高度角膜散光白内障患者植入Toric IOL的临床观察

Clinical effect of cataract surgery with higher power toric intraocular lens implantation in patients with high corneal astigmatism

目的:评估高度角膜散光患者植入高度数环曲面人工晶状体(AcrySof Toric intraocular lens,Toric IOL)术后的视力和屈光结果。方法:对21例24眼高度角膜散光的白内障患者行回顾性系列研究,术前角膜散光≥2.5D,植入AcrySof Toric IOL(T6,T7,T8或者T9)。研究数据包括术前和术后3mo的裸眼远视力(uncorrected distance visual acuities,UCDVA)、最佳矫正远视力(best-corrected distance visual acuities,BCDVA)、术前角膜散光、术后残留散光和散光轴向的偏离情况。结果:术后3mo的UCDVA中75%(18/24)患眼视力>0.5,显著高于术前BCDVA,两组差异有统计学意义(χ2=50.12,P<0.05)。术前角膜散光是3.45±0.63D。术后3mo残留的散光是0.72±0.23D。两者差异具有统计学意义(t=0.128,P<0.01)。术后67%(16/24)的眼残留散光<0.75D,83%(20/24)的眼<1.00D。术前预计矫正散光3.12±0.54D,术后实际矫正散光3.05±0.66D,两者差异无统计学意义(t=1.659,P>0.05)。人工晶状体术后3mo和1wk之间的旋转度数是3.2°±2.1°。结论:植入高度数Toric IOL是一种安全的、有效的和可预测的治疗白内障合并高度角膜散光的方法。

AIM：To evaluate the visual and refractive outcomes after higher power toric intraocular lens（IOL） implantation in patients with high amounts of corneal astigmatism. METHODS：This study comprised 21 cases 24 eyes with cataract and more than 2.5 diopters （D） of corneal astigmatism who had toric AcrySof SN60T6, SN60T7, SN60T8 or SN60T9 IOL implantation. The preoperative and postoperative 3 months uncorrected distance visual acuity （UCDVA） and best-corrected distance visual acuity （BCDVA）, preoperative corneal astigmatism, residual refractive cylinder and IOL axis and position in postoperative 1 week and 3 months were evaluated.RESULTS：Three months postoperatively, 75% of eyes showed the 0.5 or better in UCDVA. The preoperative corneal astigmatism was 3.45±0.63D. The postoperative 3 months residual refractive cylinder was 0.72±0.23D（P〈001）. The anticipated correction was 3.12±0.54D. The achieved correction was 3.05±0.66D （P〉0.05）. The mean Toric IOL misalignment was 3.2°±2.1°. CONCLUSION：Implantation of higher power toric IOL during cataract surgery is a safe, effective and predictable method in correcting high amounts of corneal astigmatism.