中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2012年
4期
307-311
,共5页
周天安%沈晔%汪阳%夏建华
週天安%瀋曄%汪暘%夏建華
주천안%침엽%왕양%하건화
近视%有晶状体眼人工晶状体植入术%手术后并发症
近視%有晶狀體眼人工晶狀體植入術%手術後併髮癥
근시%유정상체안인공정상체식입술%수술후병발증
Myopia%Phakic intraocular lenses%Postoperative complications
目的 总结有晶状体眼后房型人工晶状体植入矫正高度近视的术后并发症,评价其中远期稳定性及安全性.方法 回顾性系列病例研究.分析1996年6月至2008年12月行有晶状体眼后房型人工晶状体植入术的498例(993只眼)患者的临床资料,应用方差分析、多因素回归等方法统计分析手术有效性、各种并发症、不良事件发生率及其可能相关因素.结果 所有病例均成功植入ICL,术前检查等效球面屈光度数(16.23 ±4.12)D,末次随访等效球面屈光度数为(-0.92±1.22)D,术前眼压(13.58 ±2.93)mm Hg(1 mm Hg=0.133 kPa),末次随访眼压(13.90 ±3.01)mm Hg,随访期间屈光度数、眼压差别无统计学意义(t=0.44 ～ 1.30,P＞0.05).术前角膜内皮细胞计数(2858.21±395.13)个/mm2,末次随访角膜内皮细胞计数(2567.19±423.45)个/mm2.2只眼(0.2％)术后2h发生瞳孔阻滞性青光眼；1只眼(0.1％)术后1个月时发生瞳孔阻滞；术后6个月～1年内发生晶状体前囊膜下混浊2例,3只眼(0.3％)；另有2只眼术后4年发现瞳孔区外前囊膜下混浊.将患者年龄、晶状体间隙、屈光度数纳入统计学分析,发现白内障发生与上述因素无明显相关(F =2.42,1.98,0.81,P＞0.05).ICL表面色素沉着散在,未发现膜状沉着物.手术1年后散发黄斑出血5只眼(0.5％),3只眼无明显脉络膜新生血管；2只眼脉络膜新生血管行光动力疗法治疗,视力下降≥2行.术后1.5年发现视网膜马蹄形裂孔2只眼(0.2％)；术后发现急性虹膜炎1只眼(0.1％),慢性虹膜炎伴轻度瞳孔移位、眼压升高1只眼(0.1％)；单纯性虹膜萎缩,瞳孔移位2只眼(0.2％).结论 有晶状体眼后房型人工晶状体植入术矫正高度近视具有良好的中远期稳定性及安全性.
目的 總結有晶狀體眼後房型人工晶狀體植入矯正高度近視的術後併髮癥,評價其中遠期穩定性及安全性.方法 迴顧性繫列病例研究.分析1996年6月至2008年12月行有晶狀體眼後房型人工晶狀體植入術的498例(993隻眼)患者的臨床資料,應用方差分析、多因素迴歸等方法統計分析手術有效性、各種併髮癥、不良事件髮生率及其可能相關因素.結果 所有病例均成功植入ICL,術前檢查等效毬麵屈光度數(16.23 ±4.12)D,末次隨訪等效毬麵屈光度數為(-0.92±1.22)D,術前眼壓(13.58 ±2.93)mm Hg(1 mm Hg=0.133 kPa),末次隨訪眼壓(13.90 ±3.01)mm Hg,隨訪期間屈光度數、眼壓差彆無統計學意義(t=0.44 ～ 1.30,P＞0.05).術前角膜內皮細胞計數(2858.21±395.13)箇/mm2,末次隨訪角膜內皮細胞計數(2567.19±423.45)箇/mm2.2隻眼(0.2％)術後2h髮生瞳孔阻滯性青光眼；1隻眼(0.1％)術後1箇月時髮生瞳孔阻滯；術後6箇月～1年內髮生晶狀體前囊膜下混濁2例,3隻眼(0.3％)；另有2隻眼術後4年髮現瞳孔區外前囊膜下混濁.將患者年齡、晶狀體間隙、屈光度數納入統計學分析,髮現白內障髮生與上述因素無明顯相關(F =2.42,1.98,0.81,P＞0.05).ICL錶麵色素沉著散在,未髮現膜狀沉著物.手術1年後散髮黃斑齣血5隻眼(0.5％),3隻眼無明顯脈絡膜新生血管；2隻眼脈絡膜新生血管行光動力療法治療,視力下降≥2行.術後1.5年髮現視網膜馬蹄形裂孔2隻眼(0.2％)；術後髮現急性虹膜炎1隻眼(0.1％),慢性虹膜炎伴輕度瞳孔移位、眼壓升高1隻眼(0.1％)；單純性虹膜萎縮,瞳孔移位2隻眼(0.2％).結論 有晶狀體眼後房型人工晶狀體植入術矯正高度近視具有良好的中遠期穩定性及安全性.
