有晶状体眼后房型人工晶状体植入术后并发性白内障的研究进展

随着现代屈光手术的不断进步,有晶状体眼后房型人工晶状体(implantable contact lens,ICL)植入术作为一种屈光不正的矫正方法正逐渐被人们所接受.ICL植入术后并发性白内障发生率约2％～3.5％,严重时需白内障手术(＜1％).ICL植入术后早期并发性白内障与手术操作、患者年龄及屈光度等有关,而晚期并...     

有晶状体眼后房型人工晶状体植入矫正屈光不正的临床进展

后房型人工晶状体又称可植入式隐形眼镜（ICL），它为屈光不正的治疗提供了角膜手术以外的新途 径，可应用于高度近视、屈光参差、圆锥角膜等患者。目前临床最常用的是V4c型ICL，其特点是带 有中央孔，可改善房水的引流并增加晶状体前表面的房水循环，且术前或术中不再需要行周边虹膜 切除术。ICL植入术可有效提高裸眼及矫正视力，且术后眼压长期稳定。V4c型ICL植入术后白内障 发生率较传统V4型更低，其长期安全性及有效性高，在目前的临床应用中取得了良好的疗效，可作 为矫正上述屈光不正的主要方法。随着ICL的临床应用与研究进展，有关ICL植入术的疗效及并发 症的讨论越来越多，明确手术的安全有效性，以及对术后并发症的评估和处理是临床医师面临的重 要问题。现就ICL植入术的临床研究进展进行综述。     

有晶状体眼后房型人工晶状体植入术后的视觉质量

对有晶状体眼植入后房型人工晶状体是矫正屈光不正的有效方法,植入的后房型人工晶状体目前主要有可植入式接触镜(implantable contact lens,ICL)和有晶状体眼屈光性晶状体(phakic refractive lens,PRL)。对术后患者主观视觉质量(视力、对比敏感度)、客观视觉质量(波前像差、点扩散函数、斯特尔比率及光学传递函数)的研究显示,主观视力的提高也伴随着客观视觉质量的改善,但部分患者术后出现光晕及眩光症状。本文主要对ICL和PRL植入术后主观及客观视觉质量的临床研究做一综述,对可影响视觉质量的术后并发症如晶状体前囊膜下混浊、青光眼及角膜内皮功能异常等需进一步远期随访。     

两种有晶状体眼后房型人工晶状体矫正高度近视的远期疗效

目的 对比观察2种有晶状体眼后房型人工晶状体治疗高度近视的远期临床疗效.方法 回顾性队列研究.入选本科收治的高度近视患者51例(98眼),其中18例(33眼)行有晶状体眼后房型屈光晶状体(PC-PRL)植入术(PRL组),33例(65眼)行后房型可植入式眼内接触镜(PPC-ICL)植入术(ICL组).收集其术后2年以及2年以上的随访记录,对UCVA、屈光度、眼压、角膜内皮细胞计数、IOL后表面与自然晶状体的距离(拱高)、对比敏感度及术后并发症进行对比研究,2组间各参数比较应用Wilcoxon秩和检验或独立样本t检验.结果 PRL组和ICL组的UCVA差异无统计学意义;眼压PRL组为(12.03±2.61)mmHg,ICL组为(13.35±3.37)mmHg,2组差异无统计学意义;角膜内皮细胞计数PRL组为(2 185±516)个/mm2,ICL组为(234 1±405)个/mm2,2组差异无统计学意义;拱高PRL组为(0.37±0.15)mm,ICL组为(0.41±0.17)mm,2组差异无统计学意义;各空间频率上,2组对比敏感度值比较差异无统计学意义;PRL组发生IOL偏位1眼,白内障1眼;ICL组发生白内障1例(2眼),IOL与自然晶状体贴近合并有晶状体前囊下混浊1例(2眼).结论 PC-PRL和PPC-ICL植入均能有效地矫正高度近视患者的屈光不正,两者的远期临床疗效比较无显著差异性.     

