有晶状体眼前房型人工晶状体植入术联合角膜松解切开术矫正散光的临床观察

Astigmatic keratotomy to correct astigmatism during phakic anterior chamber intraocular lenses surgery

目的 评估角膜松解切开术（AK）在有晶状体眼前房型人工晶状体植入术（ACPIOL）时矫正散光的临床疗效.方法 前瞻性病例对照研究.高度近视患者45例（75眼）,按主觉验光结果分组：联合组30例（52眼）,散光度≥1D,等效球镜度为（-16.89±4.45）D,最佳矫正视力为4.69±0.24,先行AK再行ACPIOL;单纯组15例（23眼）,散光度＜1 D,等效球镜度为（-15.33±3.36）D,最佳矫正视力为4.82±0.17,直接行ACPIOL.术后1周、9个月,观察最佳矫正视力、等效球镜度、眼总散光度和角膜散光度的变化.使用CRAVY矢量分析法将散光分解后进行相关分析.采用重复测量的方差分析和Wilcoxon秩和检验比较术前和术后观察样本的变化.结果 最佳矫正视力：术后1周、9个月,联合组为4.81±0.15 和4.85±0.16,较术前差异均有统计学意义（P=0.007,P＜0.01）；单纯组为4.88±0.16和4.93±0.14,较术前差异均无统计学意义（P=0.261,P=0.069）.等效球镜度：术后1周、9个月,联合组为（-0.61±1.14）D和（-0.68±1.06）D,单纯组为（-0.57±0.89）D和（-0.77±0.70）D,较术前差异均有统计学意义（P均＜0.05）.验光度数进行CRAVY矢量分解、换算后,术前和术后9个月,联合组为-2.10 D×0.82°和-0.44 D×92.60°,单纯组为-0.52 D×82.18°和-0.28 D×92.04°.术后与术前差异均有统计学意义（P均＜0.05）.角膜地形图进行CRAVY矢量分解和换算后,术前和术后9个月,联合组为-1.65 D×95.59°和-0.44 D×178.70°,单纯组为-0.52 D×7.82°和-0.28 D×92.04°,术后与术前差异均有统计学意义（P均＜0.05）.联合组的安全系数为1.03（4.85/4.69）,有效系数0.79（1.66/2.10）,预测性为-0.44 D.结论 AK在ACPIOL术中矫正规则性散光是安全、有效、稳定的,预测性还有待进一步提高.

Objective To evaluate the safety,efficacy,predictability and stability of astigmatic keratotomy （AK） for the correction of astigmatism during anterior chamber phakic intraocular lens （ACPIOL） surgery.Methods This was a prospective case control study.Fifty-two eyes of 30 patients with 1.0 D or more of refractive astigmatism,underwent AK during ACPIOL surgery （treatment group）.Twenty-three eyes of 15 patients with less than 1.0 D refractive astigmatism,underwent ACPIOL surgery only （control group）.The CRAVY vector analysis of the flattening effect plotted on the target axis was used to assess the effectiveness of the treatment.Data were analyzed with repeated measure variance analysis,Wilcoxon rank sum test,Mann-Whitney U test.Results Average preoperative best corrected visual acuity （BCVA） of the treatment group was 4.69±0.24,reaching 4.81±0.15 （P=0.007）and 4.85±0.16 （P〈0.01） at 1 week and 9 months postoperatively.Average preoperative BCVA of the control group was 4.82±0.17,reaching 4.88±0.16 （P=0.261） and 4.93±0.14 （P=0.069） at 1 week and 9 months postoperatively.The average spherical equivalent （SE） of the treatment group was （-16.89±4.45）D,reaching （-0.61±1.14）D （P〈0.01） and （-0.68±1.06）D （P〈0.01） at 1 week and 9 months,respectively.Average preoperative SE of the control group was （-15.33±3.36）D,reaching （-0.57±0.89）D （P〈0.01） and （-0.77±0.70）D （P〈0.01） at 1 week and 9 months postoperatively,respectively.Eyes in the treatment and control groups showed a statistically significant refractive and corneal astigmatism reduction at the 9-month follow-up evaluation （P〈0.05）.In the treatment group,the safety index was 1.03,the correction index was 79% and the magnitude of error was -0.44 D.Conclusion AK performed during ACPIOL surgery appears to be a safe,effective and stable procedure to reduce pre-existing astigmatism,which remained consistent throughout the follow-up period.Further study is required to improve its predictability.