목적 총결유정상체안후방형인공정상체식입교정고도근시적술후병발증,평개기중원기은정성급안전성.방법 회고성계렬병례연구.분석1996년6월지2008년12월행유정상체안후방형인공정상체식입술적498례(993지안)환자적림상자료,응용방차분석、다인소회귀등방법통계분석수술유효성、각충병발증、불량사건발생솔급기가능상관인소.결과 소유병례균성공식입ICL,술전검사등효구면굴광도수(16.23 ±4.12)D,말차수방등효구면굴광도수위(-0.92±1.22)D,술전안압(13.58 ±2.93)mm Hg(1 mm Hg=0.133 kPa),말차수방안압(13.90 ±3.01)mm Hg,수방기간굴광도수、안압차별무통계학의의(t=0.44 ～ 1.30,P＞0.05).술전각막내피세포계수(2858.21±395.13)개/mm2,말차수방각막내피세포계수(2567.19±423.45)개/mm2.2지안(0.2％)술후2h발생동공조체성청광안；1지안(0.1％)술후1개월시발생동공조체；술후6개월～1년내발생정상체전낭막하혼탁2례,3지안(0.3％)；령유2지안술후4년발현동공구외전낭막하혼탁.장환자년령、정상체간극、굴광도수납입통계학분석,발현백내장발생여상술인소무명현상관(F =2.42,1.98,0.81,P＞0.05).ICL표면색소침착산재,미발현막상침착물.수술1년후산발황반출혈5지안(0.5％),3지안무명현맥락막신생혈관；2지안맥락막신생혈관행광동력요법치료,시력하강≥2행.술후1.5년발현시망막마제형렬공2지안(0.2％)；술후발현급성홍막염1지안(0.1％),만성홍막염반경도동공이위、안압승고1지안(0.1％)；단순성홍막위축,동공이위2지안(0.2％).결론 유정상체안후방형인공정상체식입술교정고도근시구유량호적중원기은정성급안전성.
Objective To evaluate the mid-long term stability and safety of posterior chamber phakic intraocular lens (ICL) implantation for the correction of extreme myopia. Methods This retrospective study included 993 eyes of 498 patients received ICL implantation from June 1996 to December 2008.Multivariate analysis and variance analysis were used to evaluate the stability of the results and to identify risk factors of the complications. Results Successful implantation was achieved in all patients.Spherical equivalent(SE) was (16.23 ±4.12,mean ±SD) D before the operation and ( -0.92 ± 1.22) D at the last examination. Intraocular pressure was (13.58 ± 2.93) mm Hg( 1 mm Hg =0.133 kPa)preoperatively which was ( 13.90 ± 3.01 ) mm Hg at the last examination. There was no statistical significance in follow-up( t =0.44 ～1.30,P ＞ 0.05 ).Endothelial cell density was (2858.21 ± 395.13 )/mm2 before the operation and (2567.19 ± 423.45 ) /mm2 at last examination.Pupillary block glaucoma occurred in 2 eyes (0.2％ ) at two hours and 1 eye (0.1％ ) at one month after the operation.Three eyes developed anterior cataracts between 6 months to 1 year after ICL implantation and another 2 eyes subcapsular opacification at semi-peripheral regions occurred 4 years after the operation,and was not related with age,SE and vaults (F=2.42,1.98,0.81,P＞0.05). Macular puckers were found in 5 eyes (0.5％) 1 year postoperatively,including 2 eyes developed choroidal neovascularization and received PDT,best corrected visual acuity lost more than 2 lines.Retinal detachment occurred in 2 eyes at 1.5 years after the operation.Acute iritis happened in 1 eye (0.1％ ) and chronic iritis in 1 eye (0.1％ ) which combined with slight pupil distortion and elevation of intraocular pressure.Iris stroma atrophy and pupil distortion were found in 2 eyes (0.2％ ).Conclusion Correction of high myopia by ICL implantation is a safe procedure and the results are stable.
