白内障超声乳化术中不同位置透明角膜切口对术后手术源性角膜高阶像差的影响

Effect of 2. 8mm clear corneal incisions in phacoemulsification on surgically induced corneal higher-order aberrations

目的:比较白内障超声乳化术中不同位置2.8mm透明角膜切口术后手术源性角膜高阶像差的改变情况。方法:回顾性分析2015-03/2016-04于我院行白内障超声乳化手术治疗并采用2.8mm透明角膜切口的100例100眼白内障患者的临床资料,按切口位置分为A组(颞侧透明角膜切口,55眼)、B组(上方透明角膜切口,45眼),比较两组患者术前和术后1d,1wk,1、3mo最佳矫正视力(best corrected visual acuity,BCVA)、手术源性散光(surgically induced astigmatism,SIA)和角膜地形图的变化,并采用波前像差分析仪测定角膜波前像差,记录角膜6mm范围内高阶像差的变化。结果:术后1d,1wk,1、3mo,两组患者BCVA(LogMAR值)均降低,与术前比较差异有统计学意义(P<0.05),A组患者术后1d、1wk、1mo时BCVA(LogMAR值)均低于B组(P<0.05);术后1wk,1、3mo两组患者SIA均降低(P<0.05),A组术后不同时间点SIA均低于B组,差异有统计学意义(P<0.05);术后1d两组患者表面非对称性指数(surface asymmetry index,SAI)、表面规则指数(surfaceregularity index,SRI)均上升,术后1wk,1、3mo逐渐降低,A组术后1d、1wk时SRI、SAI均低于B组(P<0.05);术后3mo,A组角膜表面总高阶像差(total higher-order aberrations,tHOAs)、四阶球差(spherical aberration,SA)与B组比较,差异有统计学意义(P<0.05)。结论:白内障超声乳化手术采用2.8mm颞侧透明角膜切口可促进患者术后视力恢复,减轻手术对角膜形态的影响,降低角膜高阶像差。

AIM： To compare the corneal higher - phacoemulsification with at different sites. changes of surgically induced order aberrations after 2.8mm clear corneal incisions. METHODS： The clinical data of 100 cases （100 eyes） of patients with cataract treated by phacoemulsification with 2.8mm clear corneal incision in our hospital from March 2015 to April 2016 were analyzed retrospectively. According to the site of incision, they were divided into Group A （temporal clear corneal incision, n = 55） and Group B （ upper clear corneal incision, n= 45）. Changes of the best corrected visual acuity （BCVA）, surgically induced astigmatism （SlA） and corneal topography were compared between the two groups before surgery, at 1d, 1wk, 1 and 3mo after surgery. The corneal wavefront aberrations were measured by wavefront aberration analyzer, and the changes of higher-order aberrations in corneal 6mm range were recorded.RESULTS： The BCVA of two groups decreased at ld,lwk, 1 and 3mo after surgery （ P〈0.05）, and the BCVA of Group A at ld, lwk, and lmo after surgery was lower than that of Group B （P〈0.05）. SIA of the two groups decreased at lwk, 1 and 3mo after surgery （P〈0.05）, and the SIA of Group A at different time points after surgery were lower than those of Group B （P〈0.05）. The surface asymmetry index （SAI） and the surface rule index （SRI） of the two groups increased at l d after surgery, and were gradually decreased at lwk, 1 and 3mo after surgery. The SRI and SAI in Group A were lower than those in Group B at ld and lwk after surgery （ P〈 0.05）. The total corneal higherorder aberrations （tHOAs） and four - order spherical aberration （SA） showed significant differences between the two groups at 3mo after surgery （P〈0.05）. CONCLUSION： The application of 2. 8mm temporal clear corneal incision in phacoemulsification can promote the recovery of visual acuity, reduce the effect of surgery on corneal shape, and reduce corneal higherorder aberrations.