有晶状体眼后房型人工晶状体植入术后人工晶状体位置异常原因的分析

目前近视发病率逐年上升。一直以来眼科医生通过准分子激光手术来矫正低、中度近视,然而此种手术对于角膜偏薄、圆锥角膜以及高度近视等部分患者的治疗存在局限性。1993年,瑞士STAAR公司生产了一种可植入式接触镜( ilplantable collaler lens, ICL),植入到后房睫状沟中,用来矫正屈光不正。经过设计的不断改进,ICL已经逐渐成为目前治疗中、高度近视的有效手术方式。虽然其安全性已被证实,但仍有文献报道, ICL植入术后人工晶状体的位置会发生偏位及旋转,导致视力下降,严重者产生继发性青光眼,前囊下白内障等并发症。我们针对ICL术后位置异常进行综述。     

有晶状体眼虹膜支撑型人工晶状体的研究进展

有晶状体眼虹膜支撑型人工晶状体（虹膜支撑型PIOL）植入是近年矫正屈光不正的一项新技术，它具有矫正屈光范围广、预测性和稳定性好、可逆性、保留调节功能等优点，虹膜支撑型PIOL植入可矫正高度近视眼、高度远视眼、屈光参差性弱视、穿透性角膜移植术后屈光不正、晶状体摘除联合PIOL植入治疗儿童或成年人晶状体半脱位等，复曲面有晶状体眼人工晶状体（TPIOL）植入可矫正包括2D以上散光的屈光不正。手术并发症包括角膜内皮损伤、白内障、一过性高眼压、眩光和光晕、人工晶状体偏中心或脱位、色素播散等。随着人工晶状体设计的改良和临床经验的积累，手术并发症逐渐减少。虹膜支撑型PIOL植入术初步临床观察显示近期效果满意，远期效果有待进一步观察。     

虹膜支撑型有晶状体眼人工晶状体植入术研究进展

虹膜支撑型人工晶状体是近年来矫正有晶状体眼屈光不正的一项新技术.它具有矫正屈光范围广、预测性及稳定性好、可逆性和保留调节功能等优点.虹膜支撑型人工晶状体植入可矫正高度近视眼、高度远视眼、屈光参差、穿透性角膜移植术后屈光不正等疾病.复曲面有晶状体眼人工晶状体可矫正2.00 D以上的散光.手术并发症包括角膜内皮损伤、白内障、一过性高眼压、眩光和光晕、人工晶状体偏中心或脱位等.随着人工晶状体设计的改良和临床经验的积累,初步临床观察显示近期效果满意、手术并发症逐渐减少,远期效果有待进一步观察.     

有晶状体眼人工晶状体尺寸选择的研究进展

有晶状体眼人工晶状体(ICL)植入术在治疗屈光不正中发挥着越来越重要的作用。从前房型ICL到后房型,再到中心孔型的ICL,给视界带来全新的改变。虽然目前ICL术后并发症发生率很低,但是在ICL的尺寸选择中仍会因为设备测量差异及ICL尺寸算法不同等导致植入不当的ICL,引发相关并发症。随着对ICL植入术认识地不断深入,以及眼科设备及技术地不断发展,特别是人工智能的出现,使得越来越多的指标如：睫状沟直径(STS)、晶状体矢高(CLR)、前房角直径(ATA)、虹膜色素端到虹膜色素端(PTP)、前房宽度(ACW)、前房角度数(ACA)等指标在ICL尺寸的选择中提供参考,本文就ICL尺寸选择进行综述。     

有晶状体眼人工晶状体植入术研究进展

屈光手术的种类繁多，针对各种屈光不正，均有不同的手术方式。然而对于高度屈光不正，有晶状体眼人工晶状体(phakic intraocular lens，PIOL)植入术显示了其独特的优越性。PIOL植入术的发展历史、晶状体类型、手术方法、常见并发症等，在以往的综述中都阐述较多。本文就PIOL设计和材料的改进、主要并发症及其预防措施、新出现的并发症及治疗方法、PIOL植入术的其他应用作一综述。     

