飞秒激光辅助白内障手术矫正角膜规则散光的临床观察

Efficacy of femtosecond laser assisted cataract surgery for corneal regular astigmatism correction

目的观察飞秒激光辅助白内障手术(femtosecond laser assisted cataract surgery,FLACS)矫正角膜规则散光的早期效果。方法采用前瞻性临床对照研究。选择就诊于重庆爱尔麦格眼科医院符合纳入标准的白内障合并角膜规则散光(0.75~4.00D)患者60例,分为手工组及飞秒组,每组30例(30眼)。术前测量裸眼远视力和散光量(TIA);在术后1个月和3个月,测量裸眼远视力、残余散光量(difference vector,DV)和手术矫正散光量(surgically induced astigmatism,SIA),由TIA和SIA计算出散光矫正指数(correction index,CI)。术后观察早期并发症,术后3个月采用问卷法比较两组远视力脱镜率。结果飞秒组与手工组裸眼远视力和残余散光量比较,术后1个月和3个月差异均有统计学意义(P<0.05)。术后1个月与3个月的组内比较,两组裸眼远视力和残余散光量的差异均无统计学意义(P>0.05)。术后3个月,飞秒组CI明显高于手工组,差异有统计学意义(P<0.05)。术后3个月,飞秒组脱镜率(75.0%)与手工组(41.67%)比较,差异有统计学意义(P<0.05)。结论相对于传统手工方法,飞秒激光辅助白内障手术矫正低、中度角膜规则散光的疗效优异,为白内障合并角膜规则散光患者增添了一种安全、有效的治疗选择。

Objective To observe the early efficacy of femtosecond laser assisted cataract surgery （FLACS） in astigmatism correction. Methods A prospective clinical control trial was performed on 60 cataract patients with regular corneal astigmatism （0.75~4.00D） admitted in Chongqing Aier Mega Eye Hospital from May 2016 to May 2017. They were divided into manual group and FLACS group, with 30 cases in each group. Uncorrected distance visual acuity and target induced astigmatism （TIA） were measured before surgery. At 1 and 3 months after surgery, uncorrected distance visual acuity, difference vector （DV） and surgically induced astigmatism （SIA） were measured, and astigmatism correction index （CI） was calculated from TIA and SIA. The early complications and rate of glass independence were observed at 3 months after surgery. Results There were significant differences in uncorrected distance visual acuity and DV between the FLACS group and manual group at 1 and 3 months after surgery （P〈0.05）. Compared with each group, uncorrected distance visual acuity and DV was insignificant （P〉0.05） between 1 month and 3 months after surgery. In 3 months after surgery, the FLACS group had obviously higher CI （P〈0.05） and higher rate of glass independence （75.00% vs 41.67%, P〈0.05） when compared with manual group. Conclusion Compared with the manual approach, FLACS shows an excellent efficacy for corneal regular astigmatism at low or moderate degree, which provides a safe and effective choice for such patients.