中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2011年
6期
531-538
,共8页
张志华%廉井财%廖华萍%张士胜
張誌華%廉井財%廖華萍%張士勝
장지화%렴정재%료화평%장사성
晶体,人工%近视%晶体植入,眼内%手术后并发症
晶體,人工%近視%晶體植入,眼內%手術後併髮癥
정체,인공%근시%정체식입,안내%수술후병발증
Lenses,intraocular%Myopia%Lens implantation,intraocular%Postoperative complications
目的 评价3种有晶状体眼IOL植入矫正高度近视的有效性、安全性和稳定性.方法 选取2003年12月至2009年12月就诊高度近视患者110例(208只眼),平均年龄31岁,其中59例(113只眼)行房角支撑型IOL植入术,29例(53只眼)行虹膜夹持型IOL植入术,21例(41只眼)行后房型IOL植入术,平均随访时间分别为54个月(3～72个月)、15.7个月(3～24个月)和7.2个月(3～15个月).定义安全性指数为术后平均BSCVA与术前平均BSCVA的比值,定义有效性指数为术后平均UCVA与术前平均BSCVA的比值.对手术前后角膜内皮细胞计数比较采用配对t检验.结果 术后3个月和1年时有效性指数均大于1.只有植入房角支撑型IOL的患者随访至术后5年,有效性指数下降为0.85,但仍有16%的患眼裸眼视力≥1.0,85%的患眼≥0.5.所有患者术后的随访过程中,安全性指数始终大于1.植入房角支撑型IOL的患者随访术后5年时,46%的患眼实际屈光度数与预期矫正度数在±0.50 D以内,68%的患眼实际屈光度数与预期矫正度数在±1.00 D以内.植入虹膜夹持型IOL的患者随访至术后1年时,78%的患眼实际屈光度数与预期矫正度数在±0.50 D以内,100%的患眼的实际屈光度数与预期矫正度数在±1.00 D以内.植入后房型IOL的患者随访至术后3个月时,95%的实际屈光度数与预期矫正度数在±0.50 D以内,100%的实际屈光度数与预期矫正度数在±1.00 D以内.房角支撑型IOL植入术后5年时角膜内皮细胞计数的减少与术前相比具有统计学意义(t=9.769,P=0.000),而植入虹膜夹持型IOL的患者在术后1年和植入后房型IOL的患者在术后3个月时的角膜内皮细胞计数与术前相比无统计学意义(t=1.180,0.583;P=0.249,0.566).术后1个月内分别有16只眼出现高眼压,局部应用降眼压眼液后恢复正常.植入房角支撑型IOL的患者术后最主要的并发症是瞳孔失圆,虹膜夹持组为夹持处虹膜色素的脱失,植入后房型IOL的患者为自然晶状体的混浊.结论 有晶状体眼IOL植入治疗高度近视早期预测性好、安全,但手术长期并发症的发生需要引起关注.(中华眼科杂志,2011,47:531-538)
目的 評價3種有晶狀體眼IOL植入矯正高度近視的有效性、安全性和穩定性.方法 選取2003年12月至2009年12月就診高度近視患者110例(208隻眼),平均年齡31歲,其中59例(113隻眼)行房角支撐型IOL植入術,29例(53隻眼)行虹膜夾持型IOL植入術,21例(41隻眼)行後房型IOL植入術,平均隨訪時間分彆為54箇月(3～72箇月)、15.7箇月(3～24箇月)和7.2箇月(3～15箇月).定義安全性指數為術後平均BSCVA與術前平均BSCVA的比值,定義有效性指數為術後平均UCVA與術前平均BSCVA的比值.對手術前後角膜內皮細胞計數比較採用配對t檢驗.結果 術後3箇月和1年時有效性指數均大于1.隻有植入房角支撐型IOL的患者隨訪至術後5年,有效性指數下降為0.85,但仍有16%的患眼裸眼視力≥1.0,85%的患眼≥0.5.所有患者術後的隨訪過程中,安全性指數始終大于1.植入房角支撐型IOL的患者隨訪術後5年時,46%的患眼實際屈光度數與預期矯正度數在±0.50 D以內,68%的患眼實際屈光度數與預期矯正度數在±1.00 D以內.植入虹膜夾持型IOL的患者隨訪至術後1年時,78%的患眼實際屈光度數與預期矯正度數在±0.50 D以內,100%的患眼的實際屈光度數與預期矯正度數在±1.00 D以內.植入後房型IOL的患者隨訪至術後3箇月時,95%的實際屈光度數與預期矯正度數在±0.50 D以內,100%的實際屈光度數與預期矯正度數在±1.00 D以內.房角支撐型IOL植入術後5年時角膜內皮細胞計數的減少與術前相比具有統計學意義(t=9.769,P=0.000),而植入虹膜夾持型IOL的患者在術後1年和植入後房型IOL的患者在術後3箇月時的角膜內皮細胞計數與術前相比無統計學意義(t=1.180,0.583;P=0.249,0.566).術後1箇月內分彆有16隻眼齣現高眼壓,跼部應用降眼壓眼液後恢複正常.植入房角支撐型IOL的患者術後最主要的併髮癥是瞳孔失圓,虹膜夾持組為夾持處虹膜色素的脫失,植入後房型IOL的患者為自然晶狀體的混濁.結論 有晶狀體眼IOL植入治療高度近視早期預測性好、安全,但手術長期併髮癥的髮生需要引起關註.(中華眼科雜誌,2011,47:531-538)
목적 평개3충유정상체안IOL식입교정고도근시적유효성、안전성화은정성.방법 선취2003년12월지2009년12월취진고도근시환자110례(208지안),평균년령31세,기중59례(113지안)행방각지탱형IOL식입술,29례(53지안)행홍막협지형IOL식입술,21례(41지안)행후방형IOL식입술,평균수방시간분별위54개월(3～72개월)、15.7개월(3～24개월)화7.2개월(3～15개월).정의안전성지수위술후평균BSCVA여술전평균BSCVA적비치,정의유효성지수위술후평균UCVA여술전평균BSCVA적비치.대수술전후각막내피세포계수비교채용배대t검험.결과 술후3개월화1년시유효성지수균대우1.지유식입방각지탱형IOL적환자수방지술후5년,유효성지수하강위0.85,단잉유16%적환안라안시력≥1.0,85%적환안≥0.5.소유환자술후적수방과정중,안전성지수시종대우1.식입방각지탱형IOL적환자수방술후5년시,46%적환안실제굴광도수여예기교정도수재±0.50 D이내,68%적환안실제굴광도수여예기교정도수재±1.00 D이내.식입홍막협지형IOL적환자수방지술후1년시,78%적환안실제굴광도수여예기교정도수재±0.50 D이내,100%적환안적실제굴광도수여예기교정도수재±1.00 D이내.식입후방형IOL적환자수방지술후3개월시,95%적실제굴광도수여예기교정도수재±0.50 D이내,100%적실제굴광도수여예기교정도수재±1.00 D이내.방각지탱형IOL식입술후5년시각막내피세포계수적감소여술전상비구유통계학의의(t=9.769,P=0.000),이식입홍막협지형IOL적환자재술후1년화식입후방형IOL적환자재술후3개월시적각막내피세포계수여술전상비무통계학의의(t=1.180,0.583;P=0.249,0.566).술후1개월내분별유16지안출현고안압,국부응용강안압안액후회복정상.식입방각지탱형IOL적환자술후최주요적병발증시동공실원,홍막협지조위협지처홍막색소적탈실,식입후방형IOL적환자위자연정상체적혼탁.결론 유정상체안IOL식입치료고도근시조기예측성호、안전,단수술장기병발증적발생수요인기관주.(중화안과잡지,2011,47:531-538)
