“T”切口矫正白内障合并角膜高度散光的临床观察

Effect of "T" incision on correcting cataract combined with high corneal astigmatism

目的评价超声乳化白内障摘出术中"T"形切口矫正术前角膜散光的作用。方法年龄相关性白内障患者39例(46眼),所有患者术前角膜散光度(角膜地形图检查)均>2.00D。随机将患者分为2组:A组18例(23眼),B组21例(23眼)。A组患者行透明角膜3.0mm切口超声乳化白内障摘出联合后房型人工晶状体植入术,B组患者首先完成同A组的手术操作,然后以最陡峭子午线为中心,可调钻石刀作成对横切口,即"T"形切口。观察术后1周、1个月、3个月患者的裸眼视力、角膜散光情况及散光轴向。结果 A组患者术前平均角膜散光度数为(2.43±0.34)D,术后1周、1个月、3个月平均角膜散光度数分别为(2.53±0.31)D、(2.46±0.27)D、(2.41±0.28)D,手术前后散光度数差异均无统计学意义(均为P>0.05)。B组患者术前平均角膜散光度数为(2.44±0.45)D,术后1周、1个月、3个月平均角膜散光度数分别为(1.85±0.58)D、(1.46±0.46)D、(1.36±0.47)D,手术前后散光度数差异均有统计学意义(均为P<0.01)。术后各时间点A组与B组平均角膜散光度数比较,差异均有统计学意义(P<0.05或P<0.01),B组角膜散光低于A组。两组术后各时间点手术源性散光、散光轴向构成比比较,差异均无统计学意义(均为P>0.05)。结论角膜散光>2.00D的患者在行白内障手术时联合角膜"T"切口,矫正了部分术前散光,视力恢复好,提高了患者的视觉质量。

Objective To evaluate the effect of ＂T＂ incision in phacoemulsification on correcting of preoperative corneal astigmatism.Methods There were 39 cases（46 eyes）with age-related cataract,and preoperative corneal astigmatism of all patients were more than 2.00 D.All patients were randomly divided into 2 groups,18 cases（23 eyes）in group A and 21 cases（23 eyes）in group B.Patients in group A were taken phacoemulsification with 3.0 mm transparent corneal incision combined with posterior intraocular lens implantation.Patients in group B were taken the same procedures as group A,and then steep meridian was made as central,adjustable diamond cutter was used to make lateral incision as ＂T＂ incision.Naked visual acuity,situation of corneal astigmatism and axial direction of astigmatism were observed at pre-operation and at postoperative 1 week,1 month and 3 months.Results Average corneal astigmatism were（2.43±0.34）D,（2.53±0.31）D,（2.46±0.27）D and（2.41±0.28）D at pre-operation and at postoperative 1 week,1 month and 3 months in group A,there were significant differences with pre-operation（all P0.01）.Average corneal astigmatism were（2.44±0.45）D,（1.85±0.58）D,（1.46±0.46）D and（1.36±0.47）D at pre-operation and at postoperative 1 week,1 month and 3 months in group B,there were significant differences with pre-operation（all P0.01）.There were statistical difference in average corneal astigmatism between group A and group B at different postoperative time points（P0.05 or P0.01）.Corneal astigmatism of group B was lower than that in group A.There were significant differences in operative astigmatism and axial direction of astigmatism between group A and group B at different postoperative time points（all P0.05）.Conclusions In patients with corneal astigmatism more than 2.00 D,corneal ＂T＂ incision in phacoemulsfication can correct partial preoperative astigmatism.It has a better recovery of visual acuity and improves visual quality.