超声乳化术角膜切口对角膜屈光的影响

Effect of different corneal incisions on corneal refraction af ter phacoemulsification and foldable posterior chamber intraocular lens implanta tion

目的 探讨白内障超声乳化手术中 ,颞侧和上方、斜行和隧道 3.2mm透明角膜切口对角膜屈光的影响。方法收集白内障患者 6 5例 81眼。按随机化原则将患者分为颞侧透明角膜斜行切口组 (A组 )、11:0 0钟位透明角膜斜形切口组 (B组 )和 11:0 0钟位透明角膜隧道切口组 (C组 ) 3组。在术前 1d ,术后 1d、1周、1和 3月进行视力、角膜地形图检查。结果 A、B、C 3组术前散光分别为 (0 .5 1± 0 .2 7)D、(0 .5 2± 0 .31)D、(0 .5 0± 0 .2 7)D。术后 1d、1周、1、3月 ,A组的散光分别为 (0 .74± 0 .31)D、(0 .6 9± 0 .2 9)D、(0 .6 1±0 2 7)D、(0 .5 4± 0 .2 6 )D ;B组分别为 (1.11± 0 .33)D、(1.0 2±0 .30 )D、(0 .89± 0 .31)D、(0 .78± 0 .2 8)D ;C组分别为(1 0 9± 0 .2 7)D、(1.0 1± 0 .2 7)D、(0 .86± 0 .2 9)D、(0 79±0 2 5 )D。术后各阶段散光均高于术前。A组的散光小于B、C 2组 (P <0 .0 5 ) ,B、C 2组之间无统计学差别 (P >0 .0 5 ) ,术后第 1天各组散光最大 ,以后渐减小。术后 1d、1周、1、3月 ,A组的SIA分别为 (0 .6 9± 0 .5 1)D、(0 .6 4± 0 .4 0 )D、(0 .6 5±0 38)D、(0 .5 9± 0 .33)D ;B组分别为 (1.19± 0 .74 )D、(1.0 8±0 .6 0 )D、(0 .87± 0 .4 9)D、(0 .77± 0 .4 0 )D ;

Objective To evaluate the effect of different 3.2mm clear corneal inc isions on induced change of corneal refraction after phacoemulsification and fol dable posterior chamber intraocular lens implantation. Methods In a prospective clinical study, 81 eyes of 65 patients with cataract had phacoemulsification an d implantation of a foldable intraocular lens using a 3.2mm unsutured clear cor neal incision.Sixty-five patients were divided into three groups randomly: Grou p A, received temporal clear corneal oblique incision(28 eyes of 22 cases);Group B ,received superior(11:00) clear corneal oblique incision(26 eyes of 22 cases); Group C,received superior(11:00) clear corneal tunnel incision(27 eyes of 21 ca ses).Patients were examined preoperatively and 1 day, 1 week,and 1 month and 3 months postoperatively by using slit-lamp microsope and corneal topography, and visual acuity also was performed. Surgically induced astigmatism was calculated by vector analysis. Results At preoperatively,the mean astigmatism was (0.51±0.27)D in group A,(0.52±0.31)D in group B and(0.50±0.27)D in group C,respectively.At 1 da y,1week,1 month and 3 months postoperatively,the mean astigmatism and surgicall y induced astigmatism(SIA)in group A was (0.74±0.31)D and(0.69±0.51)D,,(0.6 9±0.29)D and (0.64±0.40)D,(0.61±0.27)D and (0.65±0.38)D,( 0.54 ±0.26)D an d(0.59±0.33)D,respectively;and in group B was(1.11±0.33)D and(1.19±0.74)D,(1 .02±0.30)D and(1.08±0.60)D,(0.89±0.31)D and( 0.87 ± 0.49 )D,(0.78±0.28) D and( 0.77±0.40)D,respectively;and in group C was(1.09±0.27)D and(1.15±0.70)D,(1.0 1±0.27)D and (1.03±0.54)D,(0.86±0.29)D and(0.84±0.51)D,(0.79±0.25)D and(0.7 9±0.37)D,respectively.The mean astigmatism and SIA in group A were lower than i n group B and group C,and the difference was statistically significant(P<0 .05).The difference between group B and group C was not statistically significan t(P>0.05).The superior incision group showed against-the-rule astigmatic changes,whereas with-the-rule astigmatism was seen in the temporal incision gr oup.Conclusion There is a highly statistically significant diff erence in astigmatic and surgically induced astigmatism after temporal and super ior unsutured clear corneal oblique incisions.The degree of astigmatic and SIA a nd the difference between the temporal and the superior incisions decreased over time.There is not statistically significant difference in astigmatic and SIA a f ter oblique and tunnel unsutured clear corneal incisions.