ICL V4c联合对向透明角膜切口矫正近视合并散光的临床观察

发布时间：2018-05-27 09:23

  本文选题：后房型人工晶状体 + 对向透明角膜切口　； 参考：《青岛大学》2017年硕士论文

【摘要】：目的:评估ICL V4c(implantable collamer lens V4c,ICL V4c)联合对向透明角膜切口矫正近视合并散光的有效性。方法:前瞻性病例研究。选取2015年05月至2016年05月于青岛眼科医院行ICL V4c植入术的高度近视合并散光患者20例(40眼),为ICL组,其中男9例,女11例,平均年龄22.5±4.5岁(18~36岁);另外选取同年龄段的20例(40眼)正视眼作为视觉质量分析的对照组,其中男10例,女10例,平均年龄24.8±3.6岁(20~33岁)。ICL组纳入标准:高度近视患者术前角膜散光大于1.5D;屈光状态稳定,不能耐受戴框架眼镜或角膜接触镜;近视度数为-6.0~-18.0D;前房深度≥2.8mm;角膜内皮细胞计数≥2000个/mm2;无眼表手术史、角膜病变、白内障、青光眼、葡萄膜炎及视网膜病变等。术前于裂隙灯下在最大角膜屈光力子午线上做角膜缘标记,术中在局部麻醉下距离角膜缘约0.5~1.0mm处做对向透明角膜切口,其中一个切口用于植入ICL V4c,另一个切口用于矫正角膜散光。根据Jaffe’s矢量分析原理计算手术源性角膜散光。检查结果包括裸眼视力(uncorrected visual acuity,UCVA),最佳矫正视力(best spectacle-corrected visual acuity,BSCVA),等效球镜(manifest refraction spherical equivalent,MRSE),角膜曲率,睫状沟囊肿,高阶像差(包括总高阶像差、球差、慧差和三叶草),调制传递函数(modulation transfer function,MTF),屈光矫正者生活质量量表(Quality of Life Impact of Refractive Correction,QIRC)。结果:ICL V4c植入术后3个月Log MAR UCVA(-0.05±0.08),Log MAR BSCVA(-0.07±0.06)分别高于术前Log MAR UCVA(1.26±0.28),Log MAR BSCVA(-0.01±0.09),差异有统计学意义(t≥4.55,P0.001)。拱高平均为506.9±179.9um(250~880um)。眼压由术前14.8±2.3mm Hg(11~21mm Hg)降到13.9±2.8mm Hg(8~19mm Hg),差别无统计学意义(t=1.78,P0.05)。在ICL组,平均角膜散光由术前2.32±0.59D(1.60~3.67D)降到术后1.19±0.57D(0.10~2.70D)。Jaffe’s矢量分析法计算得出手术源性角膜散光为1.35±0.35D(0.93~2.09D)。在3mm和5mm瞳孔直径下,除在5mm瞳孔直径下三叶草,总高阶像差、球差、慧差在ICL组和对照组差别无明显统计学意义(P≥0.13)。在3mm和5mm瞳孔直径下,5~30c/d空间频率间,两组MTF值差别无明显统计学意义(P≥0.12)。ICL植入术后3个月QIRC评分(52.14±1.21)明显高于术前(39.57±2.18)。患者满意度水平高,95%患者表示满意或非常满意,没有很不满意的患者。65%的患者表示术后早期出现夜间光晕或眩光现象,但随着时间延长光晕现象逐渐减轻变得不明显。在所有患者中,有22眼(55%)发现睫状沟囊肿,囊肿直径≥0.5mm有9只眼(40.9%),囊肿直径≥1.0mm有2只眼(9.09%)。囊肿主要分布在下方(72.7%)和颞侧(77.3%)。结论:ICL V4c联合对向透明角膜切口可以有效的矫正近视合并散光,对视觉质量影响较小,对合并睫状沟囊肿患者的应用具有可行性。
[Abstract]:Objective: to evaluate the efficacy of ICL V4c(implantable collamer lens V 4 C combined with ICL 4 c in the correction of myopia with astigmatism through a transparent corneal incision. Methods: prospective case study. From May 2015 to May 2016, 20 patients with high myopia combined with astigmatism underwent ICL V4c implantation in Qingdao Ophthalmology Hospital. They were selected as ICL group, including 9 males and 11 females. The mean age was 22. 5 卤4. 5 years old and 18 / 36 years old. Another 20 cases (40 eyes) of the same age group were selected as the control group for visual quality analysis, including 10 males and 10 females. The mean age was 24.8 卤3.6 years (20 / 33). The ICL group included: preoperative corneal astigmatism was greater than 1.5 D in patients with high myopia, and the refractive state was stable and could not withstand framing glasses or contact lenses. Myopia was -6.0 ~ 18.0D, anterior chamber depth 鈮，

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