摘要
目的评价根据角膜水平直径选择有晶状体眼后房型人工晶状体（ICL）长度的临床意义及其有效性、安全性。方法回顾性系列病例研究。2005年11月15日至2011年1月15日间在浙江大学医学院附属第一医院眼科行有晶状体眼ICL植入术矫正高度近视者32例（64只眼），术前根据Orbsean Ⅱ测量的角膜水平直径选择ICL长度，行ICL植入术，术后1d、1周、1、3、6、12个月及之后每半年进行一次随访，内容包括裸眼视力、最佳矫正视力、屈光度数、眼压、角膜内皮计数、裂隙灯检查（观察晶状体透明度、眼内色素播散情况）、IOLMaster检查（测量前房深度、角膜水平直径）、超声活体显微镜检查（测量角膜内表面与自身晶状体之间的距离、角膜内表面与ICL之间的距离、ICL中央部与自身晶状体之间的距离、ICL周边部与自身晶状体之间的距离、ICL倾斜度、睫状沟间距、小梁虹膜夹角、房角开放距离500、虹膜-ICL接触距离），采用配对t检验、相关性分析及多因素回归分析等方法对所有患者术后1年时与术前的各项观察指标进行统计学分析。结果术后未发现任何术眼出现晶状体前囊膜下混浊，也未发现角膜内表面或自身晶状体前囊膜色素沉着，而在ICL前表面和后表面有Ⅰ-Ⅱ级的色素沉着，两者程度上的差异无统计学意义（X^2=2．24，P=0．13）。术前眼压为（15．67±3．23）mmHg（1mmHg=0．133kPa），术后1年时眼压为（15．78±3．23）mmHg，两者问差异无统计学意义（t=0．24，P=0．38）。术后1年中央角膜内表面与晶状体之间的距离为（2．97±0．25）mm，中央角膜内表面与ICL之间的距离为（2．24±0．27）mm，两者差异有统计学意义（t=15．77，P〈0．01）。ICL倾斜度，术后1年为0°-5°，平均为1．20°±1．05°。小梁虹膜夹角〉30°者占29．1％，21°-30°者占50．0％，11°-20°者占11．6％，≤10°者占9．3％。房角开放距离500（AOD500）为（0．32±0．15）mm。虹膜-ICL接触距离为（0．85±0．46）mm。ICL中央拱高（ICL中央部与自身晶状体之间的距离）平均为（0．47±0．25）mm，与角膜水平直径的相关系数r=0．11，与睫状沟问距的相关系数r=0．16，与前房深度的相关系数r=0．04，与ICL长度的相关系数r=0．19，均无统计学意义（P〉0．05）。ICL周边拱高（ICL周边部与自身晶状体之间的距离）为0-1．23mm，平均为（0．25±0．20）mm。结论根据角膜水平直径选择的ICL，其长度适宜，术后并发症少，ICL拱高理想，为ICL植入术良好的安全性、有效性和可预测性提供了有力保障。
Objective To evaluate the efficacy, safety and clinical value of calculating the posterior chamber phakic intraocular lens （ICL） length according to the corneal horizontal diameter. Methods This was a retrospective study. A Staar Visian implantable contact lens （ICL） was implanted in 32 patients （64 eyes） with high myopia in the Department of Ophthalmology, the First Affiliated Hospital, College of Medicine, Zhejiang University between November 15, 2005 and January 15, 2011. The lens length was calculated according to the corneal horizontal diameter measured by Orbscan Ⅱ. Patients were followed up postoperatively at 1 day, 1 week, l1 3, 6 and 12 months and every 6 months thereafter. The evaluationsincluded visual acuity, manifest refraction, applanation tonometry, endothelial cell count, slit-lamp microscopy to detect cataract, and UBM to assess the degree of ICL tilt and distances between the corneal endothelium, the ICL, and the crystalline lens. All of the preoperative and 12-month follow-up observations were analyzed using SPSS 16.0 software. Results No anterior subcapsular cataracts were found in any of the eyes after surgery. Pigmentary dispersion was observed on the anterior and posterior surface of the ICL , but the difference was not statistically significant （X^2 = 2.24 ,P = 0.13 ）. The intraocular pressure changed from （ 15.67±3.23 ） mm Hg（ 1 mm Hg = 0. 133 kPa） to（ 15.78 - 3.23 ）mm Hg, but the difference was not significant （t = 0.24, P = 0.38 ）. The corneal endothelium-lens （ central section） distance measured by UBM postoperatively was（2. 97 ±0.25 ）mm and the corneal endothelium-ICL （central section） distance was （2.24 ± 0.27 ） mm ; the difference between them was statistically significant （ t = 15.77, P 〈 0.01 ）. The degree of ICL tilt measured by UBM was 1.20°± 1.05°. The percentage of eyes with a trabecular-iris angle （TIA） greater than 30° ,between 21° and 30°, between 11°and 20°, and smaller than 10° were 29.1% , 50.0% , 11.6% , and 9. 3% , respectively. The angle opening distance at 500 micron （AOD500） measured by UBM postoperatively was （0.32±0.15 ）mm. The contact distance between the iris and the ICL measured by UBM postoperatively was （0.85±0.46 ） mm and the ICL-lens central distance was （ 0.47±0.25 ） ram. The Pearson＇s correlation coefficients between the ICL-lens central distance and the corneal horizontal diameter, sulcus diameter, anterior chamber depth（ACD） and ICL length were 0.11,0.16,0. 04 and 0.19, respectively; none were statistically significant. The ICL-lens peripheral distance measured by UBM postoperatively was （0.25 ＋ 0.20 ） mm. Conclusion Selecting the length of the ICL according to the corneal horizontal diameter is appropriate, and assures the safety, effectiveness and predictability of ICLimplantation.
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2013年第3期235-241,共7页
Chinese Journal of Ophthalmology
基金
浙江省社会发展科研基金（021107236）
浙江省科学技术厅公益技术应用研究项目（2010C33143）
