比较单侧及双侧透明角膜切口在白内障超声乳化吸除联合多焦点人工晶状体植入术后的角膜散光及视觉质量

Corneal astigmatism and optical quality after phacoemulsification and multifocal intraocular lens implantation: single versus double clear corneal incisions

目的对术前角膜散光0.50～1.75 D的白内障术眼,通过在角膜陡峭子午线上设置单侧透明角膜切口或联合对侧透明角膜切口矫正角膜散光,并行白内障超声乳化吸除联合多焦点人工晶状体(MIOL)植入术,对其术后角膜散光情况、视力、对比敏感度及立体视觉进行临床效果观察及相关分析。方法 52例(60只眼)行白内障超声乳化吸除联合MIOL植入术的白内障患者,根据术前角膜散光情况进行分组:(1)单侧透明角膜切口(CCI)矫正组(CCI组):0.50 D≤散光<1.00 D,于陡峭子午线上端做单个3.0 mm切口;(2)联合对侧透明角膜切口(OC-CI)矫正组(OCCI组):1.00 D≤散光<1.7 5 D,于陡峭子午线两端各设置一3.0 mm切口。比较在陡轴上做透明角膜切口矫正散光的患者在术前、术后1 d、1周、1个月、3个月的角膜散光的变化,并在术后3个月时比较OCCI及CCI组散光矫正度数。对术后3个月时,OCCI组、CCI组在非矫正远视力(UCDVA)、非矫正近视力(UCNVA)、对比敏感度、近立体视锐度等视觉质量指标方面进行比较并行统计分析。结果 (1)所有在陡峭子午线上做透明角膜切口的患者术前与术后1 d,1周、1个月和3个月分别相比,角膜散光差异有统计学意义(P<0.05)。(2)术后3个月时OCCI组及CCI组的平均散光矫正量分别为(0.86±0.35)D和(0.41±0.28)D,差异有统计学意义(P<0.001)。(3)术后3个月时OCCI组、CCI组的UCDVA、UCNVA、对比敏感度、近立体视锐度差异均无统计学意义(P>0.05)。结论在角膜陡峭子午线行透明角膜切口可以矫正部分术前角膜散光,双切口具有更强的矫正作用,对于0.50 D≤角膜散光≤1.75 D又期望植入MIOL的患者术后获得良好的视觉质量有重要的临床意义。

Objective The purpose of this study is to evaluate the astigmatism,visual acuity,contrast sensitivity,and stereoscopic acuity after phacoemulsification and multifocal intraocular lens（IOL） implantation using single clear corneal incisions or paired opposite clear corneal incisions on the steep axis in cataract patients with pre-existing astigmatism of 0.5 D ～ 1.75 D.Methods Sixty eyes of 52 patients were involved in this prospective clinical study.（1） CCIs group： patients who had pre-existing astigmatism less than 1.00D underwent 3.0 mm single 0pposite clear corneal incisions.（2） OCCIs group： patients who had pre-existing astigmatism between 1.00 D ～ 1.75 D underwent 3.0 mm paired 0pposite clear corneal incisions.We recorded refractory changes in all patients at 1 day,1 week,1 month and 3 months,and compared the refractory changes between OCCIs and CCIs at 3 months.Uncorrected distance and near visual acuity,contrast sensitivity,and stereoscopic acuity of OCCIs group were also compared with those of CCIs group.Results（1） The astigmatism started to improved in all patients at postoperative day 1 and continue to improve through 1 week,1 month and 3 months in the follow-up（P 0.05）.（2） At 3 months,mean astigmatism was 0.86 ± 0.35 D and 0.41 ± 0.28 D in OCCIs group and CCIs group,respectively.There was significant difference between the two groups（P 0.001）.（3） There was no difference in uncorrected distance visual acuity,uncorrected near visual acuity,contrast sensitivity,stereoscopic acuity between the two groups at 3 months after the operation.Conclusion Clear corneal incisions on the steep axis can reduce pre-existing corneal astigmatism.Paired OCCIs provide an enhanced refractory correction in cataract surgery.It helps to provide better postoperative visual quality for the patients who has pre-existing astigmatism between 0.50 D ～ 1.75 D and wishes to implant multifocal intraocular lens.