松解性角膜切开术治疗术后中高度散光的临床观察

Relaxing keratotomy for the treatment of postoperative corneal astigmatism

对人工晶体植入术和穿透性角膜移植术后一年以上 ,存在中高度散光的患者行松解性弧形角膜切开术 ,观察其临床疗效。方法 :10例 (10眼 ) ,其中人工晶体植入术 4例 ,穿透性角膜移植术 5例 ,人工晶体、穿透性角膜移植联合术 1例 ,均术后一年以上 ,3mm视区内的角膜散光≥ 2 .0 0 D,近视≤ 2 .0 0 D,患者的裸眼视力均可矫正。根据角膜地形图确定角膜最高屈折力的径线位置。用 6 .5 mm环钻在角膜中央刻痕 ,在显微镜下用德国 Martin Instrument单刃红宝石刀在屈折力最大的径线上 ,沿环钻的刻痕作一对弧形切口 ,深度为角膜厚度的 1/ 2～ 2 / 3,切口长度为 2～ 3个钟点。结果 :通过角膜地形图和检影验光发现 :术前 3mm视区的平均角膜散光为 3.46± 0 .99D,术后 6个月为 2 .0 5± 0 .75 D,统计学检验有显著性差异 P<0 .0 1;术前 10例患者的裸眼视力为 4.0 5± 0 .12 ,术后 6个月的视力明显提高为 4.45± 0 .11。结论 :本文对手术适应证、技术、角膜散光变化和并发症进行讨论 ,从而证实弧形角膜切开术是一项简单安全。

Objective: Relaxing arcuate keratotomy was performed for the patients with persistent high astigmatism over one year after intraocular lens implantation or penetrating keratoplasty. Methods: 10 cases were analyzed. The astigmatism in the all patients was ≥2. 00D within the 3mm central optic zone, while the myopia was ≤2.00D. The visual acuity could be corrected. 6.5mm trephine was used to curve on the centre of cornea, then arcuate keratotomy was done according to the curve. The blade cut down to 1/2 or 2/3 of the corneal thickness and 2 or 3 clocks, as previously measured in the zone to be trephine. Results: The mean preoperative astigmatism by the corneal topography and retinoscopy was 3. 46±0.99D within the 3mm central optic zone, while the postoperative astigmatism was 2.05±0. 75D (P<0.01). Mean preoperative uncorrected visual acuity was 4.05±0.12, while the mean postoperative uncorrected visual acuity wan 4.45±0.11. Conclusions: The indications, manipulations efficacy and complications of the operation were discussed. It proved that arcuate keratotomy seems a safe method, which can improve visual acuity rapidly.