白内障超声乳化术不同位置透明角膜切口的角膜散光变化  

The change of corneal astigmatism after cataract surgery with different locations of clear corneal incision

作　　者：张敏[1] 吴强[1] 王文清[1] 陆斌[1] 方健[1] 俞嘉怡[1] 

机构地区：[1]上海市第六人民医院眼科,,上海200233

出　　处：《中国实用眼科杂志》2011年第7期682-685,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的分析白内障患者术前角膜散光情况评估经不同位置透明角膜切El行超声乳化术后的角膜散光变化情况。方法218例（295只眼）白内障患者分为三组，第一组选择颞侧切口，第二组选择颞上方切口，第三组选择上方切口，三组患者通过透明角膜切口行白内障超声乳化及折叠式后房型人工晶体植入术。术前及术后一周、一月、三月分别检测患者角膜散光情况，并通过Holladay—Cravy—Koch方法计算术源性散光。结果术前角膜散光0．5至1．5D的占60．68％，大于等于1．5D的占11．86％，顺归散光占29．49％，逆归散光占51．19％，其余为斜轴散光。术后三次随访颞侧切口组的术源性散光最低，上方切口组的术源性散光最高，具有统计学差异（P〈0．05）。另外，在上方切口组中发现患者术后角膜散光有向逆归散光转变的趋势。结论白内障患者术前大多存在小于1．5D的角膜散光。在白内障术后早期阶段，颞侧透明角膜切VI引起的术源性散光较小，而上方透明角膜切口不仅可引起较显著的术源性散光，并且术后角膜散光有向逆归散光转变的趋势。Objective To analyze the corneal astigmatism before cataract surgery and evaluate the astigmatism changes after cataract surgery performed using clear corneal incisions with different locations. Methods： This randomized prospective clinical study comprised 295 eyes of 218 patients having phacoemulsification and implantation of foldable intraocular lens through a corneal tunnel incision. Patients were randomly divided into three groups depending on the different locations of the incision： temporal, superotemporal and superior. Corneal topography was performed preoperatively and I week, I month, and 3 months postopera- tively. Surgically induced changes were calculated by vector analyses using the Holladay-Cravy-Koch method. Results： Preoperatively, in 60.68% of eyes, corneal astigmatism was between 0.5 and 1.5 diopters （D） and in 11.86%, it was 1.5 D or higher. Meanwhile, about 29.49 percent of eyes had with-the-rule （WTR） astigmatism, while 51.19% had against-the-rule （ATR） astigmatism, and the others had oblique astigmatism. At three follow-up visits postoperatively, the mean magnitude of surgically-induced astigmatism （SIA） was lowest in the temporal incision group and highest in the superior incision group. In addition, an ATR shift was found in the superior incision group. Conclusions： Corneal astigmatism less than 1.5 D was present in most cataract surgery candidates. Cataract surgery using temporal clear corneal incision induced significantly less SIA in the early postoperative period. Superior incision may lead to an ATR astigmatism shift.

关 键 词：白内障 超声乳化 透明角膜切口 角膜散光 

分 类 号：R779.66[医药卫生—眼科]