6mm无缝线不同位置切口白内障术后散光变化

Astigmatic changes after cataract surgery with different position of 6 mm sutureless incision

目的研究角巩膜缘无缝线不同位置切口对白内障超声乳化摘除联合人工晶体植入术前后散光变化的影响并评价其手术效果。方法对67例(70只眼)白内障患者根据切口位置随机分成两组,A组:上方切口组34只眼,B组:颞上侧(右眼)或鼻上侧(左眼)切口组36只眼,用钻石刀在角巩膜缘后0.5mm做隧道长1.75mm阶梯形切口行白内障超声乳化摘除人工晶体植入术。分别于术前及术后1周、1个月、3个月及6个月用Nikon自动角膜屈光曲率仪测量角膜散光度、轴向。采用Holladay矢量分析法计算手术源性散光度和轴向,比较两组术后不同时间的平均角膜散光度、平均手术源性散光度和术后裸眼视力。结果术后1周B组平均裸眼视力明显好于A组,差异有显著性(P<0.05),术后1、3和6个月两组差异无显著性(P>0.05)。平均角膜散光度和平均手术源性散光度术后1周、1个月和3个月,A组明显大于B组,差异有显著性(P<0.05)。术后散光以术前逆规性散光最甚,术后6个月两组差异无显著性(P>0.05)。A组术后散光轴向全部为逆规性变化,B组术后散光轴向以顺规性散光变化为主。结论颞上侧或鼻上侧切口可有效地减少切口的扩张力并且产生较小的角膜散光,早期可获得良好而稳定的裸眼视力,6mm无缝线角巩膜缘隧道切口安全、可靠。

Objective To study the effect of the different position of near limbus incision on the changes of preoperative and postoperative astigmatism after phacoemulsification and intraocular lens implantation and evaluate their clinical results. Methods Seventy eyes of sixty seven patients were divided into two groups randomly according to the incision location; Group A comprised 34 eyes which had surgery using superior approach, Group B comprised 36 eyes which had surgery using the superolateral apporach. All patients underwent phacoemulsification and intraocular lens implantation through 0.5mm posterior limbus, twostepped tunnel incision which has tunnel length of 1.75mm with diamond knife. Keratometry measurements were obtained preoperatively, at postoperative 1 week, 1 month, 3 months and 6 months respectively by Nikon Keratometre We compared the mean surgically induced astigmatism （SIA）, mean postoperative uncorrected visual acuity between the two groups up to 6 months postoperatively, SIAs were analyzed by “Holladay vector method”. Results Mean uncorrected visual acuity in group B is significantly better than that in group A at 1 week postoperatively （P〈0.05）, but there are no significant differences between the two groups at 1, 3 and 6 months postoperatively （P 〉0.05）. Eyes in the group B displayed significantly less mean SIA and mean corneal astigmatism than group A at 1 week 1 month and 3 months postoperatively especially against-the-rule （ATR） astigmatism preoperatively （P〈0.05）, there are no significant differences between the two groups at 6 month postoperatively （P 〉0.05）. Astigmatic axis in group A is whole ATR astigmatism postoperatively. Astigmatic axis of large number of patients in group B are with- the - rule （WTR） astigmatism postoperatively. Conclusions The superolateral near limbus incision would effectively minimize the wound - stretching forces and result in earlier lesser degree of corneal astigmatism and better uncorrected visual acuity postoperatively. 6mm sutureless near limbus tunnel incision for phacoemulsification with intraocular lens implantation is safety and credible.