后房型有晶状体眼散光型人工晶状体矫正散光的临床研究

Clinical research on the correction of astigmatism with a posterior chamber toric intraocular lens

目的观察植入后房型有晶状体眼散光型人工晶状体矫正散光的临床效果。方法前瞻性系列病例研究。选取伴有散光的中高度近视患者61例（113眼），进行后房型有晶状体眼散光型人工晶状体植入术（TICL），于术后1、3、6个月及1、2年进行手术的安全性、有效性、可预测性、稳定性及并发症的观察。手术前后不同时间点间的最佳矫正视力（BCVA）、裸眼视力（UCVA）、眼压与角膜内皮细胞密度的总体差异比较采用重复测量的单因素方差分析，两两时间点比较采用SNK-q检验。结果术前BCVA为4．98±0．12，术后1、3、6个月及术后1、2年BCVA分别为5．04±0．08、5．02±0．09、5．05±0．10、5．04±0．09、5．03±0．11，各个时间点的BCVA差异均无统计学意义（F=2．090，P〉0．05）。术前UCVA为4．03±0．07，术后各时间点UCVA分别为4．92±0．10、4．96±0．09、4．95±0．12、4．94±0．11、4．94±0．08，术后各个时间点的UCVA均较术前有显著提高（F=6．508，P〈0．05）。术后屈光度较稳定，散光度均在0．5D以内；TICL在眼内稳定，术后6个月时106眼（93．8％）旋转小于5°，7眼（6．2％）旋转在5°-10°之间。术中术后未发现严重并发症。结论后房型有晶状体眼散光型人工晶状体植入术矫正散光安全、有效，可预测性及稳定性好。

[Abstract] Objective To investigate the clinical effect on the correction of astigmatism with a posterior chamber phakic toric implantable collamer lens （TICL）. Methods This was a prospective case study. Sixty-one patients （113 eyes） with moderate to high myopia who had undergone TICL implantation were evaluated before surgery and at 1, 3, and 6 months and 1 and 2 years after surgery to assess the safety, efficacy, predictability, stability and adverse events of the surgery. A repeated measures ANOVA test and SNK-q test were used to compare data at different time points, including best corrected visual acuity （BCVA）, uncorrected visual acuity （UCVA）, intraocular pressure （IOP） and the density of corneal endothelial cells. Results Preoperative mean BCVA was 4.98±0.12, postoperative mean BCVAs were 5.04±0.08, 5.02±0.09, 5.05±0.10, 5.04±0.09 and 5.03±0.11, respectively, at 1, 3, and 6 months and 1 and 2 years after surgery. There were no significant differences for the BCVAs at the different time points （F=2.090, P〉0.05）. Preoperative mean UCVA was 4.03-＋0.07, postoperative UCVAs were 4.92±0.10, 4.9±0.09, 4.95±0.12, 4.94±0.11, and 4.94±0.08 at different time points. All BCVAs were significantly different compared to BCVA before surgery （F=6.508,P〈0.05）. Refractive status remained stable after surgery and astigmatism fell below 0.5 D. The TICL remained stable： 106 eyes （93.8%） had rotation less than 5° and 7 eyes （6.2%） had rotation of 5°-10° when measured at 6 months after surgery. There were no serious complications during or after surgery. Conclusion Implantation of a TICL is safe and effective and provides predictable and stable refractive results in the treatment of astigmatism.