角膜K值引导透明角膜双切口在白内障超声乳化联合多焦点人工晶状体植入术中研究

A clinical study of cataract phacoemulsification and implantation of multifocal intraocular lens with paired clear corneal incision guided by K values

目的观察术前具有1．00～1．50D角膜散光的年龄相关性白内障患者行超声乳化联合多焦点人工晶状体植入术，采用角膜K值引导的透明角膜双切口方法矫正角膜散光的效果及术后视觉质量，并评价该手术方法的可行性、安全性。方法临床病例对比研究。选取2010年3月至2012年3月在乐山市人民医院眼科就诊的年龄相关性白内障角膜散光≤1．50D患者共48例（96只眼）。依据术前光学相干生物测量仪（IOL—Master）检测角膜散光的结果，将角膜散光在1．00—1．50D的患者采用最陡散光轴行透明角膜双切口白内障超声乳化联合多焦点人工晶状体植入术，作为观察组41只眼。角膜散光〈1．00D的患者采用最陡散光轴行透明角膜单切口白内障超声乳化联合多焦点人工晶状体植人术，作为对照组55只眼。术后3个月观察角膜散光度变化情况，裸眼远、中、近视力及最佳矫正远、近视力，对比敏感度和问卷调查。结果术后3个月进行两组比较，患者术后角膜散光较术前皆明显降低，差异有统计学意义（P〈O．05）；术后3个月角膜残余散光度数比较差异无统计学意义（P〉O．05）；裸眼和矫正远视力、近视力及中距离视力方面差异无统计学意义（P〉0．05）；术后3个月对比敏感度均位于正常范围内，在低频区和高频区二者的差异无统计学意义（P〉0．05），仅在中频区（6c／d）差异有统计学意义（P〈0．05），观察组低于对照组；术后3个月脱镜率、夜间视力模糊、眩光和光晕无统计学差异（P〉0．05）。结论白内障超声乳化联合多焦点人工晶状体植入术中，采用角膜K值引导的透明角膜双切口矫正1．00—1．50D角膜散光能获得与多焦点人工晶状体传统适应证范围内患者相同的全程视力和视觉质量，该方法可拓展多焦点人工晶状体的适应证范围。

Objective To observe the effect of phacoemulsification with paired clear corneal inci sion guided by K values on the correction of preoperative corneal astigmatism and the visual func tion after implantation of multifocal intraocular lens, and evaluate the feasibility and security of this surgical method. Methods Fortyeight patients （96 eyes） with agerelated cataract and corneal astig matisml.50D were enrolled in this study. According to the preoperative corneal astigmatism mea sured by IOLMaster, they were divided into two groups; 30 patients （41 eyes） whose preoperative corneal astigmatism was 1.00D to 1.50D, as observation group, 37 patients （55 eyes） whose astigma tism less than 1.0D were included in control group. The observation group received the clear come al incision on the steepest meridian axis guided by K values during phacoemulsification and implant ed IQ ReSTOR ＋3D multifocal intraocular lens, an additional symmetric clear corneal incision was made on the opposite side. And the control group only received the clear corneal incision on thesteepest meridian axis guided by K values during phacoemulsification and implanted IQ ReSTOR ＋ 3D multifocal intraocular lens. Three months after surgery, corneal astigmatism change, naked and corrected visual acuity in near, intermediate and fardistance, contrast sensitivity and patient ques tionnaires were observed. Results The mean preexisting astigmatism in the two groups significantly reduced postoperatively （after 3 months）. Between the two groups, there were significant statistical differences （P 〈0.05）, but there were no significant statistical difference in postoperative residual astigmatism （P 〉0.05）. No significant statistical difference existed in uncorrected and corrected visual acuity in near, intermediate and fardistance （P 〉0.05）. The postoperative contrast sensitivity in the two groups were normal, there was no significant difference in low frequencies and high frequencies （P 〉0.05）, only there was statistical difference in medium frequency （P 〈0.05）, the observation group lower than those of the control group. There was no statistically significant difference in the offnear glass rate, night blurred vision, glare and halos in two groups. Conclusions The cataract patients with high astigmatism who receive phacoemulsification with paired clear corneal incision guided by K values and implantation of multifocal intraocular lens can obtain good results, such as visual acuity in near, intermediate and fardistance, and quality of vision. This surgical method can develop clinical aoolication range of the multifocal intraocular lens.