高度近视植入式晶状体手术15年随访：并发症、白内障手术结果及超微结构分析

IF 4.5

Advances in ophthalmology practice and research Pub Date : 2026-08-01 Epub Date: 2026-03-13 DOI:10.1016/j.aopr.2026.02.001

Yinjie Jiang, Guanghan Xu, I-Chun Lin, Mingrui Cheng, Boliang Li, Yadi Lei, Mingwei Li, Zhiwei Mao, Rui Ning, Xun Chen, Xiaoying Wang

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引用次数: 0

摘要

本研究报告高度近视患者植入式晶状体（ICL）手术15年的结果，分析白内障手术的并发症、疗效和前囊下白内障（ASC）的超微结构机制。方法回顾性研究复旦大学附属眼科及耳鼻喉科医院的1208只眼（ICL V4）和6258只眼（ICL V4c）。术前随访，1/3/6个月随访，icl术后随访，白内障术后随访1个月随访。评估晶状体混浊、ASC率和并发症。采用扫描/透射电镜（SEM/TEM）观察前囊超微结构。结果ICL V4组（随访时间：23.12±32.06个月）的并发症发生率高于V4c组（8.95±17.40个月）：晶状体混浊（6.46%比0.16%）、ASC（2.32%比0.10%）、双胆道切除术（3.89%比0.16%）。双肠切除术将矫正距离视力从0.56±0.39提高到0.34±0.51 logMAR (P = 0.006)，恢复到icl前水平（P = 0.310），安全性/有效性指数分别为1.08±0.11和0.99±0.08。近视相关并发症包括近视性黄斑萎缩（0.38%）、脉络膜新生血管（0.24%）和视网膜脱离（0.04%）。扫描电镜/透射电镜显示晶状体上皮细胞增生，纤维连接蛋白或胶原沉积，线粒体异常（嵴增厚，核周空泡化）。结论高度近视、前房深度浅、年龄大是icl术后白内障发生的关键危险因素。虽然双胆管切除术恢复了视力，但高度近视相关的并发症仍然存在。ASC的发病机制包括机械损伤和代谢功能障碍，超微结构改变证明了这一点。这些发现强调了对高度近视的ICL患者进行长期监测的必要性。

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Fifteen-year follow-up of implantable collamer lens surgery in high myopia: Complications, cataract surgery outcomes, and ultrastructural analysis

Purposes

This study reports 15-year outcomes of implantable collamer lens (ICL) surgery in patients with high myopia, analyzing complications, efficacy of cataract surgical, and ultrastructural mechanisms of anterior subcapsular cataract (ASC).

Methods

This retrospective study included 1208 eyes (ICL V4) and 6258 eyes (ICL V4c) from Eye & ENT Hospital of Fudan University, Shanghai, China. Follow-ups occurred preoperatively, at 1/3/6 months, annually post-ICL, and 1 month post-cataract surgery. Lens opacity, ASC rates, and complications were evaluated. Anterior capsule ultrastructure was assessed using scanning/transmission electron microscopy (SEM/TEM).

Results

The ICL V4 group (follow-up: 23.12 ± 32.06 months) exhibited higher complication rates than V4c (8.95 ± 17.40 months): lens opacity (6.46% vs. 0.16%), ASC (2.32% vs. 0.10%), and bilensectomy (3.89% vs. 0.16%). Bilensectomy improved corrected distance visual acuity from 0.56 ± 0.39 to 0.34 ± 0.51 logMAR (P = 0.006), restoring pre-ICL levels (P = 0.310), with safety/efficacy indices of 1.08 ± 0.11 and 0.99 ± 0.08. Myopia-related complications included myopic macular atrophy (0.38%), choroidal neovascularization (0.24%), and retinal detachment (0.04%). SEM/TEM revealed lens epithelial cell proliferation, fibronectin or collagen deposition, and mitochondrial abnormalities (thickened cristae, perinuclear vacuolization) in ASC cases.

Conclusions

Super high myopia, shallow anterior chamber depth, and older age are key risk factors for post-ICL cataract. While bilensectomy restores vision, high myopia-related complications persist. ASC pathogenesis involves mechanical damage and metabolic dysfunction, evidenced by ultrastructural changes. These findings underscore the need for long-term monitoring in ICL patients with high myopia.

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