超声乳化白内障吸除术中对向角膜切口矫正术前角膜散光的临床观察

Effect of correcting astigmatism by paired corneal incisions after phacoemulsification

目的 观察导航系统引导下超声乳化白内障吸除术中在角膜曲率最大子午线上行对向透明角膜切口矫正术前角膜散光的临床疗效.方法 队列研究.选择35例（40眼）术前角膜散光度均大于1.0 D白内障患者为实验组,在表面麻醉下于最大角膜曲率子午线上做2.8 mm对向透明角膜切口;另选27例（30眼）术前角膜散光度均大于1.0 D白内障患者为对照组,在表面麻醉下于最大角膜曲率子午线上做2.8 mm单个透明角膜切口.观察2组术前及术后3个月角膜散光度及平均角膜曲率的变化.根据Jaffe＇s矢量分析原理计算手术源性角膜散光,采用独立样本t检验与配对t检验进行数据分析.结果 对照组术前及术后3个月角膜散光度分别为（1.84±0.40）D和（1.49±0.36）D,差异有统计学意义（t=7.55,P＜0.05）.实验组分别为（1.89±0.74）D和（0.71±0.60）D,差异有统计学意义（t=13.93,P＜0.05）.术后3个月2组角膜散光度相比差异有统计学意义（t=-6.31,P＜0.05）.2组手术源性散光分别为（0.38±0.18）D和（1.55±0.84）D.对照组术前及术后3个月平均角膜曲率分别为（44.18±1.31）D和（44.14±1.31）D,差异无统计学意义（t=1.21,P＞0.05）.实验组分别为（44.33±1.51）D和（44.29±1.52）D,差异无统计学意义（t=0.73,P＞0.05）.结论 超声乳化吸除术中行对向透明角膜切口是一种安全、有效的矫正角膜散光的方法。

Objective To observe the effect of paired corneal incisions in correcting astigmatism after phacoemulsification guided by a navigation system.Methods In this cohort study,patients with 〉1.0 D preoperative corneal astigmatism were selected.Thirty-five patients （40 eyes） who were selected for 2.8 mm paired corneal incisions were the experimental group,and 27 patients （30 eyes） who were selected for 2.8 mm single corneal incision were the control group.The changes in astigmatism were compared 3 months after the operation.The induced surgical astigmatism was calculated by vector analysis.An independent samples t test and a paired samples t test were used for statistical analysis.Results Corneal astigmatism before and 3 months after the operation in the control group was 1.84±0.40 D and 1.49±0.36 D,and was 1.89±0.74 D and 0.71±0.60 D in the experimental group.The differences were statistically significant （t=7.55,P〈0.05; t=13.93,P〈0.05）.The difference between the 2 groups 3 months after the operation was also statistically significant （t=-631,P〈0.05）.Surgically induced astigmatism in the control and experimental groups was 0.38±0.18 D and 1.55±0.84 D,respectively.The average corneal curvatures before and 3 months after the operation in the control group were 44.18±1.31 D and 44.14±1.31 D,and were 44.33±1.51 D and 44.29±1.52 D in the experimental group.The difference was not statistically significant （t=1.21,P〉0.05; t=0.73,P〉0.05）.Conclusion Paired corneal incisions in phacoemulsification are a safe and effective method for correcting corneal astigmatism.