【作者】 汪晓宇；

【导师】 李毓敏；

【作者基本信息】 浙江大学 ， 眼科学， 2007， 硕士

【摘要】 研究背景：有晶状体眼的后房型人工晶体(posterior chamber phakic intraocular lens，PCPIOL)植入术是将人工晶体固定于睫状沟内，因此既保留了患者的调节力，又具有潜在的可逆性，对角膜内皮损伤较小，与前房型人工晶体植入术相比更符合生理解剖状态。同时，由于植入的人工晶体紧贴虹膜，并接近晶状体，易引起白内障和高眼压等并发症，此手术的安全性在临床上也受到越来越多的关注。很多学者采用房角镜、超声生物显微镜(Ultrasound biomicroscopy，UBM)、光学断层扫描仪(Optical coherence tomography，OCT)等进行前后房及房角的观察，研究其在眼内的位置及与周围组织的关系、和眼压的相关性。目的：应用超声生物显微镜(Ultrasound biomiscroscopy，UBM)评价有晶状体眼后房型人工晶体植入术后前后房及房角的变化。方法：对13例(26眼)有晶状体眼后房型人工晶体植入术患者的临床资料进行回顾性研究，观察术前、术后1周、1月、3月、6月及一年的眼压、末次随访(术后一年)时的最佳矫正视力、屈光状态，并行UBM检查，测量中央前房深度、植入式胶原镜(implantable collamer lens，implantable contact lens，ICL)，后表面与晶状体之间的距离、小梁虹膜夹角，ICL周边部与晶状体之间的距离、房角开放距离500。结果：术前平均屈光度为-17.99±4.97D，术后平均屈光度为-1.69±0.98D；术后最佳矫正视力(best correct visual acuity，BCVA)均好于术前，其中73.1％BCVA比术前提高≥2行；术前眼压为10～18mmHg(平均13.94±2.37mmHg)，术后1周、1个月、3个月、6个月及一年时眼压分别为14.42±1.86mmHg、14.96±2.18mmHg、14.38±2.34mmHg、14.33±2.79mmHg和14.17±2.99mmHg，术后各次眼压均与术前比较，仅术后1个月时有统计学差异(t=-3.418，p=0.002)。UBM检查发现中央角膜内表面与晶状体之间的距离为2.83mm～3.17mm(平均2.97±0.12mm)，中央角膜内表面与ICL之间的距离为1.87～2.57mm(平均2.22±0.21mm)，两者之间有显著性差异(t=20.63，P＜0.005)。仅56.7％手术眼的小梁虹膜夹角＞30°，ICL周边部与晶状体之间的距离周边部12：00的距离为0.45±0.15mm，3：00位为0.46±0.13mm，6：00为0.37±0.13mm，9：00为0.46±0.12mm，行组间比较后，无显著性差异(F=2.619，P=0.055)。房角开放距离500(AOD500)在12：00、3：00、6：00及9：00分别为0.32±0.13mm，0.35±0.15mm，0.31±0.73mm及0.33±0.14mm，行组间比较后，无显著性差异(F=0.594，P=0.620)。ICL后表面与晶状体之间的距离为0.40～0.94mm，平均0.64±0.16mm，ICL与晶状体无接触。结论：有晶状体眼后房型人工晶体植入术后视力恢复快，术后最佳矫正视力均好于术前。ICL位于晶状体前，致使术后中央前房深度变浅、部分手术眼前房角宽度变窄，但未发现术后眼压持续升高。ICL与晶状体无接触，与虹膜后表面接触，术后未发现晶状体混浊。对于有晶状体眼后房型人工晶体植入手术安全性的评价，UBM具有简便、可重复性好，是一种理想的客观检查方法。更多还原

【Abstract】 Purpose:To study the changes of angle structures anterior chamber after implantable contact lens(ICL) for high myopia using ultrasound biomicroscopy(UBM).Methods:A Staar implantable contact lens (ICL) was implanted in 13 patients (26 eyes) with high myopia. The patients were followed for one year. Spherical equivalent (SE) refraction, best correct visual acuity (BCVA), intraocular pressure (IOP) were performed after surgery. All eyes were examined by UBM one year after surgery:central anterior chamber depth (ACD), trabecular-iris angle (TIA),ICL peripheral distance-lens and angle opening distance at points 500 microm (AOD 500) were measured.Results:The preoperative mean SE was -17. 99 ± 4. 97D, the postoperative mean SE was -1.69 ± 0.98D. The postoperative BCVA was better than the preoperative one .The percentage of eyes that improved two or more lines of BCVA was 73. 1%. Intraocular pressure change from (13. 94 ± 2. 37)mmHg before surgery to ( 14. 42 ± 1.86)mmHg at 1 week, 14.96 ±2. 18mmHg at 1 months , 14. 38 ± 2. 34mmHg at 3 months , 14. 33 ± 2. 79mmHg at 6 months and 14. 17± 2. 99mmHg at 12 months. There was a statistically significant increase ofthe IOP at 1 month after surgery (t= - 3. 418, p=0.002) , which normalized completely at 3 months after surgery. Endothelium distance-ICL (central section) is 2. 22 + 0. 20mm; endothelium distance-lens (central Section) is 2.97 ± 0. 12mm, there were significant differences between them (p < 0. 005. TIA large than 30 degrees in 46.2% to 65. 4%(mean 56. 7%). ICL central distance-lens (central section) is 0.64 ± 0. 16mm. ICL peripheral distance-lens at 12:00,3:00,6:00 and 9:00 were 0.45 ± 0.15mm, 0.46 ± 0.13mm, 0. 37 ± 0. 13mm and 0. 46 + 0. 12mm. No contact was found between the ICL and the crystalline lens.Conclusions:Posterior chamber phakic intraocular lens implantation for the surgical correction of high myopia is a safe procedure with regard to immediate visual and refractive results. We found the reduction of the iridocorneal angle, and the depth of the anterior chamber after surgery. The distance between the crystalline lens and ICL is generally large and the ICL contact with the iris confirmed by UBM. However, there was no direct influence on IOP. Studies with longer follow-up periods must be carried out to determine the long-term safety of this lens implant.更多还原