有晶状体眼后房型人工晶状体植入术的研究进展

随着有晶状体眼后房型人工晶状体(phakic posterior chamber intraocular lens,PPCIOL)制作材料、设计和工艺的日趋改善,PPCIOL植入术在治疗中高度近视、远视及散光方面,与激光手术比较具有明显优势,术后屈光状态稳定,并且手术具有可逆性,手术并发症发生概率低.因此越来越多的医生和患者将其作为矫正屈光不正的首选手术.本文就PPCIOL的设计、手术适应证及禁忌证、手术方法、术后观察、并发症及其防治等方面进行综述,以期为临床应用提供参考.     

后房型有晶状体眼人工晶状体植入术治疗高度近视及散光

目的 探讨后房型有晶状体眼人工晶状体植入术治疗高度近视及散光的安全性和疗效性.方法 后房型有晶状体眼人工晶状体植人术治疗高度近视及散光22例39只眼.术前屈光度(等效球镜)为-7.0～-24.0D,平均(-14.50D±3.50)0;散光-0.50～-4.50D,平均(-2.25±1.32)D.术后检查视力、眼压、裂隙...     

Toric implantable collamer lens for patients with moderate to severe myopic astigmatism: 12‐month follow‐up

Purpose: To report on the 12‐month follow‐up of 77 eyes with moderate to high myopic astigmatism implanted with toric implantable collamer lenses (ICLs). Methods: Retrospective case‐note review of 77 eyes from 42 patients undergoing toric ICL placement by one surgeon. Preoperative mean spherical equivalent ?2.50 dioptres (D) to ?15.00 D myopia and 1.00 D to 7.00 D astigmatism. Results: At 12 months, mean manifest refractive cylinder (MRC) decreased 81% from 2.38 D to 0.44 D. MRC within 1.00 D occurred in 99% (76/77) of eyes, whereas 86% (66/77) had MRC within 0.75 D. 99% (76/77) had postoperative best‐corrected visual acuity (BCVA) better than or equal to preoperative values, whereas 78% (60/77) gained up to one line BCVA and 1% (1/77) lost one line BCVA. Uncorrected binocular vision of 6/6 or better occurred in 90% (38/42) of patients compared with binocular BCVA of 6/6 or better in 67% (28/42) preoperatively. One ICL was replaced due to low vaulting. Two eyes with astigmatism of 3.25 D and 3.50 D received subsequent laser in situ keratomileusis (LASIK) to reduce residual small refractive errors. Indications for ICL were: myopia too high for LASIK (73%), cornea too thin for LASIK (44%) and contact lens intolerance (33%). Night halos were reported in 10% (8/77) of eyes at 12 months. One ICL was removed due to unrecognized preoperative glaucoma. There were no cases of cataract formation, or endophthalmitis. Conclusion: This study is the largest reported series of toric ICL implantation in New Zealand. It supports the safety, efficacy and predictability of toric ICLs to treat myopic astigmatism.     

Implantable collamer lens for residual refractive error after corneal refractive surgery

AIM: To assess the safety, efficacy, predictability and stability of implantable collamer lens (ICL) for residual refractive error after corneal refractive surgery. METHODS: This study evaluated 19 eyes of 12 patients who underwent ICL implantation after corneal refractive surgeries. They were followed up for 1y to 5y of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refractive error, flat and steep K value, axial length, intraocular pressure, corneal endothelial cell density, adverse events after ICL surgery. RESULTS: The mean follow-up period was 39.05±19.22 mo (range, 1-5y). Spherical equivalent refractive error changed from -7.45±3.02 D preoperatively to -0.85±1.10 D 1wk to 1mo after ICL implantation, with the safety and efficacy indices being 1.12 and 1.15, respectively. A total of 52.63% of eyes were within ±0.5 D of the predicted spherical equivalents, 73.68% were within ±1.0 D. A trend of mild regression towards myopia with axial elongation after 5y was observed. One eye with mild anterior capsule opacity and retinal detachment 1y after surgery were observed. CONCLUSION: ICL implantation is safe and effective for the correction of residual refractive error after corneal refractive surgeries, especially in moderate to high residual myopia.     

