Toric人工晶状体植入矫正特殊角膜散光的疗效观察

Effect of toric intraocular lens in correcting special corneal astigmatism during cataract surgery

目的:回顾分析Toric(环曲面)人工晶状体植入治疗合并特殊角膜散光的白内障患者的临床治疗效果。方法:对10例12眼合并特殊角膜散光的白内障患者行超声乳化白内障吸出及人工晶状体植入术治疗,进行回顾性分析。其中4眼为翼状胬肉切除术后,3眼为外伤后角膜散光,5眼为角膜云翳或斑翳患者。术后随访6mo,分析不同时间点裸眼视力、术后残余散光、并发症等,观察Toric人工晶状体植入后的疗效,旋转稳定性。结果:术后随访观察6mo,术后裸眼视力平均0.62±0.31,最佳矫正视力0.70±0.35。裸眼视力≥0.8者2眼,占17%。裸眼视力≥0.5者9眼,占75%。术后残余散光0.51±0.36D。术后角膜源性散光未见明显改变,全眼总合散光得到明显改善,差异有统计学意义。术后全眼总合散光与术前预计残余散光值接近,无显著性差异。术后6mo旋转度为(3.80±1.46)°。末次随访时间点,植入Toric人工晶状体的12眼中,旋转度小于5°的11眼,占92%。仅1例术后旋转度为6°。结论:对于某些特殊原因导致角膜散光的白内障患者,经过严格的手术前筛选,行白内障超声乳化吸出联合Toric人工晶状体植入,能够安全、有效的改善患者的散光,提高术后视觉质量,预测性好。

AIM： To evaluate the clinical effect of toric intraocular lens （IOL） implantation as a treatment of special corneal astigmatism during phacoemulsification.METHODS： Ten patients 12 eyes with cataract and corneal astigmatism had toric IOL implantation during phacoemulsification. 4 eyes had pterygium surgery before, 3 eyes got corneal scar after wound, 5 eyes had corneal nebula or macula. Outcome measurements were uncorrected distance visual acuity （UDVA）, best-corrected distance visual acuity （BCDVA）, postoperative refractive cylinder, toric IOL axis rotational stability and complications in 6 months following-up.RESULTS： Six months postoperatively, mean UDVA was 0.62±0.31, mean BCDVA was 0.70±0.35. UDVA was better than 0.8 in 2 eyes （17%） and better than 0.5 in 9 eyes （75%）. Residual refractive cylinder postoperatively was 0.51±0.36D. Corneal astigmatism did not change significantly. Residual astigmatism was significantly lower than preoperative. The mean IOL misalignment was 3.80±1.46 degrees, less than 5 degrees in 11 eyes （92%）. Only 1 eye got rotation in 6 degrees.CONCLUSION： Implantation of the toric IOL during cataract surgery is effective, predictable and safe in correcting some special cases with corneal astigmatism.