Toric有晶状体眼后房型人工晶状体矫正高度近视散光的临床观察

Toric implantable collamer lens implantation for high myopic astigmatism

目的研究Toric有晶状体眼后房型人工晶状体(Toric implantable collamer lenses,TICL)植入术的视觉效果和对角膜及全眼像差的影响。方法前瞻性非随机临床试验研究。收集行TICL术患者19例33眼,所有患者在术前、术后3个月随访裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best spectacle corrected visual acuity,BCVA)、主觉验光、波前像差、角膜曲率、角膜散光及角膜像差,并对手术前后各项指标进行分析比较。结果术前BCVA达到1.0的比例为33.3%,术前BCVA达到0.8的比例为69.7%;术后UCVA达到1.0的比例为54.5%,术后UCVA达到0.8的比例为87.9%,所有术眼术后的UCVA均超过术前的BCVA(P=0.000)。术前所有眼散光度数>-1.00 DC,术后97.0%散光度数≤-1.50 DC,87.9%术后散光度数≤-0.50 DC,81.8%术后没有散光。术后对比敏感度和眩光对比敏感度均较术前显著提高(均为P<0.05),特别是高频部分(均为P<0.01)。术后3个月像差的均方根值(root mean square,RMS)和术前比较轻微减小,从0.68μm降低到0.59μm,但是差异无统计学意义(P=0.587)。慧差和术前比较也有所降低,差异无统计学意义(P=0.285)。术后球差和术前比较显著降低,差异有显著统计学意义(P=0.002)。术后全眼闪光和离焦等像差均较术前降低(均为P<0.05)。结论 TICL能够安全有效矫正近视散光,TICL植入术后对全眼高阶像差RMS值、慧差无影响,球差由正球差向负球差转变。

Objective To evaluate the visual outcomes and higher-order aberrations（HOA） after Toric implantable collamer lens（TICL） implantation.Methods Thirty-four eyes of 19 patients undergoing TICL insertion to correct myopic astigmatism were included.The uncorrected visual acuity（UCVA）,best corrected visual acuity（BCVA） and refraction were detected preoperatively and 3 months postoperatively.Changes in corneal curvature,astigmatism,wavefront high order aberration（HOAs） of cornea and the whole eye were measured and analyzed.Results Preoperative BCVA was0.8 in 69.7%of eyes and 1.0 in 33.3%of eyes.Postoperative UCVA was 0.8 in 87.9%of eyes and 1.0 in 54.5%of eyes.The postoperative UCVA in all eyes were higher than the preoperative BCVA（P =0.000）.Preoperatively,the astigmatism in all eyes were more than- 1.00 DC;Postoperatively,97.0%of eyes were equal to or less than-1.50 DC,87.9%of eyes equal to or less than-0.50 DC,81.8%of eyes had no astigmatism.The postoperative contrast sensitivity with glare or without glare were improved at each frequency,there were statistical differences compared with pre-operation（all P〈0.05）,especially at high frequency.The postoperative root mean square value of total eye slightly decreased,which was from 0.68 μm to 0.59.However,the difference was not statistically significant compared with pre-operation（P = 0.587）.The changes in coma were slight and not statistically significant（P = 0.285）.The postoperative spherical aberration was lower than pre-operation（P = 0.002）.Conclusion TICL is effective and safe to correct myopic astigmatism.The total negative spherical aberration after implantation supports the value of TICL to compensate for spherical aberrations of the cornea.