Objective To evaluate the efficacy, safety and stability of three kinds of phakic intraocular lens implantation for the correction of high myopia. Methods This study included 208 eyes of 110 patients with a mean age of 31 years(21-53) from December 2003 to December 2009. Angle-supported lens(Phakic 6H, OII) were inserted into 113 eyes, iris-fixated lens(Artisan, OPHTEC) were inserted into 53 eyes and implantable contact lens(ICL) (V4, STAAR)were inserted into 41eyes. The average follow-up time of the three groups were 54.0 months(3-72 months), 15.7 months(3-24 months)and 7.2 months(3-15 months)respectively. Results At 3 months and 12 months, the efficacy indexes of the three groups were all above 1.00. Only the angle-supported group was followed up to 72 months postoperatively when the efficacy index dropped to 0.85, but still UCVA was 1.0 (20/20) or better in 16% eyes and 0.5 (20/40) or better in 85% eyes. The safety indexes of the three groups were always above 1.00 during the follow up. In the angle-supported group, 46% eyes were within ±0.50 D of the desired refraction and 68% eyes were within ±1.00 D at 5 years postoperatively. In the iris-fixated group, 78% eyes were within ±0.50 D of the desired refraction and 100% eyes were within ±1.00 D at 1 years postoperatively. In the ICL group, 95% eyes were within ±0.50 D of the desired refraction and 100% eyes were within ±1.00 D at 3 months postoperatively. No statistically significant differences were found between preoperative and 3-month postoperative endothelial cell density in the ICL group. Also, there was no statistically significant reduction in endothelial cell density at 1 years in the iris-fixated group. However, when preoperative and 5-year postoperative measurements were compared in the angle-supported group, the total decrease in cell density is statistically significant(t=9.769, P=0.000). 16 eyes developed high IOP within 1 month postoperatively which resolved after intervention. In the three groups(angle-supported, iris-fixated and ICL), the most common complications were pupil ovalization, iris atrophy plus pigment dispersion and lens opacification respectively. Conclusion Although phakic IOL implantation is predictable and safe for treatment of high myopia in short-term, the long-term complications should be concerned and treated well.
