Toric人工晶状体植入矫正白内障术前高度角膜散光的临床观察

Clinical study of Toric intraocular lens for high corneal astigmatism correction in patients having cataract surgery

目的观察Acrysof Toric人工晶状体(IOL)植入矫正白内障合并高度角膜散光的临床疗效。方法前瞻性系列病例研究。对白内障合并规则角膜散光的51例(69只眼)患者行白内障超声乳化吸除联合Toric IOL植人。依据术前角膜散光度进行分组,散光>2.5 D患者为高度角膜散光组(HCA组),植入SN6AT6-9IOL矫正;散光1~2.5 D患者为中度角膜散光组(MCA组),植人SN6AT3~5 IOL矫正。术后3个月评估两组的裸眼视力、最佳矫正视力、术后残余散光、IOL轴向等。结果术后3个月两组裸眼视力均有显著性提高。两组术后最佳矫正视力差异无统计学意义(P>0.05)。术后残留散光,HCA组为(-0.84±0.64)D,MCA组为(-0.45±0.37)D,两组间差异有统计学意义(t=2.94,P=0.005)。术后IOL旋转度,两组间差异无统计学意义(t=-0.176,P=0.857);旋转度>5°者均约在70%,但在IOL旋转度>5。患者,HCA组残留散光为(-1.19±0.27)D,MCA组残留散光为(-0.73±0.29)D,两组间差异有统计学意义(t=-3.72,P=0.001)。结论Acrysof Toric IOL能有效、安全矫正白内障合并高度角膜散光患者。相对于中度角膜散光而言,合并高度角膜散光的白内障患者术后IOL旋转稳定性相当,但旋转度>5°的高度角膜散光患者术后残留更多的散光。

Objective To evaluate the clinical efficacy of Acrysof Toric intraocular lens(IOL)for correction of high comeal astigmatism in patients underwent cataract surgery.Methods A prospective case series study.Fifty-one patients(69 eyes)with regular comeal astigmatism underwent phacoemulsification and toric IOL implantation in the Wenzhou medical university eye hospital.Patients with more than 2.5D corneal astigmatism were divided into high comeal astigmatism group(HCA group)and with SN6AT6-9 implantation.While patients with corneal astigmatism between ID to 2.5D were divided into moderate comeal astigmatism group(MCA group)and corrected by SN6AT3-5.Log-MAR visual acuities[uncorrected(UCVA)and best corrected(BCVA)],residual cylinder and IOL axis were evaluated 3 months postoperatively.Results The UCVA significantly improved 3 months postoperatively.There was no difference in BCVA between the two groups.The residual cylinder in HCA group was(-0.84±0.64)D,that was higher in MCA group(-0.45±0.37D,t=2.94,P=0.005).The IOL axis in two groups was found no significant difference(t=-0.176,P=0.857).The percentage of IOL rotation less than and egual to 5 degrees was about 70%in the both groups,the difference between the two groups was not statistically significant(t=1.30,P=0.201).However,in pa-tients with more than 5 degrees IOL rotation,the residual cylinder in HCA group was-1.19±0.27D,and in MCA group was-0.73±0.29D(t=-3.72,P=0.001).Conclusions Toric IOL implantation is an effective and stable approach to correct preexisting high comeal astigmatism in cataract patients.Both patients with moderate and high astigmatism could achieve similar IOL rotation stability,however there is higher residual cylinder when the IOL rotation is more than 5 degrees in patients with high astigmatism.