不同方向巩膜隧道切口对白内障术后角膜散光的影响

Effect of scleral tunnel incision cataract extraction with different directions on corneal astigmatism

目的比较与评价不同方向巩膜隧道切口对白内障术后角膜散光的影响。方法回顾性研究78例(80只眼)白内障,行巩膜隧道切口白内障摘除联合硬性人工晶状体植入术,切口在颞上方为A组,切口在鼻上方为B组。设定从巩膜反眉状隧道切口的顶点作一条切线,该切线与术前角膜散光轴形成的夹角,称之为切角。按照切角的度数将上述病例分为C组(小切角组,0°～45°)和D组(大切角组,45°～90°)。比较术后1周、1个月、3个月裸眼视力及角膜散光数值。结果 A组与B组在术后视力和手术后各时期角膜散光度数变化的差异均无统计学意义。C组术后3个月视力优于D组(P<0.05),且手术后各时期角膜散光度数变化的差异均有统计学意义(P<0.05)。结论对于采用小切口无缝线白内障摘除术,根据术前散光轴位选择小切角,可减小术后角膜散光,获得更好的裸眼视力。

Objective To compare and evaluate the effect of scleral tunnel incision cataract extraction with different directions on corneal astigmatism on corneal astigmatism.Methods A retrospective study of 78 patiens（80 eyes） were performed by scleral tunnel incision cataract extraction and rigid intraocular lens implantation,team A with the incision on superior temperal,and team B with the incision on superior nasel.Set a tangent was made from the vertex of inversed frown shaped scleral incision,the Angle formed by the tangent and preoperative corneal astigmatism axis was called Cutting Angle,all the cases were divided into two groups according to the degree of the Cutting Angle,including group C performed with 0°～45°Cutting Angle;Group D performed with 45°～90° Cutting Angle.The visual acuity and corneal astigmatism were measured and compared at postoperative 1 week,1 month and 3 months.Results There were no significant difference in statistics in visual acuity and coneal astigmatism between group A and B at each period after the surgery.At 3 months after surgry,group C achieved better vision than group D（P〈0.05）,and there were significant difference in statistics in the change of corneal astigmatism at each period（P〈0.05）.Conclusion Better visual acuity and less postoperate astigmatism can be got with small sutureless incision cataract extraction to choose small Cutting Angle.