双焦点散光IOL植入和双焦点IOL植入联合角膜缘松解切开术效果比较

Bifocal Toric Intraocular Lenses Versus Bifocal Intraocular Lenses Combined with Limbal Relaxing Incisions to Correct Moderate Astigmatism

目的:比较双焦点散光人工晶状体(IOL)植入术和双焦点IOL植入联合角膜缘松解切开术治疗合并角膜散光的白内障患者的疗效。方法:前瞻性非随机对照研究。连续性纳入2019年7月至2022年6月在抚顺市眼病医院拟行白内障摘除手术且角膜散光度数为0.75~2.50 D的年龄相关性白内障患者67例。患者均行单眼白内障手术。根据自愿原则,其中32例患者行超声乳化白内障吸除术后植入AcrySof IQ ReSTOR Toric IOL作为ART组,35例患者植入AcrySof IQ ReSTOR IOL联合角膜缘松解切开术(LRIs)作为LRIs组。术后3个月对患者进行裸眼远视力(UDVA)、裸眼近视力(UNVA)、对比敏感度和阅读功能等检查,对残余散光进行Alpins矢量分析,并通过视觉质量量表对患者的视觉质量进行综合评估。阅读功能检查采用Radner-Vissum测试进行。术后视觉质量评估采用美国国家眼科研究院屈光不正生活质量量表。采用广义线性模型分别计算2组多因素校正后视觉质量量表各项分数,并采用独立样本t检验对上述数据进行分析。结果:与ART组相比,LRIs组差异向量[(0.52±0.45)D vs.(0.79±0.53)D,t=-3.30,P=0.003]、误差值[(-0.17±0.68)D vs.(-0.37±0.74)D,t=5.24,P<0.001]、错位角绝对值[(-3.39±38.62)°vs.(-2.86±24.71)°,t=-2.10,P=0.036]、矫正指数(0.79±0.71 vs.0.64±0.73,t=2.04,P=0.045)均较小,差异均有统计学意义。ART组成功指数(0.47±0.36)小于LRIs组(0.63±0.49),差异有统计学意义(t=-2.31,P=0.023)。2组术后对比敏感度(包括明视和暗视)、阅读能力比较差异均无统计学意义(均P>0.05)。ART组患者视远脱镜率得分为87.49±15.56,高于LRIs组患者(78.98±16.03),差异有统计学意义(t=2.02,P=0.048),其余视觉质量亚项得分差异无统计学意义(均P>0.05)。结论:ART植入和ReSTOR联合LRIs均能有效地矫正白内障患者散光并解决患者术后视近、视远的脱镜需求。ART植入矫正散光客观效果更好,但2种术式在改善患者主观视觉质量方面,尤其在近距离用眼方面效果无差异。

Objective:To compare the effects of bifocal toric intraocular lens(IOL)implantation and standard nontoric bifocal IOL implantation combined with peripheral corneal limbal relaxing incisions(LRI)in cataract patients with moderate preexisting corneal astigmatism.Methods:A prospective non-randomized controlled study was conducted between July 2019 and June 2022 in Fushun Eye Hospital.Totally of 67 patients with corneal astigmatism between 0.75-2.50 diopters(D)who were scheduled for cataract surgery were included.All patients underwent unilateral cataract surgery and based on the voluntary principle,32 patients underwent ultrasonic emulsification cataract aspiration followed by implantation of AcrySof IQ ReSTOR Toric IOL(ART group),while other 35 patients received AcrySof IQ ReSTOR IOL implantation combined with LRIs(LRIs group).The uncorrected distance visual acuity(UDVA),uncorrected near visual acuity(UNVA),residual astigmatism analysis,contrast sensitivity,reading function,and quality of life were evaluated 3 months after surgery.Reading function was measured using the Radner-Vissum test,and postoperative quality of life was assessed using the National Eye Institute Refractive Error Quality of Life(NEI-RQL)questionnaire.Independent sample t-tests were used to analyze the data.Generalized linear models were used to calculate the scores of NEI-RQL for both groups.Results:Compared with the ART group,the LRIs group had smaller difference vector(0.52±0.45 D vs.0.79±0.53 D,t=-3.30,P=0.003),magnitude of error(-0.17±0.68 D vs.-0.37±0.74 D,t=5.24,P<0.001),absolute value of angle of error(-3.39±38.62°vs.-2.86±24.71°,t=-2.10,P=0.036),and correction index(0.79±0.71 vs.0.64±0.73,t=2.04,P=0.045).The success index of the ART group was significantly lower than that of the LRIs group(0.47±0.36 and 0.63±0.49,t=-2.31,P=0.023),while the successful rate of not wearing glasses after surgery was significantly higher than LRIs group(87.49±15.56 and 78.98±16.03,t=2.02,P=0.048).The postoperative comparison between the two groups showed no statistically significant differences in contrast sensitivity(both photopic and scotopic)or reading ability(all P>0.05).Conclusions:Both ART implantation and ReSTOR combined with LRIs can effectively correct patients'astigmatism and address their postoperative need for not wearing glasses.ART implantation showed better efficiency in correcting astigmatism,while the two therapies exhibited comparable efficacy in improving patients'subjective visual quality,especially in terms of near vision.