透明角膜切口联合对侧单切口角膜缘松解术矫正散光的临床效果

Cataract surgery with a single limbal relaxing incision combined with clear corneal incision on correction of astigmatism

目的动态观察透明角膜切口联合对侧单切口角膜缘松解术对角膜散光的矫正效果。方法选取就诊于我院的白内障患者共68例(76眼),患者术前散光均≥1.5D,随机分为观察组32例(36眼)和对照组36例(40眼),术中观察组在最陡散光轴行透明角膜切口联合对侧单切口角膜缘松解术;对照组在角膜最陡散光轴做成对的角膜缘松解切口,然后按照常规方法进行超声乳化手术。结果所有患者术后散光有了明显的减少,术前与术后的散光值比较,差异有统计学意义(均为P<0.05);术后裸眼视力均有明显的改善,观察组术后3个月视力>0.8的患者占61.1%,对照组占65.0%;观察组与对照组术前散光在1.5～3.0D的患者,术后1d、1周、1个月、3个月的散光值之间比较,差异无统计学意义(均为P>0.05);术前散光>3.0D患者,术后3个月观察组的散光值(1.44±0.41)D与对照组的散光值(1.05±0.36)D比较,差异有统计学意义(t=2.195,P<0.05)。结论采用最陡散光轴的透明角膜切口联合对侧单切口角膜缘松解术与成对的角膜缘松解矫正术前中、低度散光患者具有同样的临床效果,但对于术前高度散光患者后者的效果优于前者。

Objective To compare the effects of performing a single limbal relaxing incision（LRI） combined with a clear corneal incision on a corneal astigmatism with that of paired LRI in cataract surgery.Methods A total of 68 patients（76 eyes） with preoperative astigmatism ≥1.5 D were divided into two groups,32 patients（36 eyes） in observation group performed a single LRI combined with a clear corneal incision on a corneal astigmatism,and 36 patients（40 eyes） in control group performed paired LRI,the routine phacoemulsification was carried in two groups.Results In both groups,postoperative uncorrected visual acuity was significantly improved,the patients with visual acuity 0.8 accounted for 61.1%（22/36） after 3 months in observation group,and the control group was 65.0%（26/40）.Meanwhile,the mean preexisting astigmatism of all patients had significantly reduced,there were statistical differences（all P0.05）.There was no statistical difference at postoperative 1 day,1 week,1 month,3 months in patients with preoperative astigmatism from 1.5 D to 3.0 D（all P0.05）.In the patients with preoperative astigmatism more than 3.0 D,the postoperative astigmatism at 3 months in observation group was（1.44±0.41）D,which in control group was（1.05±0.36）D,there was statistical difference（t=2.195,P0.05）.Conclusion The effect of a single LRI combined with clear corneal incision on a corneal astigmatism appears to be as effective as performing paired LRI when preexisting low and middle astigmatism,but for the high astigmatism,the latter is more effective than the former.