ICL植入后在眼内的位置稳定性与术眼视觉质量变化的研究进展

后房型有晶状体眼人工晶状体(implantable collamer lens, ICL)及环曲面ICL(toric ICL,TICL)是目前临床上常用的可植入式人工晶状体,主要矫治高度近视以及角膜条件不适合角膜激光手术的中低度近视。术前精准的测量,术中安全的植入与术后合适的位置是保证ICL矫正效果的关键,且中央孔型V4c ICL的出现更大程度地保证了该手术的安全性。然而术后ICL及TICL在眼内的位置并非一成不变,有研究表明,ICL术后拱高有逐年降低的趋势,原因不明。TICL术后可发生自发旋转,引起视力的下降,是TICL更换的主因之一。术后中央孔的位置的变化也需要引起关注。此外,ICL/TICL植入术后术眼的视觉质量会发生改变,然而人工晶状体在眼内位置的变动是否会对术后的视觉质量造成影响,也是需要关注并探究的问题。因此本文将对ICL术后拱高的变化、TICL轴位的改变、ICL术后中央孔位置的变化及其原因,以及这些改变对术后视觉质量的影响进行综述,希望对术前ICL/TICL的精准选择以及手术设计有临床指导意义,提高ICL植入矫正近视屈光不正的有效性和稳定性。     

有晶状体眼后房型人工晶状体植入术矫治高度近视

目的：：观察有晶状体眼后房型人工晶状体( ICL/TICL )矫治高度近视的安全性和有效性。方法：回顾2010-10/2014-06在我院行有晶状体眼后房型人工晶状体植入术的患者160例310眼,分析其裸眼视力( UCVA)、最佳矫正视力( BCVA)、屈光度、眼压、角膜内皮计数等指标及并发症情况。结果：视力和屈光度显著改善且稳定。术后 UCVA>0.8的有86％,BCVA未见下降,11％比术前提高1行,68％比术前提高≥2行;96％眼的实际屈光度数稳定在预期的±1.00D。有晶状体眼后房型人工晶状体( ICL)植入术后1h有14眼眼压升高,均未超过28mmHg,术中晶状体损失1眼行透明晶状体摘除及人工晶状体植入;术后有晶状体眼后房型环曲面人工晶状体( TICL )旋转1眼,术后视网膜脱离3眼,黄斑出血1眼。结论：有晶状体眼后房型人工晶状体植入术矫治高度近视安全、有效,可预测性高,并发症少,患者满意度高,值得推广,其远期并发症有待进一步观察。     

Derzeitiger Stand der refraktiven Chirurgie an Hornhaut und Linse

Refractive surgery includes all procedures which are primarily targeted at changing the refractive power of the eye. Currently laser-assisted in situ keratomileusis (LASIK) is indicated to correct myopia of up to ??8 D, hyperopia up to +?3 D and astigmatism up to 5 D. Photorefractive keratectomy (PRK) and laser epithelial keratomileusis (LASEK) are primarily recommended for myopia up to ??6 D and for greater refractive errors, phakic intraocular lenses (IOL) are the first choice (myopia greater than ??6 D and hyperopia greater than +?3 D). If presbyopia is present in addition to the high refractive error, refractive lens exchange is another alternative.     

