不同眼轴长度白内障患者植入散光矫正型人工晶状体的旋转稳定性及其相关因素分析

The rotational stability of Toric intraocular lenses and influencing factors in cataract patients with different axial length

目的观察不同眼轴长度白内障患者植入散光矫正型人工晶状体(TIOL)后TIOL的旋转稳定性并分析其相关影响因素。方法回顾性队列研究。连续纳入2018年5月至2019年1月在北京大学第三医院眼科行超声乳化白内障吸除联合AcrySof TIOL植入术的患者。所有患者均为单眼入组,并依据眼轴长度分为两组,眼轴长度≤24 mm为A组,眼轴长度>24 mm为B组。采用术后3个月的数据分析TIOL的旋转稳定性及其与眼轴长度、角膜缘白到白距离、术前晶状体厚度及植入的TIOL球镜度数之间的相关性。统计学分析采用t检验、非参数检验、χ2检验及Spearman检验。结果A组纳入39例患者(男性17例,女性22例),年龄中位数为74岁(36~86岁);B组纳入26例患者(男性11例,女性15例),年龄中位数为68岁(36~86岁)。A组术前最佳矫正远视力(最小分辨角对数)为0.30(0.10,1.00),术前角膜散光度数为2.11(0.95,5.10)D,术后最佳矫正远视力为0.10(0.00,0.60),残余散光度数为1.00(0.00,1.75)D;B组术前最佳矫正远视力为0.36(0.05,1.00),术前角膜散光度数为2.00(0.78,3.76)D,术后最佳矫正远视力为0.05(0.00,0.40),残余散光度数为0.75(0.00,2.25)D;两组术前最佳矫正远视力、角膜散光度数差异均无统计学意义(P=0.604,0.789),两组术后最佳矫正远视力均较术前显著提高、散光度数均显著减低(均P<0.01),两组间术后最佳矫正远视力和残余散光度数差异均无统计学意义(P=0.536,0.076)。旋转稳定性方面,A组TIOL术后3个月的旋转度数为5.15°±3.62°,B组的旋转度数为6.50°±4.66°,两组比较差异无统计学意义(P=0.195)。可预测性方面,旋转度数≤5°的眼在A组中占59.0%(23只眼),在B组中占50.0%(13只眼),两组比较差异无统计学意义(P=0.647)。相关性分析显示,TIOL的旋转度数与眼轴长度、角膜缘白到白距离、晶状体厚度及植入的TIOL球镜度数之间均无明显相关性(P=0.836,0.568,0.170,0.365)。结论TIOL植入术后3个月,眼轴>24 mm与眼轴≤24 mm患者TIOL旋转稳定性无明显差别,旋转稳定性与眼轴长度、角膜缘白到白距离、晶状体厚度及TIOL球镜度数之间无明显关系。

Objective To evaluate the rotational stability of the Toric intraocular lens(TIOL)and influencing factors in cataract patients with different axial length.Methods This retrospective cohort study consecutively enrolled patients who had phacoemulsification and AcrySof TIOL implantation in Peking University Third Hospital from May 2018 to January 2019.Based on axial length,patients were divided into two groups.Group A consisted of patients whose axial length was≤24 mm.Patients whose axial length was>24 mm were included in group B.Data at three months postoperatively were used to evaluate the rotational stability of TIOL and its correlation with axial length,corneal white to white distance,lens thickness and TIOL spherical power.And t test,nonparametric test,chi-square test and Spearman test were used for statistical analysis.Results Group A enrolled 39 patients(17 males and 22 females),with a median age of 74 years(range,36-86 years).Group B enrolled 26 patients(11 males and 15 females),with a median age of 68 years(range,36-86 years).For the efficacy of TIOL,in group A,the best corrected distance visual acuity(BCDVA,logarithm of the minimum angle of resolution)was 0.30(0.10,1.00)preoperatively and 0.10(0.00,0.60)postoperatively,and the astigmatism was 2.11(0.95,5.10)D preoperatively and 1.00(0.00,1.75)D postoperatively.In group B,the BCDVA was 0.36(0.05,1.00)preoperatively and 0.05(0.00,0.40)postoperatively,and the astigmatism was 2.00(0.78,3.76)D preoperatively and 0.75(0.00,2.25)D postoperatively.Between group A and group B,there were no significant differences in BCDVA(P=0.604)and astigmatism(P=0.789)preoperatively.In these two groups,postoperative BCDVA and astigmatism both significantly improved compared to preoperative parameters(both P<0.01).Between group A and group B,there were no significant differences in BCDVA(P=0.536)and astigmatism(P=0.076)postoperatively.In terms of rotational stability,the rotation in group A was 5.15°±3.62°,and that in group B was 6.50°±4.66°.There was no statistical difference between two groups(P=0.195).As for predictability,the percentage of eyes with rotation≤5°was 59.0%(23 eyes)in group A and 50.0%(13 eyes)in group B.There was no statistical difference between the two groups(P=0.647).There was no significant correlation between the rotational stability of TIOL and axial length,corneal white to white distance,lens thickness or TIOL spherical power(P=0.836,0.568,0.170,0.365).Conclusions The rotational stability of TIOL at three months postoperatively in patients whose axial length>24 mm is of no difference with patients whose axial length≤24 mm.It has no correlation with axial length,corneal white to white distance,lens thickness and TIOL spherical power.(Chin J Ophthalmol,2020,56:41-46)