矢量法评价V4c TICL植入术后旋转对近视合并散光矫治效果的影响  

Vector analysis for evaluating the effect of rotation on myopic astigmatism correction after V4c toric collamer lens implantation

作　　者：张波 杜文文 王浩 庞辰久 杨靖 王树林 孙早荷 李金 顾宇伟 Zhang Bo;Du Wenwen;Wang Hao;Pang Chenjiu;Yang Jing;Wang Shulin;Sun Zaohe;Li Jin;Gu Yuwei(Henan Provincial People's Hospital,Henan Eye Hospital,People's Hospital of Zhengzhou University,People's Hospital of Henan University,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院,河南省立眼科医院,郑州大学人民医院,河南大学人民医院,郑州450003

出　　处：《中华实验眼科杂志》2025年第2期144-152,共9页Chinese Journal Of Experimental Ophthalmology

基　　金：河南省科技厅科技攻关联合基金(232103810052)。

摘　　要：目的应用标准化矢量分析法评价V4c复曲面后房型有晶状体眼人工晶状体(TICL)植入术后TICL旋转对近视合并散光矫治效果的影响。方法采用系列病例观察研究方法,选取2021年1—12月在河南省立眼科医院行V4c TICL植入的近视合并散光患者152例268眼,术前球镜度为-15.00~-3.25 D,柱镜度为-5.00~-0.50 D,等效球镜度(SE)为-16.50~-3.88 D。采用扫频眼前节光学相干断层扫描测量术后拱高及TICL实际轴向,计算术后TICL偏转角度。记录术前和术后1个月的裸眼视力(UCVA)、最佳矫正视力(BCVA)、球镜度、柱镜度、SE、目标散光矢量,根据术后1个月主觉验光结果及V4c TICL柱镜轴向计算有效性指数、安全性指数、手术矫正散光矢量(SIA)、误差幅度(ME)、差异矢量绝对值(|DV|)、矫正指数(CI)和成功指数(IS)。比较不同术前散光度、TICL术中固定角度、TICL术后偏转角度及术后拱高患者间各矢量分析参数;评估TICL术后偏转角度与TICL固定角度偏差、术后拱高、视力、屈光度以及各矢量分析参数间的相关性。结果术后1个月,手术安全性和有效性指数分别为1.27和1.29。预期SE和术后SE分别为(-0.11±0.13)和(-0.07±0.52)D,差异无统计学意义(t=-0.994,P=0.321)。V4c TICL植入术后术眼UCVA、BCVA和柱镜度均较术前改善,差异均有统计学意义(t=17.854、5.446、-25.634,均P<0.001)。V4c TICL偏转角度为0°~25°,平均(5.41±4.35)°,与TICL固定角度偏差呈正相关(r s=0.461,P<0.001),与术后柱镜度呈负相关,与术后UCVA、|DV|、SIA均呈正相关(r=-0.360、0.191、0.205、0.142,均P<0.05)。不同分组矢量分析结果比较显示,低散光组患者术后拱高、SIA、|DV|均低于高散光组,CI、IS均高于高散光组,差异均有统计学意义(Z=-3.017、-13.569、-2.793、-2.761、-4.779,均P<0.05)。小角度差组患者术后TICL偏转角度和|DV|均小于大角度差组,差异均有统计学意义(Z=-7.865、-2.080,均P<0.05)。低度偏转Objective To evaluate the effect of toric collamer lens(TICL)rotation on myopia combined with astigmatism correction after V4c TICL implantation using standardized vector analysis.Methods An observational case series study was performed.A total of 152 patients(268 eyes)who underwent V4c TICL implantation for the correction of myopia and myopic astigmatism were enrolled at Henan Eye Hospital from January to December 2021.The preoperative spherical diopter,cylindrical diopter,and spherical equivalent(SE)were-15.00 to-3.25 D,-5.00 to-0.50 D,-16.50 to-3.88 D,respectively.Postoperative TICL vault and axis were measured by anterior segment optical coherence tomography,and postoperative TICL rotation was calculated.Uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),spherical diopter,cylindrical diopter,SE,and target astigmatism vector were recorded before and 1 month after surgery.The effectiveness index,safety index,surgically induced astigmatism vector(SIA),margin of error(ME),absolute value of the difference vector|DV|,correction index(CI),and achievement index(IS)were calculated based on the subjective refraction results 1 month after surgery and the cylindrical axis of the V4c TICL.Vector analysis parameters was compared among patients with different preoperative astigmatism,intraoperative TICL fixation,postoperative TICL rotation,and postoperative vault.The correlation between postoperative TICL rotation and TICL fixed angle deviation,postoperative vault,visual acuity and refraction,and vector analysis parameters were evaluated.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Henan Eye Hospital(No.HNEECKY-2021[13]).Written informed consent was obtained from each subject.Results At 1 month postoperatively,the mean safety and efficacy indices were 1.27 and 1.29,respectively.There was no statistically significant difference between the predicted SE of(-0.11±0.13)D and the postoperative SE of(-0.07±0.52)D(t=-0.994,P=0.321).UCVA,BCVA and cyli

关 键 词：近视 散光 旋转 体层摄影术 光学相干 眼前节 矢量分析 有晶状体眼人工晶状体 后房型 复曲面 

分 类 号：R779.6[医药卫生—眼科]