角膜地形图引导下的角膜切口白内障手术矫正角膜散光的研究

Clinical study on astigmatism of phacoemulsification incision decided by corneal topography

目的 观察角膜地形图引导下的透明角膜切口白内障手术对术前及术后散光度的影响.方法 透明角膜切口晶状体超声乳化术240只眼,随机分成三组,每组80只眼.A组：切口位于角膜最大屈光轴方向;B组：切口位于90°方向;C组：切口位于180°方向.观察术前、术后1周、1月、3月角膜散光度和视力变化.结果 （1）A组术后1周、1月和3月裸眼视力＞ 0. 7者多于B组和C组（P ＜ 0. 05）;三组患者术后最佳矫正视力＞ 0. 6者基本相同.（2）A组患者术后1周、1月及3月与术前相比,散光度明显减小（P＜0.01）;术后1周与术后1月、3月相比,散光度也减小（P＜0.05）;而术后1月与3月相比,散光度基本相似（P＞0.05）.（3）A组与B组相比,术后1周、1月及3月时的散光度均明显减小（P＜0.05）;A组与C组相比,术后1周、1月及3月时的散光度也明显减小（P＜0.05）.结论 角膜地形图引导下位于角膜最大屈光轴方向的切口有助于减小术前及术后散光,术后获得较好的裸眼视力.

Objective To observe preoperative and postoperative astigmatism of corneal incision decided by the corneal topography. Methods A total of 240 eyes underwent phacoemulsification with corneal incision were randomly divided into three groups. Group A （80 eyes）, incision at the steepest corneal meridian decided by corneal topography; group B （80 eyes）, incision at 90 °; group C （80 eyes）, incision at 180 °. Corneal astigmatism, visual changes of preoperative and 1 week, 1 month and 3 months postoperative were observed. Results Uncorrected visual acuity （〉0.7） of group A were better than group B and C （P〈0. 05） 1 week, 1 month and 3 months after operation; the best corrected visual acuity （〉0.6） were the same in all three groups of the patients. Astigmatism of group A were significantly reduced （P 〈0.01） 1 week, 1 month and 3 months after operation compared with the preoperative; 1 week compared with 1 month and 3 months postoperative （P 〈0.05）; however, astigmatism was similar 1 month after operation compared with 3 months postoperative （P 〉0.05）. Astigmatism of group A were significantly reduced （P 〈0.05） 1 week, 1 month and 3 months postoperative compared with group B and group C （P 〈0.05）. Conclusions The incision which located at the steepest corneal meridian under the guidance of corneal topography reduces the preoperative and postoperative astigmatism, and attains better uncorrected visual acuity postoperative.