白内障术中飞秒激光弧形角膜切开术矫正角膜散光的疗效  

Clinical Observation on Correction of Corneal Astigmatism by Femtosceond Laser-Assisted Arcuate Keratotomy during Cataract Surgery

作　　者：张帆 李绍伟 霍冬梅 李秋梅 苗源 梁伟彦 李鑫鑫 Fan Zhang;Shaowei Li;Dongmei Huo;Qiumei Li;Yuan Miao;Weiyan Liang;Xinxin Li(Aier School of Ophthalmology,Central South University,Changsha 410009,China;Beijing Aier-Intech Eye Hospital,Beijing 100021,China)

机构地区：[1]中南大学爱尔眼科学院,长沙410009 [2]北京爱尔英智眼科医院,北京100021

出　　处：《中华眼视光学与视觉科学杂志》2023年第1期24-32,共9页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的:研究白内障术中飞秒激光弧形角膜切开术(FSAK)矫正术前角膜散光的临床疗效。方法:回顾性病例对照研究。连续纳入北京爱尔英智眼科医院2017年3月至2021年12月术前规则角膜散光为0.75~2.00 D且接受飞秒激光辅助白内障手术的患者89例(89眼)。所有患者按照术前角膜散光轴位分为顺规散光组(90°±30°)、逆规散光组(180°±30°)及斜轴散光组(45°±15°、135°±15°)。飞秒激光辅助白内障手术及弧形角膜切开术使用Lensx平台。观察患者总体和顺规、逆规散光组术前及术后3个月角膜散光的变化及分布情况。使用配对样本t检验或Wilcoxon符号秩检验比较总体及各亚组术前、术后的散光差异;使用独立样本t检验或Mann-Whitney U检验比较顺规散光组及逆规散光组的差异;散光变化的分析采用Alpins矢量分析法。结果:纳入的89例(89眼)患者中,顺规散光组38例,逆规散光组44例,斜轴散光组7例。所有患者角膜水平径为(11.48±0.57)mm,垂直径为(10.66±0.60)mm。患者总体术后裸眼远视力、最佳矫正远视力相比术前有显著改善(Z=8.01、-7.49,P<0.001)。总体术前角膜散光为(1.28±0.33)D,术后3个月残余散光(0.67±0.37)D,散光矫正量为(0.61±0.33)D。顺规及逆规散光组角膜散光矫正量分别为(0.48±0.27)D、(0.74±0.34)D。总体及顺规、逆规散光组术后平坦轴角膜曲率均有明显升高,而陡峭轴角膜曲率则出现明显下降。矢量分析法显示总体散光矫正指数为0.63±0.30,平坦指数为0.58±0.30,成功指数为0.51±0.25,误差角为-1.83°±12.59°。逆规散光组矫正效果最佳,矫正指数为0.81±0.25,平坦指数为0.75±0.26,成功指数为0.40±0.24;顺规散光组次之,矫正指数为0.42±0.21,平坦指数为0.39±0.21,成功指数为0.63±0.21。结论:白内障术中FSAK矫正术前角膜散光具有良好的有效性和安全性,相同的弧形切口设计方式在逆规散光中取得了更好的疗效,角�Objective:To research the clinical effect of femtosceond laser-assisted arcuate keratotomy(FSAK)in the correction of preoperative corneal astigmatism during cataract surgery.Methods:This was a retrospective case control study.Eight-nine patients(89 eyes)with preoperative regular corneal astigmatism of 0.75-2.00 D who underwent femtosecond laser-assisted cataract surgery from March 2017 to December 2021 in Beijing Aier-Intech Eye Hospital were continuously collected.Femtosecond laser assisted cataract surgery and arcuate keratotomy were performed on Lensx platform.All patients were divided into 3 subgroups according to the axis of preoperative astigmatism,with the rule astigmatism group(90°±30°),against the rule astigmatism group(180°±30°)and the oblique astigmatism group(45°±15°and 135°±15°).Femtosecond laser-assisted cataract surgery and arcuate incisions were performed on Lensx platform.Observe the changes and distribution of corneal astigmatism before and 3 months after surgery in the general and subgroups of with the rule and against the rule subgroups.Paired samples t-test or Wilcoxon signed-rank test were used to compare the preoperative and postoperative astigmatism differences between the whole and each subgroup.Independent samples t-test or Mann-Whitney U test were used to compare the differences between the with-the-rule and the against-the-rule astigmatism groups,astigmatism change analysis using Alpins vector analysis method.Results:Eighty-nine patients(89 eyes)were included,there were 38 cases in with the rule group,44 cases in against the rule group and 7 cases in oblique group.The corneal horizontal diameter was 11.48±0.57 mm and the vertical diameter was 10.66±0.60 mm.The post-operative uncorrected distance visual acuity and corrected distance visual acuity of the patients were significantly improved compared with pre-operative.Total mean corneal astigmatism before operation was 1.28±0.33 D,and the residual corneal astigmatism was 0.67±0.37 D at 3 months after operation,the correct

关 键 词：白内障 角膜散光 飞秒激光 弧形角膜切开 角膜直径 

分 类 号：R779.6[医药卫生—眼科]