孔，左眼均用0.005%卡巴胆碱稀释液行前房注射。检测指标为手术持续时间、术后2 h眼压及术后24 h内全身胆碱样反应的发生率。结果 0.01%卡巴胆碱原液组和0.005%卡巴胆碱稀释液组手术持续时间分别为（11.86±2.39）min和（11.22±1.85）min，组间比较差异无统计学意义（t＝1.851，P＝0.066）。0.01%卡巴胆碱原液组手术前后的眼压值分别为（15.76±2.18）mmHg（1 mmHg＝0.133 kPa）和（13.58±2.24）mmHg，而0.005%卡巴胆碱稀释液组分别为（15.70±2.35）mmHg和（13.12±2.17）mmHg，2个浓度卡巴胆碱对眼压值的影响差异无统计学意义（F分组＝0.986，P＝0.322）；术后2 h眼压值低于术前，差异有统计学意义（F时间＝97.339，P＝0.000）；不同时间与药物浓度之间无交互作用（F交互作用＝0.772，P＝0.381）。0.005%卡巴胆碱稀释液组患者头晕、恶心、呕吐的发生率均明显低于0.01%卡巴胆碱原液组，差异均有统计学意义（χ2＝13.01、5.16、4.03，均P〈0.05）。结论 0.005%卡巴胆碱稀释液能有效发挥缩瞳作用和保证手术时间，同时可降低患者全身胆碱样反应的发生率。

对比两种眼内屈光术矫正高度近视术后的视觉质量

目的:对比有晶状体眼虹膜夹型和后房型人工晶状体植入术矫正高度近视术后的视觉质量,为更好的矫正高度近视提供指导。方法:选择2009年12月-2010年12月来本院眼科进行矫正术的高度近视患者56例,根据手术方式不同分为虹膜组和后房组各28例,虹膜组采用有晶状体眼虹膜夹型植入术,后房组采用后房型人工晶状体植入术,对比两组患者术后的视觉质量。结果:虹膜组和后房组患者术前及术后6个月裸眼视力分别为(0.43±0.12)vs(0.99±1.34)、(0.42±0.24)vs(0.84±1.23)(P<0.05);虹膜组和后房组术前及术后6个月最佳矫正视力分别为(0.65±0.32)vs(1.04±0.18)、(0.69±0.11)vs(1.01±0.13),差异均具有统计学意义(P<0.05);术前及术后6个月眩光敏感度、对比敏感度在各个频率段的变化差异均具有统计学意义(P<0.05);两组患者组间术后6个月各观察指标间差异均无统计学意义(P>0.05)。结论:两种植入术术后6个月的视觉质量均能达到预期效果,虹膜夹型植入术的视觉质量略好于后房型,远期视觉质量两组间是否具有差异,还有待进一步研究。

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.

有晶状体眼后房型人工晶状体植入术后前房及前房角的超声活体显微镜观察

目的应用超声活体显微镜（UBM）评价有晶状体眼后房型人工晶状体（ICL）植入术后前房及前房角的变化。方法前瞻性系列病例研究。分析15例（30只眼）高度近视患者术前及ICL植入术后1周、1、3、6个月及1年的眼压变化；末次随访（术后1年）时行UBM检查，测量中央前房深度（ACD）、ICL后表面与晶状体之间的距离、小梁虹膜夹角，ICL周边部与晶状体之间的距离。小梁虹膜夹角比较则采用非参数检验；ICL周边部与晶状体之间的距离采用One—wayANOVA分析；术前术后各时间点的眼压比较采用重复测量方差分析和Bonferroni检验；中央ACD比较采用配对t检验。结果术前眼压为（13．75±2．27）mmHg（1mmHg=0．133kPa），术后1周、1个月、3个月、6个月及1年时眼压分别为（14．27±1．70）mmHg、（14．70±2．07）mmHg、（14．07±2．24）mmHg、（14．00±2．69）mmHg和（13．97±2．95）mmHg，术前及术后各次眼压间进行比较，发现仅术后1个月时眼压与术前、术后3个月时眼压比较差异有统计学意义（t=-3．706、3．898，P〈0．05）。UBM检查发现中央角膜内表面与晶状体之间的距离为（2．97±0．11）mm，中央角膜内表面与ICL之间的距离为（2．24±0．21）mm，两者之间差异有统计学意义（t=20．63，P〈0．01）。小梁虹膜夹角在钟表位12：00、3：00、6：00、9：00位差异无统计学意义，仅55．8％手术眼的小梁虹膜夹角〉30°，ICL周边部与晶状体之间的距离在钟表位12：00、3：00、6：00、9：00位差异无统计学意义。ICL后表面与晶状体之间的距离为（0．63±0．16）mm，ICL与晶状体无接触。结论ICL植入术后ICL位于晶状体前，致使术后中央ACD变浅、部分手术眼前房角宽度变窄。ICL与晶状体无接触，与虹膜后表面接触。

