两种人工晶状体在角膜散光白内障的应用研究

Study of two different intraocular lens implantation in cataract patients with binocular astigmatism

目的观察比较双眼角膜散光白内障患眼植入AcrySofReSTOR＋3D或AcrySofToric人工晶状体（IOL）后的远、中、近视力、屈光状态和脱镜率。方法前瞻性对照研究。白内障24例（48眼），年龄18—30岁，术前角膜散光0．75～1．50D，根据患者意愿分为试验组12例（24眼）和对照组12例（24眼）。两组患者行超声乳化吸出术后，试验组双眼均植入AcrySofReSTOR＋3DIOL，对照组双眼均植入AcrySofToricIOL。每位患者两眼手术时间问隔2～4周。以第2眼术后为标准随访3个月。检测双眼的裸眼及最佳矫正远视力、最佳远视力矫正下的中、近视力、屈光状态及问卷调查脱镜率情况，进行相应统计学分析。结果试验组与对照组间术后3个月平均裸眼近视力比较，差异有统计学意义（P〈0．05），试验组优于对照组。两组间术后最佳矫正远视力下的25～70em距离的近、中视力比较，差异有统计学意义（P〈0．05），试验组优于对照组。两组间术后残余散光比较，差异无统计学意义（P〉0．05）。两组中均有83％的患者术后3个月视远时完全脱镜，两组比较差异无统计学意义（P〉0．05）。75％的试验组患者和33％的对照组患者术后3个月视近时完全脱镜，两组比较差异有统计学意义（P〈0．05），试验组优于对照组。结论对于双眼角膜散光小于1．50D、年龄小于30岁的白内障患者，若其视近脱镜的要求较高，且经良好沟通者，行白内障超声乳化时双眼均植入AcrySofReSTOR＋3DIOL，可使具有良好的远、中、近全程视力、较好的满意度和较高的脱镜率。

Objective To assess full vision, refractive condition, the rate of removal of glasses af- ter implantation of AcrySof RoSTOR ＋ 3D or AcrySof Torie intraocular lens （IOL） in cataract patients with binocular astigmatism. Methods This was a prospective case-control study. 24 patients （48 eyes） with 0.75 to 1.25 diopter in our hospital were selected and divided into two groups： the experimental group （12 patients, 24 eyes） and the control group（ 12 patients, 24 eyes）. After phaeoemulsification, the experimental group was implanted with AcrySof RoSTOR ＋ 3D IOL and the control group was implanted with AcrySof Toric IOL. The time interval between two eyes was 2 to 4 weeks. Visual acuity from far to near distance and stere- oscopic vision were evaluated 3 months postoperatively. The uncorrected visual acuity and corrected visual a- cuity, residual refractive spherical and cylindrical power, rate of removal of spectacles were analyzed. Re- suits 3 months after implantation , average uncorrected visual acuities in the experimental group were bet- ter than that in the control group. The near vision, middle vision and distance corrected visual acuities （25 cm to 70 cm） in the experimental group were better than that in control group. The differences were statisti- cally significant （ P 〈 0.05 ）. There was no statistically significant difference in residual cylinder between two groups （P 〉 0.05）. 83% patients in each group took off glasses after 3 months when seeing distance. Therewas no statistically significant difference between two groups （P 〉 0.05 ）＇. 75% patients in the experimental group and 33% patients in the control group took off glasses when seeing near. The difference was statistical- ly significant （P 〈 0.05 ）. Conclusion For cat/tract patients with degree of astigmatism less than 1.5 D, age less than 30 years old and desire for removing the glasses, phacoemulsification combined with implanta- tion of AcrySof RoSTOR ＋ 3D IOL in both eyes can improve their full vision and this surgery has high rate of removal of glasses and high degree of satisfaction.