ICL联合Trans-PRK治疗超高度近视患者的疗效及对角膜内皮细胞密度的影响
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摘要
目的:探索可植入式隐形眼镜(implantablecollamerlense,ICL)联合经角膜上皮激光角膜切削术(laser keratectomy via corneal epithelium,Trans-PRK)治疗超高度近视患者的疗效及对角膜内皮细胞密度(corneal endothelial cell density)的影响。方法:分析研究本院眼科2014年3月～2017年3月期间收治的超高度近视患者,在接受ICL植入术后6个月仍残留近视并再次接受Trans-PRK治疗,病例数为30例52眼。术后对患者进行随访,于术前、ICL植入术后6个月、Trans-PRK术后6个月观察裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)、屈光度(dioptre,D)、眼压(intraocular pressure)、ICL拱高(arch height)、前房容积(anterior chamber volume)、前房深度(anterior chamber depth)以及角膜内皮细胞数变化情况,以此评价手术的有效性及安全性。结果:ICL植入术后6个月、Trans-PRK术后6个月术眼UCVA、BCVA均明显高于术前(P=0.000),且Trans-PRK术后6个月术眼UCVA明显高于ICL植入术后6个月(P<0.05);所有患者术后均未出现眼压增高的情况,术前、ICL植入术后6个月及Trans-PRK术后6个月术眼眼压差异无统计学意义(P>0.05),Trans-PRK术后6个月术眼ICL拱高稍低于ICL植入术后6个月,但差异无统计学意义(P>0.05);ICL植入术后6个月、Trans-PRK术后6个月术眼前房容积、前房深度均明显小于术前(P=0.000),且Trans-PRK术后6个月前房深度明显低于ICL植入术后6个月(P<0.05);ICL植入术后6个月术眼角膜内皮细胞数略少于术前,差异不具有统计学意义(P>0.05),Trans-PRK术后6个月角膜内皮细胞数较ICL植入术后6个月有所回升,接近术前水平。结论:Trans-PRK治疗可有效改善高度近视ICL植入术后残留近视患者眼球的屈光度,对角膜内皮细胞密度影响小,显著提升视力水平,提升视力水平,达到预期手术效果,且操作安全,值得临床推广。
Objective: To explore the efficacy of ICL combined with Trans-PRK in the treatment of high myopia and its effect on corneal endothelial cell density. Methods: A prospective analysis was performed on the patients with ultra-high myopia admitted to the ophthalmology department of our hospital from March 2014 to March 2017. Six months after ICL implantation, the patients still had myopia and received trans-prk treatment again. The number of cases was 30 and 52 eyes. Patients were followed up postoperatively. The uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA) and Dioptre(Dioptre) were observed preoperatively, 6 months after ICL implantation and 6 months after Trans PRK. D) Intraocular pressure, Arch height, Anterior chamber volume, Anterior chamber depth, and corneal endothelial cell count changes in order to assess the procedure's effectiveness and safety. Results: UCVA, BCVA and refractive index of the eyes were significantly higher 6 months after the implantation of ICL and 6 months after the trans-prk than before(P=0.000), and UCVA of the eyes 6 months after the trans-prk was significantly higher than that 6 months after the implantation of ICL(P<0.05). There was no increase in intraocular pressure in all patients after surgery. There was no significant difference in intraocular pressure before surgery, 6 months after ICL implantation and 6 months after trans-prk(P>0.05). Both anterior chamber volume and anterior chamber depth were significantly lower 6 months after ICL implantation and 6 months after trans-prk than before(P=0.000), and anterior chamber depth was significantly lower 6 months after trans-prk than after ICL implantation(P<0.05). The number of corneal endothelial cells 6 months after ICL implantation was slightly less than that before surgery, but it was not statistically significant(P>0.05). The number of corneal endothelial cells 6 months after trans-prk was higher than that after ICL implantation and close to the preoperative level. Conclusion: Trans-prk can effectively improve the eye diopter of patients with high myopia and residual myopia after ICL implantation. It has little effect on the density of corneal endothelial cells, significantly improves the level of vision, improves the level of vision, achieves the expected operation effect, and the operation is safe, which is worthy of clinical promotion.
