小切口白内障手术切口类型对患者角膜形态的影响

Incision influence of small incision cataract surgery on corneal topography

目的:探讨小切口手法碎核术不同切口类型对白内障患者角膜地形图的影响,为其临床治疗方案优选提供参考。方法:选取白内障患者71例94眼,随机分为A组和B组,分别以直线形和反眉弓形切口进行手术,将A组和B组进一步随机分为三组,控制切口至角膜缘距离分别为1.5mm,2.0mm,2.5mm;对比各组手术前后的视力水平和角膜地形图指标ACP,CYL,SAI和SRI。结果:切口形态和切口至角膜缘距离对患者的术后视力和角膜地形图均有影响(P<0.05),各检测时间术后视力和角膜地形图不全等(P<0.05),且时间和组别之间不存在交互作用(P>0.05)。各组患者术后1wk的视力优于术前,术后3mo优于术后1wk,差异有统计学意义(P<0.05);同时,术后1wk的ACP,CYL,SAI和SRI水平高于术前(P<0.05),术后3mo时逐渐降低,与术前水平无统计学差异(P>0.05)。术前,各组视力和角膜地形图无统计学差异(P>0.05)。术后1wk,2.0mm B组和2.5mm B组的视力水平明显高于其他各组(P<0.05),且两组之间无统计学差异(P>0.05);2.0mm B组和2.5mm B组的ACP,CYL,SAI和SRI水平明显低于其他各组,且2.5mm B组低于2.0mm B组(P<0.05)。术后3mo,各组视力、SAI及SRI水平均无统计学差异(P>0.05);但2.0mm B组和2.5mm B组患者的ACP和CYL依然明显高于其他组(P<0.05),且两组之间无统计学差异(P>0.05)。结论:小切口手法碎核术采用反眉弓形切口,并适当拉长切口至角膜缘的距离,可降低对白内障患者角膜地形图的影响,控制术后散光。

AIM： To explore the incision influence of small incision cataract surgery on corneal topography of patients, so as to provide a reference for the optimization of operation method. METHODS： Seventy- one patients （94 eyes） were divided into two groups, which were given straight （group A） and eyebrow arched incision （group B）. Patients in both groups A and B were divided into three subgroups respectively, which were given incision with different length from corneal limbus （1.5mm, 2.0mm and 2.5mm）. The visual acuity level and corneal topography indexes （ACP, CYL, SAI and SRI） were compared before and after treatment. RESULTS. There was influence on visual acuity level and corneal topography of incision morphology and length from corneal limbus （P〈 0. 05）, and there was difference in acuity level and corneal topography at different test time （ P〈 0.05）, and the influence had no interaction with test time （P〉 0. 05）. One week after surgery, the visual acuity level of all patients was higher than that before surgery, and 3mo after surgery, it was higher than that of lwk after surgery too （P〈0.05）. One week after surgery, ACP, CYL, SAI, SRI level of all patients was higher than that before surgery （ P〈 0.05）, and 3mo after surgery, which decreased and had no statistical difference with preoperative levels （P〉 0.05）. Before surgery, there was no significant difference in visual acuity level and corneal topography between groups （P〉 0. 05）. One week after surgery, the visual acuity level of subgroup 2.0mm and 2.5mm in group B was higher than the others （ P〈0.05）, and there was no significant difference between （P〉0.05）. the ACP, CYL,SAI, SRI level of subgroups 2.0mm and 2.5mm in group B were lower than the others, and those of subgroup 2.5mm in group B were higher than those of subgroup 2. 0mm of group B （P〈0.05）. Three months after surgery, there was no significant difference in visual acuity, SAI and SRI levels between groups （ P〉 0.05）, but the ACP and CYL level of subgroup 2.0mm and 2.5mm of group B were higher than those of the others （P〈0.05）, and there was no significant difference between （P〉0.05）. CONCLUSION. Using eyebrow arched incision and appropriate distance to corneal limbus in the small incision cataract surgery can reduce the impact on corneal topography and benefit for control of postoperative astigmatism.