不同切口白内障手术角膜散光变化的临床观察

Clinical Observation of Corneal Astigmatism after Cataract Operation by Different Incision

目的:观察不同手术切口的白内障囊外摘除联合人工晶状体植入手术后角膜散光的变化。方法:将194例212眼年龄相关性白内障随机分为三组。A组69眼,为上方角巩缘大阶梯切口,切口长度为11mm弦长(约120°弧度);B组71眼,为上方巩角膜切口,切口长度为5.8mm弦长;C组72眼,为距角巩缘3mm的反眉弓形巩膜遂道切口,遂道宽度示为5.8mm。晶状体核处理:A组采用双手压迫法将核娩出,B、C组均以碎核器将晶状体核分为两半后再用晶状体圈匙捞出。三组均为同一术者并用同种人工晶状体及逢线,术后处理也基本一致。术前、术后1周、1月、3月查视力及应用角膜曲率计观察角膜散光变化。结果:术前A、B、C组平均角膜散光为0.81±0.33、0.84±0.30、0.79±0.29D。术后1周、1月、3月平均角膜散光度及裸眼远视力≥0.5的眼数分别是:A组:4.31±1.37、3.56±1.24、2.46±1.18D,36眼,49眼,60眼;B组:3.54±1.05D,3.03±1.03D,2.35±1.01D,42眼,55眼,65眼;C组:1.72±0.43D,1.36±0.41D,0.88±0.36D,56眼,61眼,70眼。经t及χ2检验,三组间以上二种参数分别进行比较,术后1周及1个月时,有显著性差异(P<0.05);3个月时,A组及B组比较无显著性差异(P<0.05),但C组与A、B组比较均有显著差异(P<0.05)。结论:白内障囊外摘除联合人工晶状体植入术采用巩膜遂道切口,术后散光小,视力恢复快,值得临床推广。

Objective:To observe the changes of corneal astigmatism after surgery for cataract by different incision. Methods: One hundred and ninety four cases (212 eyes)were divided into three groups at random. The incision of group A (69 eyes) was a big ladder kind on superior limbus,the lenth of wound was 11 mm. The length of superior sclerocornea wound of B groups (71 eyes) was 5. 8 mm , and the lenth of scleral tunnel incision that was 3 mm in group C (72 eyes). Lens nucleus were extruded in group A and were taken out after being divided into the two halves in B and C group. All other treatment were the same basically. The visual acuity and corneal astigmatism were observed before operation and at 1 w ,1 m ,3 m after operation. Rosults:Before operation,the average astigmatism were 0.81±0.33 D in group A; 0.84±0.30 D in group B; 0.79±0.29 D in group C. The average astigmatism and the amount of uncorrected visual acuity (≥0.5) wre observed postoperative at 1 w ,1m and 3m in all three groups.The difffrences among the three groups were significant (P<0.05) at 1w and 1m after operation,but the difference between group A and group B was not significant at 3 m after operation (but group C versus A and B group ,P<0.05). Conclusion: Surgically induced astigmatism is very small after extracapsular cataract extraction combined with IOL implantation through scleral tunnel incision, a better and quicker rehabilitation of uncorrected visual acuity can be obtained in the early postoperative period.