Objective: To explore the efficacy of ICL combined with Trans-PRK in the treatment of high myopia and its effect on corneal endothelial cell density. Methods: A prospective analysis was performed on the patients with ultra-high myopia admitted to the ophthalmology department of our hospital from March 2014 to March 2017. Six months after ICL implantation, the patients still had myopia and received trans-prk treatment again. The number of cases was 30 and 52 eyes. Patients were followed up postoperatively. The uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA) and Dioptre(Dioptre) were observed preoperatively, 6 months after ICL implantation and 6 months after Trans PRK. D) Intraocular pressure, Arch height, Anterior chamber volume, Anterior chamber depth, and corneal endothelial cell count changes in order to assess the procedure's effectiveness and safety. Results: UCVA, BCVA and refractive index of the eyes were significantly higher 6 months after the implantation of ICL and 6 months after the trans-prk than before(P=0.000), and UCVA of the eyes 6 months after the trans-prk was significantly higher than that 6 months after the implantation of ICL(P<0.05). There was no increase in intraocular pressure in all patients after surgery. There was no significant difference in intraocular pressure before surgery, 6 months after ICL implantation and 6 months after trans-prk(P>0.05). Both anterior chamber volume and anterior chamber depth were significantly lower 6 months after ICL implantation and 6 months after trans-prk than before(P=0.000), and anterior chamber depth was significantly lower 6 months after trans-prk than after ICL implantation(P<0.05). The number of corneal endothelial cells 6 months after ICL implantation was slightly less than that before surgery, but it was not statistically significant(P>0.05). The number of corneal endothelial cells 6 months after trans-prk was higher than that after ICL implantation and close to the preoperative level. Conclusion: Trans-prk can effectively improve the eye diopter of patients with high myopia and residual myopia after ICL implantation. It has little effect on the density of corneal endothelial cells, significantly improves the level of vision, improves the level of vision, achieves the expected operation effect, and the operation is safe, which is worthy of clinical promotion.
引文
1 邓骏杰,何鲜桂,许迅.高度近视巩膜厚度研究现状与进展[J].中华眼底病杂志,2017,33(1):87-89.
2 王秀,何晴,路晓晓,等.后巩膜加固术治疗高度近视性视网膜病变的安全性和有效性分析[J].眼科新进展,2018,38(1):49-52.
3 侯思梦,张景尚,万修华.高度近视手术矫正及治疗方法研究进展[J].眼科新进展,2018,38(10):921-924.
4 Chen P,Cai X,Xu L,et al.Assessing oxygen saturation in retinal vessels in high myopia patients pre- and post-implantable collamer lens implantation surgery[J].Acta Ophthalmologica,2017,95(6):576-582.
5 唐磊,廖荣丰.中央孔型有晶状体眼后房型人工晶体矫正高度近视的临床研究[J].安徽医科大学学报,2017,52(6):915-920.
6 Kamiya K,Shimizu K,Igarashi A,et al.Posterior chamber phakic intraocular lens implantation:comparative,multicentre study in 351 eyes with low-to-moderate or high myopia[J].Br J Ophthalmol,2018,102(2):177-181.
7 Jin-yu LI,Ri-ping Z,Li-xia S,et al.Efficacy and safety of low dose MMC to prevent haze in Trans-PRK with moderate and high myopia[J].Int Eye Sci,2017,17(7):1313-1316.
8 张灵丽,刘世纯,邬羽飞,等.高度近视与原发性开角型青光眼关系的研究进展[J].眼科新进展,2017,37(3):297-300.
9 李少玉,蒋文君,毕宏生.高度近视相关基因的研究进展[J].眼科新进展,2017,37(5):488-491.
10 Bashir ZS,Ali MH,Anwar A,et al.Femto-lasik:The recent innovation in laser assisted refractive surgery.[J].J Pakistan Med Assoc,2017,67(4):609-612.
11 Qu H.Study on influencing factors of arch height change in patients with high myopia undergoing ICL implantation[J].Int Eye Sci,2019,19(3):514-516.
12 郑金华,谷浩,龙秋容,等.超高度近视有晶状体眼后房型人工晶状体植入术后残留近视的LASEK治疗效果[J].中华实验眼科杂志,2017,35(06):527-531.
13 赵姣,曾莉,刘宗顺,等.SMILE与Trans-PRK手术矫正近视对角膜前表面像差的影响[J].国际眼科杂志,2018,18(3):438-441.
14 Ding BY,Shih YF,Lin LL,et al.Myopia among school children in East Asia and Singapore.[J].Survey Ophthalmol,2017,62(5):677-697.
15 王瑞娜,郭红亮,马挺,等.有晶状体后房型人工晶状体植入术与飞秒激光LASIK术后视觉质量的比较[J].中华实验眼科杂志,2017,35(9):833-837.
