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后房型人工晶状体
谢晓兰
2012.8
人工晶状体的进展
第一代 1949-1954 原始的Ridley后房型人工晶状体
第二代 1952-1962 早期前房型人工晶状体
第三代 1953-1973 白内障囊内摘除术后使用过的包括
虹膜囊膜的虹膜支撑型人工晶状体
第四代 1963-1992 从早期前房人工晶状体过渡到新
型前房型人工晶状体
第五代 1977-1992 后房型人工晶状体的过渡和成熟
阶段
第六代 1992-2000 新型人工晶状体
但是,作为理想的人
工晶状体应该具备哪
些特征呢?





光学性能高
质量轻
生物相容性好
性能稳定,无生物降解作用
无刺激,无致癌性
(一) 聚甲基丙烯酸酯 PMMA
(二) 硅胶 Silicone
(三) 水凝胶 Hydrogel
(四)丙烯酸酯 Acrylic 是PMMA 的衍生物,是苯乙基丙烯酸
酯和苯乙基烯酸甲酯大的聚合物。目前是临床上最常用、引起后发障
最少的可折叠人工晶状体材料。
 But ,how about the implantation of
posterior chamber phakic intraocular lens
with a central hole → (Hole ICL)
?
Slit-lamp photograph of the eye after implantation of an
implantable collamer lens with a central hole (Hole ICL).
 To prevent pupillary block, this surgical
technique unavoidably requires two
preoperative laser iridectomies, which
are frequently accompanied by some pain;
OR intraoperative peripheral iridectomy,
which is sometimes complicated by iris
haemorrhage, causing surgical difficulties.
EVEN
Implantation of a newly developed Hole
ICL offered good results for all measures of
safety,efficacy, predictability and stability
for the correction of moderate to high
myopic errors, even without peripheral
iridectomy, suggesting its viability as a
surgical option for the treatment of such
eyes.
the RISK of cataract formation,presumably
resulting from direct physical contact
between the ICL and the crystalline lens or
from localised malnutrition causing poor
circulation of the aqueous humour.
A new ICL with an artificial central hole
(Hole ICL) in order to overcome these
disadvantages is coming up
D
PIOL
with a hole
convetional
advantanges ?
with a central
hole
efficacy
predictability
safety
ICL
less adversity
without peripheral
iridectomy
evaluated 20 eyes of 20 patients with
spherical equivalents of 7.3662.13 D
(mean6SD) who underwent Hole ICL
implantation.
Before surgery and at 1 week and 1, 3 and
6 months after surgery,
Safety outcomes
Effectiveness outcomes
Predictability
Stability
IOP
Endothelial cell density
Secondary surgeries/adverse events
Hole ICL implantation is safe and effective,
and provides predictable and stable
refractive results in the correction of
moderate to high myopia throughout a 6month observation period. Moreover, no
visionthreatening complications occurred
throughout the follow-up period.
A modified implantable collamer lens (ICL)
with a central hole (diameter, 0.36 mm), a
“Hole-ICL”, was created to improve
aqueous humour circulation
?
Locations
of aqueous humour inflow and outflow. 1: location
of aqueous humour outflow; 2: location of aqueous humour inflow
Flow distribution along the long axis of the cross-sectional surface
of the Hole-ICL. The length of the arrow corresponds to the flow
velocity
Flow distribution along the long axis of the cross-sectional
surface for the conventional ICL. The length of the arrow
corresponds to the flow velocity
Comparison of flow velocity along the long axis of the
crosssectional surface of the Hole-ICL, conventional ICL, and the
eye without an ICL. The solid line represents the flow velocity of
the Hole-ICL, and the dotted line represents the flow velocity for
the conventional ICL
Comparison of flow velocity along the short axis of the
crosssectional surface in the Hole-ICL, conventional ICL,
and the ey ewithout an ICL
The flow distribution between the anterior surface of the
crystalline lens and the posterior surface of the Hole-ICL was
higher than that between the crystalline lens and the conventional
ICL
Trajectory analysis in the Hole-ICL (left) and
conventional ICL (right). Representative lines are
shown
The flow distribution between the anterior
surface of the crystalline lens and the
posterior surface of the Hole-ICL was
higher than that between the crystalline
lens and the conventional ICL
Therefore, the circulation of aqueous
humour to the anterior surface of the
crystalline lens in a Hole-ICL would be
higher than that in a conventional ICL.
the importance of aqueous humour circulation
anterior chamber depth decrease
Your Tesurgical trauma
myopia
age
Many surgeons also perform peripheral
laser iridotomy (LI) prior to ICL
implantation to prevent a pupillary block. LI
may cause complications including iritis
intraocular haemorrhage,elevation of
intraocular pressure, posterior iris
synechia, and corneal decompensation,
such as bullous keratopathy.
Using of the Hole-ICL may improve
aqueous humour circulation, preventing
secondary cataracts and eliminating the
need for LI.

↓↓↓
Hole-ICLs improve the circulation of
aqueous humour to the anterior surface of
the crystalline lens.
IN all :
 ICL with a hole is a tendency .
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