有晶状体眼后房型人工晶状体(ICL)植入术为儿童高度近视、屈光参差及弱视治疗提供了新方法,尤其适用于不接受配戴框架眼镜及角膜接触镜、不适合行角膜屈光手术儿童的屈光矫正。该手术可提高儿童未矫正视力,增加对比敏感度,促进心理健康并提高生活质量。植入ICL后对弱视的治疗效果持续显著,且术后屈光状态高度稳定,其稳定性优于全飞秒激光小切口角膜基质透镜取出术及准分子激光上皮下角膜磨镶术。ICL的规格和屈光度的选择对手术的成功至关重要,术前需对拱高进行精准预测并综合考虑儿童眼发育,以预估屈光度数。围手术期的麻醉、切口方式、用药类型、剂量及持续时间与成人不同。儿童常见的术后并发症包括瞳孔阻滞、眼压升高、角膜内皮细胞丢失、伤口渗漏及ICL创伤性脱位。ICL植入术为儿童屈光发育敏感期的阶段性治疗,待双眼屈光发育稳定后可通过其他方式矫正屈光不正。本文就ICL植入术治疗儿童高度近视及弱视的优势、ICL选择、术后并发症及尚存问题进行综述,以期为临床应用提供参考。
Implantable collamer lenses (ICL) implantation provides a new method for the treatment of children with high myopia, anisometropia and amblyopia, who may be spectacle aversive and unsuited to contact lens wear and corneal refractive surgery.Surgery can improve children's uncorrected visual acuity, increase contrast sensitivity, promote mental health and improve quality of life.This treatment has a significant effect on amblyopia.After ICL implantation, the refractive state is highly stable, and the stability is better than small incision lenticule extraction and laser subepithelial keratomileusis.The selection of ICL size and power is critical to the success of surgery, and preoperative prediction of vault should be made in consideration of children's eye development.Perioperative anesthesia, incision method as well as type, amount and duration of postoperative medication are different from those of adults.Furthermore, common postoperative complications in children include pupillary block glaucoma, elevation of intraocular pressure, loss of corneal endothelial cells, wound leak, and traumatic dislocation of the ICL.Implantation of ICL in children is a staged treatment during the sensitive period of refractive development.After the refractive development of both eyes is stabilized, refractive errors can be corrected by other methods.This article reviews the advantages of ICL implantation in the treatment of children with high myopia and amblyopia, and focuses on ICL selection, postoperative complications and remaining problems, to provide a reference for clinical application.
杜雪瑜,严宏,张坚. ICL植入术治疗儿童高度近视及弱视安全性的研究进展[J]. 中华实验眼科杂志,2024,42(09):866-870.
DOI:10.3760/cma.j.cn115989-20220518-00228版权归中华医学会所有。
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