不同位置角膜切口白内障超声乳化对角膜表面形态的影响

Corneal superficial shape changes induced by phacoemulsification at different corneal incisions

目的探讨颞侧和上方3.2mm透明角膜切口白内障超声乳化联合折叠式人工晶状体植入术对角膜表面形态的不同影响。方法收集老年性白内障患者44例54眼,将患者随机分为颞侧透明角膜切口组(A组)和上方透明角膜切口组(B组)。检查术前、术后1d、1周、1个月和3个月视力、手术源性散光(surgically induced astigmatism,SIA)和角膜地形图。结果术后1d、1周、1个月、3个月,A组SIA分别为(0.70±0.34)D、(0.64±0.29)D、(0.60±0.27)D、(0.55±0.26)D,B组分别为(1.18±0.48)D、(1.05±0.42)D、(0.88±0.38)D、(0.77±0.35)D。术后1d,A组SIA较B组小,差异有统计学意义(P<0.05);随着时间的推移,2组SIA逐渐有减小趋势,但A组SIA仍小于B组,术后3个月差异仍有统计学意义(P<0.05)。术后1d,2组角膜表面非对称性指数(surface asymmetry index,SAI)、角膜表面规则指数(surface regularity index,SRI)均较术前增大,差异有统计学意义(P<0.05),其中A组的SAI、SRI较B组小,差异有统计学意义(P<0.05)。术后1周,A组SAI、SRI同术前相比差异无统计学意义(P>0.05);B组SAI、SRI仍比术前高,差异有统计学意义(P<0.05)。术后1个月、3个月2组SAI、SRI同术前相比差异均无统计学意义(P>0.05),2组之间各相应时间点SAI、SRI的差异也均无统计学意义(P>0.05)。结论颞侧透明角膜切口操作方便,术后SIA、SAI、SRI均小于上方透明角膜切口,对角膜表面形态的影响小,术后早期视力恢复好,是较理想的手术切口方位。

Objective To investigate the corneal superficial shape changes induced by phacoemulsification and foldable IOL implantation with 3.2 nun clear corneal incision at temple or superior part. Methods Fifty four eyes of 44 patients with senile cataract were collected. All patients were randomly divided into two groups. Group A received temporal clear corneal incision;Group B received superior clear corneal inci- sion. Visual acuity, surgically induced astigmatism （SIA） and corneal topography were examined preoperatively and at 1 day, 1 week, and 1 month and 3 months postoperatively. Results At 1 day, 1 week, 1 month and 3 months postoperative, SIA in group Awere （0.70 ＋0.34）D, （0.54 ＋0.29）D, （0.60 ＋0.27）D and （0.55 ＋0.26）D, respectively, and in groupBwere （1.18＋0.48）D, （1.05＋0.42）D, （0.88 ＋0.38）D and （0. 77 ＋ 0.35 ） D, respectively. At 1 day postoperative, SIA of group A was lower than that of group B （P 〈 0.05 ）. With the time prolonged, SIA of both two groups had the tendency to decrease, but SIA of group A was still lower that of group B at each corresponding time （P 〈 0.05 ）. And there was statistical difference between two groups at 3 months postoperatively（P 〈 0.05 ）. At 1 day postoperatively, surface asymmetry inde （SAI） and surface regularity index（SRI） of two groups were higher than those preoperatively（P 〈0.05）, and the SAI and SRI of group B were higher than those of group A （ both P 〈 0. 05 ）. At 1 week postoperatively, the SAI and SRI of group A had no significant difference with those preoperatively（ both P 〉 0.05 ）. SAI and SRI of group B were higher than those preoperatively（ both P 〈 0.05 ）. At 1 month and 3 months postoperatively, the SAI and SRI of two groups had no statistical significance with those preoperatively（ all P 〉 0.05 ）, and there was no significant difference in SAI or SRI between two groups at each corresponding time （ all P 〉 0. 05 ）. Conclusions The temporal clear corneal incision is easy performed, with less corneal superficial shape changes and well visual acuity recovery at early stage postoperatively. SIA, SAI and SRI of temporal clear corneal incision are less than those of superior clear corneal incision. Temple is an ideal position for corneal incision.