前房深度对有晶状体眼后房型人工晶状体植入术后前房形态的影响

目的观察术前前房深度（ACD）对有晶状体眼后房型人工晶状体（PPC-ICL）植入术后房角形态的影响。方法回顾性系列病例研究。连续选取已接受PPC-ICL植入术的近视患者80例（132眼）。根据患者术前ACD分为3组：A组：ACD〈3．0mm；B组：3．0≤ACD〈3．5mm；C组：ACD≥3．5mm。术前和术后3个月时分别采用前节光学相干断层扫描仪（AS-OCT）对患者进行眼前节生物测量。检测指标包括中央ACD、0°与180°方位房角开放距离（AOD500）、虹膜小梁空间面积（TISA500）和巩膜突角（SSA）。使用方差分析、直线相关分析和配对t检验对数据进行分析。结果所有患者术前AOD500（0°、180°）（r=0．51、0．47），TISA500（0°、180°）（r=0．55、0．52）和SSA（0°、180°）（r=0．46、0．58）测量值均与ACD呈正相关（P〈0．01）。术后3个月时，3组患者平均ACD、AOD500、TISA500以及SSA测量值较术前均下降（P〈0．05）。3组患者的AOD500（F=7．00、5．08）、TISA500（F=6．42、3．06）以及SSA（F=7．20、4．73）差异有统计学意义（P〈0．05），其中A组患者的3个指标值均低于B组和C组（P〈0．01），而B组和C组相比差异无统计学意义。3组患者的AOD500、TISA500和SSA在术后发生相同比例的下降，差异无统计学意义。3组拱高差异有统计学意义（F=5．37，P〈0．05），A组和B组拱高均显著低于C组（P〈0．05）。术后3个月时AOD500（0°、180°）（r=0．54、0．50），TISA500（0°、180°）（r=0．49、0．48）及SSA（0°、180°）（r=0．60、0．61）手术前后变化率均与拱高呈正相关（P〈0．01）。3组患者随访期内均未见房角关闭，手术前后眼压差异均无统计学意义。结论PPC-ICL植入术后房角形态发生显著改变，浅前房患者术后前房更浅、房角更窄．且拱高较高者术后前房形态改变更为明显。

有晶状体眼后房型人工晶状体植入术后前房角的变化及其相关因素

目的 研究高度近视眼植入有晶状体眼后房型人工晶状体（PPC-ICL）后前房角（ACA）的变化及其相关因素.方法 前瞻性研究.收集2013年3月至2014年4月在上海交通大学医学院附属第九人民医院行PPC-ICL植入手术的中高度近视患者26例（45眼）.术后平均随访（4.3±3.2）个月.Pentacam测量术前及术后ACA、前房深度、角膜曲率、PPC-ICL拱高（vault）.IOLMaster测量白到白距离和眼轴长度.同时记录术前及术后UCVA、等效球镜度及IOP.采用配对t检验、Wilcoxon符号秩和检验、Pearson相关、Spearman秩相关、多元回归分析进行数据分析.结果 3点方位术后ACA宽度为27.44°-±5.24°,与术前43.23°±5.72°比较,差异有统计学意义（Z=-5.841,P＜0.01）.3点方位ACA宽度的变化量与PPC-ICL拱高、同方位术前ACA宽度呈正相关（r=0.556、0.530,P＜0.01）,术后ACA宽度与拱高、术前ACA宽度回归方程为ACA术后=4.860-0.009 vault±0.621 ACA术前（F=20.032,P＜0.01）.9点方位ACA宽度术后为26.82°±4.73°,与术前42.40°±5.81°比较,差异有统计学意义（t=20.890,P＜0.01）;9点方位ACA宽度的变化量与PPC-ICL拱高、同方位术前ACA宽度呈正相关（r=0.581、0.626,P＜0.01）,术后ACA宽度和拱高、术前ACA宽度回归方程为ACA术后=5.767-0.008 vault±0.586 ACA术前（F=24.775,P＜0.01）.结论 PPC-ICL植入术后水平方向ACA宽度显著变小,变化量和术前ACA宽度、拱高均呈正相关.