16 赵世强,接英,李蕾,等.超高度近视屈光性手术后主诉视觉质量下降原因分析[J].首都医科大学学报,2018,39(3):148-151.
17 李猛,王怀洲,刘玥,等.有孔和无孔眼内镜植入术后房角改变的对比研究[J].眼科,2017,26(6):393-396.
18 赵伟,王雁,李华,等.不同程度近视和散光患者行飞秒激光小切口角膜基质透镜取出术的早期临床疗效评估[J].中华实验眼科杂志,2017,35(4):349-354.
19 侯杰,王雁,雷玉琳,等.准分子激光屈光性角膜切削术矫治近视术后角膜上皮的重塑及相关因素分析[J].中华实验眼科杂志,2017,35(12):1104-1108.
20 赵炜,董泽红,师蓉,等.Trans-PRK和LASEK术后恢复的对比研究[J].中华眼视光学与视觉科学杂志,2017,19(5):296-300.
2 王秀,何晴,路晓晓,等.后巩膜加固术治疗高度近视性视网膜病变的安全性和有效性分析[J].眼科新进展,2018,38(1):49-52.
3 侯思梦,张景尚,万修华.高度近视手术矫正及治疗方法研究进展[J].眼科新进展,2018,38(10):921-924.
4 Chen P,Cai X,Xu L,et al.Assessing oxygen saturation in retinal vessels in high myopia patients pre- and post-implantable collamer lens implantation surgery[J].Acta Ophthalmologica,2017,95(6):576-582.
5 唐磊,廖荣丰.中央孔型有晶状体眼后房型人工晶体矫正高度近视的临床研究[J].安徽医科大学学报,2017,52(6):915-920.
6 Kamiya K,Shimizu K,Igarashi A,et al.Posterior chamber phakic intraocular lens implantation:comparative,multicentre study in 351 eyes with low-to-moderate or high myopia[J].Br J Ophthalmol,2018,102(2):177-181.
7 Jin-yu LI,Ri-ping Z,Li-xia S,et al.Efficacy and safety of low dose MMC to prevent haze in Trans-PRK with moderate and high myopia[J].Int Eye Sci,2017,17(7):1313-1316.
8 张灵丽,刘世纯,邬羽飞,等.高度近视与原发性开角型青光眼关系的研究进展[J].眼科新进展,2017,37(3):297-300.
9 李少玉,蒋文君,毕宏生.高度近视相关基因的研究进展[J].眼科新进展,2017,37(5):488-491.
10 Bashir ZS,Ali MH,Anwar A,et al.Femto-lasik:The recent innovation in laser assisted refractive surgery.[J].J Pakistan Med Assoc,2017,67(4):609-612.
11 Qu H.Study on influencing factors of arch height change in patients with high myopia undergoing ICL implantation[J].Int Eye Sci,2019,19(3):514-516.
12 郑金华,谷浩,龙秋容,等.超高度近视有晶状体眼后房型人工晶状体植入术后残留近视的LASEK治疗效果[J].中华实验眼科杂志,2017,35(06):527-531.
13 赵姣,曾莉,刘宗顺,等.SMILE与Trans-PRK手术矫正近视对角膜前表面像差的影响[J].国际眼科杂志,2018,18(3):438-441.
14 Ding BY,Shih YF,Lin LL,et al.Myopia among school children in East Asia and Singapore.[J].Survey Ophthalmol,2017,62(5):677-697.
15 王瑞娜,郭红亮,马挺,等.有晶状体后房型人工晶状体植入术与飞秒激光LASIK术后视觉质量的比较[J].中华实验眼科杂志,2017,35(9):833-837.
16 赵世强,接英,李蕾,等.超高度近视屈光性手术后主诉视觉质量下降原因分析[J].首都医科大学学报,2018,39(3):148-151.
17 李猛,王怀洲,刘玥,等.有孔和无孔眼内镜植入术后房角改变的对比研究[J].眼科,2017,26(6):393-396.
18 赵伟,王雁,李华,等.不同程度近视和散光患者行飞秒激光小切口角膜基质透镜取出术的早期临床疗效评估[J].中华实验眼科杂志,2017,35(4):349-354.
19 侯杰,王雁,雷玉琳,等.准分子激光屈光性角膜切削术矫治近视术后角膜上皮的重塑及相关因素分析[J].中华实验眼科杂志,2017,35(12):1104-1108.
20 赵炜,董泽红,师蓉,等.Trans-PRK和LASEK术后恢复的对比研究[J].中华眼视光学与视觉科学杂志,2017,19(5):296-300.