两种不同手术矫治高度近视的对比研究

Comparative study on two different operations of high myopia

摘要:

目的：比较有晶状体眼后房型人工晶状体(implantable contact lens，ICL)植入术与透明晶状体摘除术联合后房型人工晶状体植入术两种术式矫治高度近视的安全性、有效性及稳定性。

方法：选取高度近视患者56例100眼，分为两组：Ⅰ组ICL植入术组患者32例58眼，Ⅱ组透明晶状体摘除联合后房型人工晶状体植入术组患者24例42眼。手术前、后观察两组患者的视力、屈光度、眼压、角膜内皮细胞计数、前房深度、晶状体透明度、手术并发症及视觉不良症状。

结果：Ⅰ组和Ⅱ组术后3mo的裸眼视力>0.5者分别为69.0%和71.4%； 术后1a，裸眼视力>0.5分别为72.4%和73.8%。术后1a，Ⅰ组62.1%、Ⅱ组57.1%患者的屈光度在预期屈光度±1.0D之内； ICL光学部后表面与透明晶状体的距离0.35～0.54(平均0.40±0.16)mm； 术后一过性高眼压发生率：Ⅰ组为12.1%，Ⅱ组为7.1%； 角膜内皮细胞计数与术前相比，差异有统计学意义(P<0.001)。Ⅰ组其他手术并发症：ICL移位1眼，前囊下晶状体局限性混浊2眼，夜间出现眩光4眼。Ⅱ组后囊膜轻度混浊3眼，夜间出现眩光3眼，视近困难12眼。

结论：有晶状体眼后房型人工晶状体植入术与透明晶状体摘除术矫治高度近视具有较好的安全性、有效性和稳定性，但仍需长期随访，注意远期并发症的发生。

Abstract:

AIM: To evaluate the safety, efficacy and stability of posterior chamber phakic intraocular lens(ICL)implanation and clear lens extraction for the correction of high myopia.

METHODS: The study enrolled 56 cases(100 eyes)of high myopia. Group I comprised 32 cases(58 eyes)receiving ICL implantation and Group II comprised 24 cases(42 eyes)undergoing clear lens extraction. In this study, we evaluated the two groups of subject's the visual and refractive results, intraocular pressure(IOP), endothelial cell density(ECD), anterior chamber depth(ACD), lens transparency, the surgical complications as well as visual adverse symptoms before and after surgery.

RESULTS: The postoperative subjects in group I and group II were followed, uncorrected vision acuity(UCVA)>0.5 were 69.0% in group I and 71.4% in group II after 3mo. UCVA>0.5 were 72.4% in group I and 73.8% in group II after 1a. Predictability of the manifest spherical equivalent refraction within ±1.00D was achieved in 62.1% of eyes in group I and 57.1% in group II after 1a. The central vault of the ICL(distance from posterior surface of ICL to the crystalline lens)measured with anterior segment optical coherence tomography(AS-OCT)was 0.35-0.54(0.40±0.16)mm. Twelve point one percent of eyes in group I and 7.1% of eyes in group II had transient mild increase in IOP. Here were statistically significant differences between preoperative and postoperative ECD(P<0.001). Complications of surgery: 1 eye had ICL spontaneous rotation, 2 eyes had anterior subcapsular cataract, 4 eyes noticed halos around lights at night in group I. Three eyes had posterior capsule mild opacification, 3 eyes noticed halos around lights at night, 12 eyes had difficulty in near vision in group II.

CONCLUSION: ICL implantation and clear lens extraction are effective, safe and predictable surgical option for the management of high myopia. No severe complications occurred, but its long time effect and safety still need more time to prove.