Refractive results with secondary piggyback implantation to correct pseudophakic refractive errors

PURPOSE: To assess the efficacy and safety of implanting a second intraocular lens (IOL) to correct pseudophakic refractive errors. SETTING: Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel. METHODS: This prospective noncomparative case series included 10 pseudophakic eyes, 5 with a myopic residual refractive error and 5 with a hyperopic residual refractive error. All eyes had secondary piggyback IOL implantation with the IOL placed in the ciliary sulcus. Five types of IOLs were used to correct the residual refractive error. RESULTS: The mean preoperative myopia was -6.6 diopters +/- 3.3 (SD), and the refractive outcome was within 0.5 +/- 0.7 D of the desired refraction (range -1.5 [undercorrected] and +1.0 D [overcorrected]). The mean preoperative hyperopia was +3.8 +/- 0.8 D, and the refractive outcome was within 0.46 +/- 0.4 D of the desired refraction (range 0 and 1.0 D overcorrected). All patients showed visual acuity improvement. Best spectacle-corrected visual acuity improved from 20/44 to 20/30 (P<.05). CONCLUSION: An IOL type that is appropriate for implantation in the ciliary sulcus is a viable option for correcting pseudophakic refractive error using the piggyback technique.     

有晶状体眼后房型人工晶状体植入术对高度近视的疗效

目的：通过双通道客观视觉质量分析系统Ⅱ(OQAS Ⅱ)评价有晶状体眼后房型人工晶状体(ICL)植入术对高度近视的临床疗效。

方法：选取2017-12/2018-12安徽医科大学第一附属医院收治的高度近视患者26例52眼,所有患者均行ICL植入术。随访获取所有患者术前BCVA以及术前和术后1wk,1、3mo的UCVA、客观散射指数(OSI)、调制传递函数(MTF)、斯特列尔比(SR)和100%、20%及9%的模拟对比度视力(Predicted VA)等一系列参数。

结果：与术前BCVA相比,术后1wk,1、3mo UCVA情况均优于术前且日渐改善(P<0.01)。与术前OSI、MTF、SR和Predicted VA 100%、20%及9%相比,术后1wk,1、3mo情况均好转(P<0.01)。

结论：ICL植入术能够有效地矫正高度近视,提高裸眼视力。通过OQAS Ⅱ分析,ICL植入术后OSI比术前减小,术后的MTF、SR和Predicted VA 100%、20%及9%比术前均有提高,高度近视患者视觉质量得到良好的改善。     

Associations of lens thickness and axial length with outcomes of laser peripheral iridotomy

AIM: To compare clinical outcomes and refractive stability of implantable collamer lens (ICL) implantation and femtosecond laser assisted laser in situ keratomileusis (FS-LASIK) for high myopia correction. METHODS: The Optical Quality Analysis System (OQAS) was used to evaluate clinical outcomes objectively after operation for high myopia correction. We compared the two procedures in terms of 1-year changes in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), safety index, efficacy index, spherical equivalent, modulation transfer function (MTF) cutoff frequency, strehl ratio (SR) and objective scatter index (OSI). RESULTS: At 1y postoperatively, the safety indices was 1.33±0.27 in ICL group, and 1.17±0.24 in FS-LASIK group. 39.58% in the ICL group and 27.59% in the FS-LASIK group gained CDVA in 2 lines or better than that in preoperative CDVA. The efficacy indices was 1.28±0.22 in ICL group, and 1.13±0.26 in FS-LASIK group. The changes of spherical equivalent from 1wk to 1y postoperatively was -0.12±0.37 D in ICL group, and -0.79±0.58 D in FS-LASIK group (P<0.05). Spherical equivalent within ±0.50D was achieved in 97.92% in ICL group and 68.97% in FS-LASIK group. Modulation transfer function (MTF) cutoff frequency were higher with ICL as compared to FS-LASIK (P<0.05) at each postoperative follow-up stage; For postoperative 1mo later, strehl ratio (SR) was statistically significant difference between two groups (P<0.05); With no statistically significant difference in Objective scatter index (OSI) between two groups (P>0.05) in postoperative 3mo later. CONCLUSION: ICL implantation and FS-LASIK procedures both provide good safety and predictability in high myopia correction. ICL implantation provides better clinical outcomes and refractive stability than FS-LASIK.