不同位置角膜缘切口对Toric ICL植入术后角膜散光影响的临床观察

The effect of different corneal limbus incision methods on corneal astigmatism after Toric implantable collamer lens surgery

目的观察不同位置角膜缘切口对Toric ICL后房人工晶状体植入术后角膜散光影响。方法选择44例(88只眼)高度近视且为顺规性散光患者,随机均分为上方陡轴和颞侧水平角膜缘切口组,表麻下后房人工晶状体植入,IOLmaster测量术前、术后1周、1个月和3个月角膜曲率,观察手术前后角膜散光变化。结果上方陡轴角膜缘切口组(A组)和颞侧水平角膜缘切口组(B组)术前角膜散光分别为(-2.27±0.80)D和(-2.21±0.84)D(t=0.224,P=0.824),角膜散光陡轴方向平均为(89.6±8.52)°,均为顺规性散光者。术后1周,A组和B组角膜散光分别为(-1.53±0.87)D和(-2.77±0.83)D(t=5.059,P=0.000);术后1个月,A组和B组角膜散光分别为(-1.90±0.84)D和(-2.42±0.79)D(t=2.222,P=0.031);术后3个月,A组和B组角膜散光分别为(-1.96±0.76)D和(-2.35±0.78)D(t=1.761,P=0.085)。结论上方陡轴角膜缘切口能一定程度减少顺规性角膜散光,与颞侧水平角膜缘切口相比无明显优势。

Objective To assess the efficacy of different corneal limbus incision methods on corneal astigmatism after Toric implantable collamer lenses（ ICL,STAAR Surgical,Switzerland） implantation. Methods Totally 48 patients（ 88 eyes） with myopia and astigmatism were consecutively enrolled. Patients were randomly assigned into two groups,and superior（ group A） or temporal（ group B） limbus incisions were made under topical anesthesia respectively,followed by Toric ICL implantation. Corneal astigmatism was observed preoperatively and at 1 week,1 month,3 months postoperatively using IOL master. Results Preoperative astigmatism were- 2. 27 ± 0. 80 D and- 2. 21 ± 0. 84 D in group A and group B respectively（ t = 0. 224,P = 0. 824）. At 1 week after surgery,astigmatism was-1. 53 ± 0. 87D（ group A） and- 2. 77 ±0. 83D（ group B; t = 5. 059,P = 0. 000）. Astigmatism became- 1. 90 ± 0. 84 D in group A and- 2. 42 ± 0. 79 D in group B at 1 month（ t = 2. 222,P = 0. 031）,and- 1. 96 ± 0. 76D（ group A） and- 2. 35 ± 0. 78D（ group B; t = 1. 761,P =0. 085） at 3 months after surgery. Conclusions Superior limbus incision is not better than temporal limbus incision on reducing corneal astigmatism after Toric implantable collamer lens surgery.