有晶状体眼CACHET人工晶状体植入术治疗高度近视

doi:DOI:10.3760/cma.j.issn.1674-845X.2016.04.009

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摘要

目的探讨有晶状体眼AcrySof?誖CACHETTM人工晶状体（PIOL）植入术治疗高度近视的有效性、安全性、可预测性、稳定性及患者满意度。方法前瞻性研究。选取2012年1月至2013年2月于山西省眼科医院就诊的高度近视患者共12例（22眼），年龄（28.2±5.9）岁，术前等效球镜度（SE）为-17.25~-6.50 D，平均（-11.97±3.03）D。22眼行PIOL植入术后1 d、1个月、3个月、6个月、1年进行随访，对比观察术前及术后各时间点患者视觉效果及安全性参数。观察指标包括视力（裸眼视力、最佳矫正视力、近视力）、屈光度、眼压（IOP）、角膜内皮细胞计数、对比敏感度、手术并发症，以前节OCT测量PIOL位置，前节照相测量PIOL旋转度及问卷调查患者满意度。不同时间点间各指标差异采用重复测量设计的方差分析进行比较。结果随访期间各时间点所有患眼实际SE与预期SE差值在±1 D以内，其中20眼实际SE与预期SE差值在±0.5 D以内。术后各时间点安全性指数分别为1.31、1.36、1.34、1.41、1.31；有效性指数分别为1.23、1.28、1.22、1.23、1.31。中央区角膜内皮细胞计数累计丢失率分别为1.69%±2.2%、2.25%±3.15%、4.32%±3.04%、4.27%±3.52%、3.82%±2.15%。患眼术前最佳矫正近视力为5.0±0.2，IOP为（14.6±3.0）mmHg（1 mmHg=0.133 kPa），二者术后各时间点与术前相比差异无统计学意义。术后1个月时前节OCT测量PIOL光学区中心及边缘与角膜内皮间垂直距离分别为（1.96±0.25）mm（>1.5 mm）、（0.99±0.08）mm（>0.8 mm），与自然晶状体间垂直距离分别为（1.36±0.22）mm（>1.0 mm）、（0.94±0.09）mm（>0.8 mm）。随访过程中，11眼PIOL位置稳定，6眼顺时针旋转，5眼逆时针旋转，6眼旋转大于15°。与术前相比，术后3个月内各空间频率对比敏感度均明显提高，尤其以夜间眩光状态下提高最为显著。问卷调查显示患者对手术及术后效果非常满意。结论 AcrySof?誖CACHETTM人工晶状体矫正高度近视眼具有良好的有效性、安全性、可预测性且患者满意度高，是有效的眼内屈光手术之一，但是其长期的安全性有待进一步研究。

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	曹伟芳
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关键词 ：有晶状体眼人工晶状体植入术, 近视, 退行性, AcrySof?誖CACHETTM人工晶状体

Abstract：

Objective To evaluate the efficacy, safety, stability and predictability of the AcrySof®CACHETTM phakic intraocular lens (PIOL) for the correction of high myopia. Methods In this prospective study, 12 patients (22 eyes) who ranged in age from 19 to 40 with high myopia at -17.25~-6.50 (-11.97±3.03) diopters (D) were implanted with angle-supported phakic intraocular lenses from 2012 January to 2013 February. Visual acuity, refraction, intraocular pressure, corneal endothelium, PIOL position, contrast sensitivity, glare sensitivity, surgical complications and poor visual symptoms were assessed preoperatively and 1 day, 1 month, 3 months, 6 months and 1 year after treatment. The repeated measures ANOVA was used for statistical analysis. Results The mean manifest refraction at the one-year follow-up was within 1D of the attempted correction in 22/22 eyes and 20/22 eyes were within 0.5 D of the attempted correction. At 1 day, 1 month, 3 months, 6 months and 1 year postoperatively, the mean safety indexes were 1.31, 1.36, 1.34, 1.41, 1.31 and the mean efficacy index was 1.23, 1.28, 1.22, 1.23, 1.31. The differences in near vision and intraocular pressure were not statistically significant at any time point. The mean loss of corneal endothelium was 1.69%±2.2%, 2.25%±3.15%, 4.32%±3.04%, 4.27%±3.52%, 3.82%±2.15% at 1 day, 1 month, 3 months, 6 months and 1 year postoperatively. The distance from the central and peripheral corneal epithelium to the AcrySof®CACHETTM phakic IOL was 1.96±0.25 mm (>1.5 mm) and 1.36±0.22 mm (>1.0 mm), and was 0.99±0.08 mm (>0.8 mm) and 0.94±0.09 (>0.8 mm) from the AcrySof®CACHETTM phakic IOL to the natural lens. An analysis of the results of the steadiness of the PIOL showed that it was stable in 11/22 but 6/22 had a clockwise rotation and 5/22 had a counter-clockwise rotation. Improvements were statistically significant when contrast sensitivity and glare sensitivity were compared preoperatively and postoperatively. The study showed that there was a high degree of satisfaction among patients. Conclusion AcrySof®CACHETTM phakic IOL implantation for the correction of high myopia is effective, safe and predictable. It can be a supplement to corneal refractive surgery but follow-up is still required to evaluate the long-term results.

Key words： Phakic intraocular lenses Myopia, degenerative AcrySof®CACHETTM phakic intraocular lenses

收稿日期: 2015-11-12

通信作者: 张素华，Email：cfykys@163.com

引用本文:

曹伟芳,张素华,赵炬伟,等. 有晶状体眼CACHET人工晶状体植入术治疗高度近视. 中华眼视光学与视觉科学杂志, 2016, 18(4):237-242. DOI:DOI:10.3760/cma.j.issn.1674-845X.2016.04.009.
Cao Weifang,Zhang Suhua,Zhao Juwei,et al. Clinical study of the CACHET phakic intraocular lens for the correction of high myopia. Chinese Journal of Optometry Ophthalmology and Visual science, 2016, 18(4):237-242.

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