Toric IOL植入与角膜缘松解切开术矫正白内障低中度角膜散光的效果及安全性观察  

Effects and Safety of Toric IOL and Keratotomy in Correcting Low-to-moderate Corneal Astigmatism in Cataract

作　　者：黄燕治 欧婷婷 吴瑜瑜[1] HUANG Yan-zhi;OU Ting-ting;WU Yu-yu(Department of Ophthalmology,the Second Affiliated Hospital of Fujian Medical University,Quanzhou,Fujian 362000,China)

机构地区：[1]福建医科大学附属第二医院眼科,福建泉州362000

出　　处：《临床误诊误治》2021年第2期103-108,共6页Clinical Misdiagnosis & Mistherapy

基　　金：福建省自然科学基金(2019J01414)。

摘　　要：目的研究散光矫正型人工晶状体(toric intraocular lens,Toric IOL)植入和角膜缘松解切开术(limbal relaxingincision,LRI)矫正白内障低中度角膜散光的效果及安全性。方法选取2016年1月—2020年1月我院行白内障超声乳化及散光矫正治疗的白内障低中度角膜散光90例(90眼),根据手术方案不同分为观察组38例(38眼)和对照组52例(52眼),观察组予Toric IOL植入,对照组予LRI治疗,比较两组术前和术后3个月时裸眼视力(UCVA)、最佳矫正视力(BCVA)、角膜散光相关指标、手术源性散光和散瞳前后眼压、前房容积、中央区及切口区角膜厚度,术前及术后3个月时瞳孔6 mm范围内彗差(Coma)、三叶草像差(Trefoil)及总高阶像差(HOA),并观察术中和术后3个月并发症发生情况。结果两组UCVA和BCVA较术前均明显降低,且观察组UCVA低于对照组,差异有统计学意义(P<0.01)。术后3个月,两组角膜散光、CJ0和CJ45均较术前明显降低,且观察组角膜散光、CJ0和CJ45低于对照组,差异均有统计学意义(P<0.05或P<0.01)。对照组散瞳前、后切口区角膜厚度较术前均明显增加且高于观察组(P<0.01)。术后3个月,对照组Coma、Trefoil和HOA较术前明显增加(P<0.01),且观察组Coma、Trefoil和HOA均低于对照组,差异有统计学意义(P<0.05或P<0.01)。两组术中及术后3个月并发症发生率比较差异无统计学意义(χ^2=0.509,P=0.476)。结论Toric IOL植入和LRI两种手术方案治疗白内障低中度角膜散光均具有良好效果和安全性,但Toric IOL植入有利于减少切口对角膜厚度和高阶像差的影响,UCVA和角膜散光改善效果较LRI更佳。Objective To study the effects and safety of toric intraocular lens(Toric IOL)and keratotomy in correcting low-to-moderate corneal astigmatism in cataract.Methods A total of 90 patients(90 eyes)who underwent phacoemulsification and astigmatism correction in our hospital were selected from January 2016 to January 2020.According to the different surgical regimens,they were divided into IOL group(38 cases,38 eyes)and limbal relaxing incision(LRI)group(52 cases,52 eyes).The uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),corneal astigmatism-related indexes,surgically induced astigmatism(SIA),and intraocular pressure,anterior chamber volume and corneal thickness in the central area and incision area before and after mydriasis and coma aberration within 6 mm of the pupil(Coma),trefoil and total higher-order aberration(HOA)before surgery and at 3 months after surgery were compared between the two groups.The occurrence of intraoperative and postoperative complications were observed.Results The UCVA and BCVA in the two groups were significantly reduced compared with those before surgery,and the UCVA in IOL group was lower than that in LRI group(P<0.01).At 3 months after surgery,the corneal astigmatism,CJ0 and CJ45 in the two groups were significantly reduced compared with those before surgery,and the corneal astigmatism,CJ0 and CJ45 in IOL group were lower than those in LRI group(P<0.05 or P<0.01).The corneal thickness in the incision area before and after mydriasis in LRI group was significantly increased compared with that before surgery and was higher than that in IOL group(P<0.01).At 3 months after surgery,the Coma,trefoil and HOA in LRI group were significantly increased compared with those before surgery(P<0.01),and the Coma,trefoil and HOA in IOL group were lower than those in LRI group(P<0.05 or P<0.01).There was no significant difference in the incidence rate of complications between the two groups(χ^2=0.509,P=0.476).Conclusion Both Toric IOL and LRI have good effects and safety in the treatme

关 键 词：白内障 散光 散光矫正型人工晶状体 角膜切开 裸眼视力 最佳矫正视力 角膜厚度 三叶草像差 

分 类 号：R776.1[医药卫生—眼科]