飞秒激光联合对称弧形角膜切口对白内障合并角膜散光患者的治疗效果  

Therapeutic effect of femtosecond laser combined with symmetrical curved corneal incision on the patients with cataract accompanied by corneal astigmatism

作　　者：胡尊霞 柯妍 曹加国 李康[1] 龙静姬 郭琼天 何洁琼 刘颖[1] 司马晶 HU Zunxia;KE Yan;CAO Jiaguo;LI Kang;LONG Jingji;GUO Qiongtian;HE Jieqiong;LIU Ying;SIMA Jing(Shenzhen Aier Eye Hospital,Jinan University,Shenzhen 518000,Guangdong Province,China)

机构地区：[1]暨南大学附属爱尔眼科医院(深圳)白内障科,广东省深圳市518000

出　　处：《眼科新进展》2023年第3期221-225,共5页Recent Advances in Ophthalmology

基　　金：深圳爱尔眼科医院科研项目(编号:SZAE2020B03);爱尔眼科医院集团科研基金资助项目(编号:AF2102D5)。

摘　　要：目的 评估飞秒激光联合对称弧形角膜切口对白内障合并角膜散光患者的治疗效果。方法 前瞻性研究。收集43例(57眼)白内障合并≥0.75 D角膜规则散光的患者,均行飞秒激光超声乳化白内障手术,术中同时采用对称弧形角膜切口矫正角膜散光。弧形切口设置在角膜直径中央8.0 mm处,深度为角膜厚度的85%,术中开口器分离弧形切口。术前及术后均采用Pentacam三维眼前节分析系统记录角膜散光。采用Alpins矢量法分析术后角膜散光变化,并分析散光类型、年龄与散光矫正效果的相关性。结果 术中及术后所有患者均未出现角膜穿透、上皮损伤、角膜上皮增生、切口感染等并发症。术前患眼角膜散光为(1.23±0.31)D,术后3个月患眼角膜散光下降到(0.85±0.34)D,差异有统计学意义(t=4.645,P=0.000)。对患者手术前后角膜散光的变化进行矢量分析,结果显示,目标诱导散光为0.80~2.10(1.23±0.31)D,手术诱导散光为0.00~1.80(0.68±0.45)D,差异向量为0.26~1.70(0.89±0.42)D,矫正指数为0.00~1.01(0.55±0.27),理想值为1,提示总体为欠矫。误差角为≤15°者50.88%(29眼)。成功指数为0.20~1.30(0.77±0.38)。年龄及术前角膜散光度数与矫正指数无线性关系。逆规散光患者矫正效果优于顺规散光(P=0.027)。结论 飞秒激光联合对称弧形角膜切口矫正白内障合并角膜散光安全、有效,逆规散光患者矫正效果较好,但总体欠矫。Objective To evaluate the correction effect of femtosecond laser-assisted cataract surgery combined with symmetrical curved corneal incision on cataract patients with corneal astigmatism. Methods A prospective study was conducted. A total of 43 patients(57 eyes) with cataract accompanied by regular corneal astigmatism ≥0.75 D who underwent the femtosecond laser-assisted phacoemulsification cataract surgery combined with symmetrical curved corneal incision were included. The incision was set at 8 mm from the central cornea intraoperatively with a spreader, with a depth of 85% of the corneal thickness. Corneal astigmatism was recorded by Pentacam 3D anterior segment analysis system before and after the surgery. The changes in postoperative corneal astigmatism were analyzed by the Alpins vector method, and the correlation between astigmatism type, age and astigmatism correction effect was analyzed. Results There were no complications such as corneal penetration, epithelial injury, corneal epithelial hyperplasia, and incision infection intraoperatively and postoperatively. The preoperative corneal astigmatism was(1.23±0.31) D, and that 3 months after the surgery decreased to(0.85±0.34) D, showing a significant difference(t=4.645, P=0.000). Vector analysis of the changes in corneal astigmatism showed that the target-induced astigmatism was 0.80 to 2.10(1.23±0.31) D, the surgery-induced astigmatism was 0.00 to 1.80(0.68±0.45) D, and the difference vector was 0.26 to 1.70(0.89±0.42) D, the correction index(CI) was 0.00 to 1.01(0.55±0.27) with an ideal value of 1, indicating the overall under-correction. The error angle is no more than 15° or 50.88%(29 eyes). The index of success was 0.20 to 1.30(0.77±0.38). Age and preoperative corneal astigmatism did not correlate with CI;the correction effect of against-the-rule astigmatism was better than with-the-rule astigmatism(P=0.027). Conclusion Femtosecond laser-assisted cataract surgery combined with the symmetrical curved corneal incision is safe and effective, sho

关 键 词：飞秒激光辅助白内障手术 飞秒激光弧形角膜切口散光矫正术 角膜散光 白内障 

分 类 号：R776.1[医药卫生—眼科]