不同手术方式对白内障术后角膜散光的影响  

Impact of different methods of cataract surgery on postoperative corneal astigmatism

作　　者：宋颖[1] 周绍荣[1] 张琳[1] 

机构地区：[1]上海第二医科大学仁济医院眼科,上海200001

出　　处：《上海第二医科大学学报》2004年第B11期80-83,共4页Acta Universitatis Medicinalis Secondae Shanghai

摘　　要：目的了解不同手术方式对白内障术后角膜散光的影响。方法将 113例 (12 8只眼 )白内障患者随机分成 3组 ,各 4 4例(5 1只眼 )、4 0例 (45只眼 )、2 9例 (32只眼 ) ,分别行白内障囊外摘除术 (Ⅰ组 )、小切口囊外摘除术 (Ⅱ组 )和超声乳化吸出术 (Ⅲ组 ) ,并植入人工晶体 ,于术前、术后 1周、1、3、6月随访远视力、角膜散光及其轴位等指标。结果Ⅱ组和Ⅲ组术后 1周、1、3、6月的视力明显高于Ⅰ组 ,其差异有显著性意义 (P <0 .0 5 )。术前平均散光值Ⅰ组、Ⅱ组、Ⅲ组统计无显著差异 (P >0 .0 5 ) ;Ⅰ组平均散光值在术后 1周、1、3、6月时均大于Ⅱ、Ⅲ组 ,且差异有显著性意义 (P <0 .0 1) ,Ⅱ组与Ⅲ组平均散光值在术后 1周和 1月时差异有显著性意义 (P <0 .0 1) ,3月后统计无显著差异 (P >0 .0 5 )。Ⅰ组、Ⅱ组、Ⅲ组术后早期均以顺规性散光为主 ,随着时间的推移Ⅲ组术后散光漂移最明显 ,而Ⅰ组则漂移最少。结论超声乳化吸出及人工晶体植入术是白内障手术发展的方向 ,但在无条件行超乳术时 ,调整切口大小、位置、深度、缝合技术等 ,术后仍可达到较低的散光度和满意的视力。Objective To evaluate the impact of different methods of cataract surgery on postoperative corneal astigmatism. Methods 128 eyes of 113 patients were assigned randomly to three groups according to the method of cataract surgery: group Ⅰ, extracapsular cataract extraction; group Ⅱ, small-incision extracapsular cataract extraction; group Ⅲ, phacoemulsifications; with intraocular lens implantation. Visual acuity and corneal astigmatism with axis by corneal topography examinations were taken for all eyes preoperatively as well as at 1 week and at 1, 3, 6 months post-operatively. Results Both groups Ⅱ and Ⅲ displayed better visual acuity than group I (P<0.05) after surgery. Mean corneal astigmatism in group Ⅰ was significantly greater than that in groups Ⅱ and Ⅲ throughout the whole postoperative period (P<0.01); there were significant differences in mean corneal astigmatism between group Ⅱ and group Ⅲ at 1 week and 1 month postoperatively (P<0.01), but no statistic difference between them after 3 months (P>0.05). All groups displayed astigmatism with-the-rule in the early postoperative period, and produced astigmatism against-the-rule as time passed by. Conclusion Phacoemulsification is the best method of cataract surgery, which has relatively slighter shift in corneal astigmatism, and more rapid restoration of visual acuity. Otherwise, small-incision extracapsular cataract extraction is also a good choice.

关 键 词：白内障术后 角膜散光 手术方式 术前 视力 白内障囊外摘除术 术后早期 显著性 结论 意义 

分 类 号：R779.66[医药卫生—眼科] R776.1[医药卫生—临床医学]