超声乳化白内障摘除联合人工晶状体植入及散光性角膜切开术治疗白内障术前散光的临床观察

Clinical observation of phacoemulsification combined with intraocular lens implantation and astigmatic corneal incision in the treatment of astigmatism before cataract surgery

目的观察超声乳化白内障摘除联合人工晶状体植入及散光性角膜切开术治疗白内障术前散光的临床效果。方法收集2015年3月至2016年6月在包头医学院第二附属医院眼科术前检查具有散光且行超声乳化白内障吸除术的30例（33只眼）患者的临床资料。其中，男性14例（15只眼），女性16例（18只眼），年龄60～85岁。所有患者术前进行视力、裂隙灯显做镜、眼压及角膜地形图等检佥。手术方式采取最陡径线上的双侧对切口设计。除眼部常规检查外，分别于术后ld、3d、1周、1个月及3个月还对患者进行角膜曲率检查，术后3个月行角膜地形图检查。术前与术后的裸眼视力（UCVA）及最佳矫正视力（BCVA）按照是否〉0．5分为两类，术前与术后的比较采用X^2检验。比较患者术前及术后各个时间点角膜散光、散光矢量分解及角膜曲率的变化。角膜散光、散光矢量分解、角膜曲率、表面不对称指数、表面规则指数及角膜表面散光值经One-Sample Kolmogorv-Smirnov检验呈正态分布，以均数±标准差（x±s）表示，采用单因素重复测量方差分析的方法，当差异有统计学意义时，进一步采用LSD-t检验进行两两比较。角膜散光矢量分解值CJ0、CJ45与角膜散光进行多元线性回归分析。术前与术后表面不对称指数、表面规则指数及角膜表面散光值的比较采用配对t检验。结果术后3个月UCVA〉0．5者占75．76％，BCVA〉0．5者占84．85％，两项指标与术前相比均显著提高，差异有统计学意义（x^2=5．23，6．45；P〈0．05）。术后各时间点的角膜散光度数与术前相比均有所减小，差异有统计学意义（t=10．15，8．24，7．98，6．45，5．57：P〈0．05）。术后1d的散光度数较术后其它各个时间点的散光度数小，差异有统计学意义（t=2．60，2．81，3．02，3．34；P〈0．05）。术后各个时间点的CJ0值与术前比较均有所减少，差异有统计学意义（F9．48，7．32，6．54，5．98，6．01；P〈0．05）。术后各个时间点的CJ45值与术前比较均有所减少，但仅有术后1d与术前比较差异有统计学意义（t=2．83，P〈0．05）。散光变化的90.8％可以用CJ0和CJ45的变化来解释。垂直曲率变化幅度较水平曲率大，两种曲率在术后1个月趋于稳定。各个时间点K1差异无统计学意义（F=0．50．P〉0．05）。K2术后各个时间点与术前比较，均有所减少，但仪有术后1d与术前相比差异有统计学意义（t=4．12，P〈0．05）。结论采用超声乳化白内障摘除联合人工晶状体植人及以角膜周边切口的散光性角膜切开术治疗白内障术前散光是安全可靠的方法。

Objective To observe the effect of preoperative corneal astigmatism in phacoemulsifiealion with peripheral corneal incision. Methods This study collected from March 2015 to June 2016 with astigmatism and phaeoemulsifieation surgery in 30 cases （33 eyes） of ophthalmic phacoemulsification cataract Second Affiliated Hospital of Baotou Medical College in patients with clitfieal data, including 14 cases （ 15 eyes） of male, and 16 cases （ 18 eyes） of female. Their ages ranged from 60 to 85 years. All patients performed a series of ophthalmic examinations, including visual acuity, slit lamp microscope, intraocular pressure and corneal topography. In addition to routine eye examination, corneal curvature was performed at one day, three days, one week, one month and three months after surgery, and corneal topography was performed after three months. Preoperative and postoperative uncon＇ected visual acuity （UCVA） and best corrected visual acuity （BCVA） according to whether 〉 0. 5 is divided into two categories, preoperative and postoperative comparison usingX2 test. Change vector decomposition astigmatism and corneal curvature, corneal astigmatism at various time points before and after surgery were compared, Corneal astigmatism, astigmatism vector decomposition, corneal curvature, surface asymmetry index, surface regularity index and corneal astigmatism by One-Sample Kolmogorv-Smirnov test showed normal distribution, with （x±s）, repeated measurement of variance analysis with single factor, while the difference was statistically significant, the the LSD-t test is compared with each other. Multivariate linear regression analysis of corneal astigmatism vector decomposition value CJ0, CJ45 and corneal astigmatism. Preoperative and postoperative surface asymmetry index, surface rule index and corneal astigmatism were compared by paired t-test. Results At three months after surgery, UCVA〉0.5 accounted for 75.76%, BCVA〉0.5 accounted for 84.85%, compared with the preoperative were significantly improved, the difference was statistically significant （X^2 =5.23, 6.45; P〈0.05）. There was a decrease in the degree of corneal astigmatism at each time postoperatively compared with the preoperative, and the difference was statistically significant （t = 10.15, 8.24, 7.98, 6.45, 5.57; P〈0.05）. The degree of astigmatism after one day was smaller than that of the other points at different time points, and the difference was statistically significant （t=2.60, 2.81, 3.02, 3.34; P 〈 0.05 ）. The C j0 value of each time point was decreased, and the difference was statistically significant （t= 9.48, 7,32, 6.54, 5.98, 6.01; P〈0.05）. The Cj4s value of each time point was decreased, but the difference was statistically significant （t = 2.83, P〈0.05） before and after one day. 90.8% of astigmatism change can be explained by the change of CJ0 and C J45. There was no significant difference in Kt at all time points （F=0.50, P〉0.05）. Compared with the preoperative K2, each time point was decreased, but the difference was statistically significant （t = 4. 12, P 〈 0. 05 ） before and after one day. Conclusion Phacoemulsification combined with intraocular lens implantation and corneal astigmatism with peripheral corneal incision is a safe and reliable method to treat astigmatism before cataract surgery.