《2019年美国白内障手术中散光管理共识》解读  

Interpretation of Consensus on Astigmatism Management in Cataract Surgery in the United States in 2019

作　　者：王滨 马华锋[1,2] 李会[1,2] Bin Wang;Hua-Feng Ma;Hui Li(Chongqing Medical University,Chongqing 400016,China;Department of Ophthalmology,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学,重庆市400016 [2]重庆医科大学附属第二医院眼科,重庆市400010

出　　处：《国际眼科杂志》2022年第10期1652-1657,共6页International Eye Science

摘　　要：美国白内障医师协会发布了《2019年美国白内障手术中散光管理共识》,为了帮助我国眼科医生更好地参考和使用该共识,以下进行解释说明,主要内容如下:矫正角膜散光首选散光矫正型人工晶状体(Toric IOL)植入术,术前测量应使用3种或以上的仪器,取其中结果相近的值,然后使用Barrett Toric计算器计算Toric IOL。计算时需考虑手术切口位置、术源性散光(SIA)等,然后选择使术后散光接近0且不翻转散光轴向的Toric IOL,可采用术中自动图像导航系统指导植入。若残余散光引起不适,可选用准分子激光原位角膜磨镶术(LASIK)或人工晶状体置换术矫正。对于存在假性剥脱综合征(PXF)、黄斑病变的患者,不推荐植入Toric IOL。晶状体功能失调综合征(DLS)患者手术禁忌较多,建议高年资医生方可开展。未来需进一步探索襻形状和材料对IOL旋转稳定性的影响。术中像差仪、自动图像引导系统和飞秒激光辅助的白内障手术成为主流方式仍需进一步发展。The American Association of Cataract Surgeons issued the Consensus on Astigmatism Management in Cataract Surgery in 2019. To help Chinese ophthalmologists better comprehend the consensus, the main contents are explained: Toric intraocular lens(Toric IOL) implantation is the first choice for correcting corneal astigmatism. Three or more than three instruments should be used for preoperative measurement, and the values that are consistent with results should be taken. Then the Barrett Toric calculator can be used to calculate Toric IOL. When calculating toric IOL,the position of the surgical incision, surgically induced astigmatism(SIA), etc. should be considered. Then, the Toric IOL that makes resultant astigmatism close to 0 without flipping the astigmatism axis can be selected. The intraoperative automated image-guided systems can be used to guide the implantation. If residual astigmatism causes discomfort, laser in situ keratomileusis(LASIK) or IOL replacement can be used for correction. Toric IOL implantation is not recommended for patients with pseudoexfoliation(PXF) syndrome or macular lesions. There are many contraindications in dysfunctional lens syndrome(DLS) patients, which should be carried out by senior doctors. In the future, it is necessary to explore further the influence of haptic design and optic material on the rotational stability of IOL. Cataract surgery assisted by intraoperative aberrometers, automated image-guided systems or femtosecond laser still needs further development.

关 键 词：白内障 散光 人工晶状体 共识 

分 类 号：R779.66[医药卫生—眼科]