Toric IOL植入术与PCRI联合传统IOL植入术矫正白内障患者角膜散光的Meta分析

Toric Intraocular Lens Implantation and Traditional IOL Implantation Combined with Peripheral Corneal Relaxing Incisions in the Correction of Age-Related Cataract with Corneal Astigmatism: A Meta-Analysis

目的:系统评价Toric人工晶状体(Toric IOL)植入术与传统IOL植入联合角膜缘松解术(PCRI)在矫正年龄相关性白内障患者合并≤3 D角膜散光的有效性、安全性以及对视功能的影响。方法:循证医学研究。采用Cochrane系统评价方法,计算机检索PubMed、EMBASE、Cochrane图书馆、Clinicalkey、Web of Science、中国知网、中国万方、中国维普数据库等,搜集有关白内障合并角膜散光及其治疗措施的相关文章,由2位评价者独立进行文献检索、文献筛选及质量评价,将术后裸眼远视力(UCDVA)、散光矫正量、术后残余散光、对比敏感度等方面进行比较,视力采用最小分辨角对数视力表(LogMAR)的形式进行记录。采用RevMan软件(Ver 5.3)对纳入文献进行Meta分析。结果:共纳入8项随机对照研究,包含白内障患者352例(510眼)。Meta分析结果显示:与传统IOL植入联合PCRI(对照组)相比,Toric IOL矫正年龄相关性白内障合并≤3 D的角膜散光在术后3、6个月UCDVA的更好[均数差(MD)=-0.04,95%CI:-0.07~-0.01,P=0.005];植入Toric IOL组手术散光矫正量大于对照组[MD=0.56,95%CI:0.36~0.76,P<0.001;标准均数差(SMD)=0.94,95%CI:0.47~1.40,P<0.001];植入Toric IOL组术后1个月残余散光度数(MD=-0.13,95%CI:-0.21~-0.04,P=0.003;SMD=-0.34,95%CI:-0.59~-0.10,P=0.007)及术后3、6个月残余散光度数(MD=-0.30,95%CI:-0.51~-0.10,P=0.004;SMD=-0.84,95%CI:-1.42~-0.25,P=0.005)均低于对照组;植入Toric IOL组术后3个月对比敏感度与对照组差异无统计学意义(MD=-0.01,95%CI:-0.08~0.11,P=0.77)。结论:与传统IOL植入联合PCRI相比,Toric IOL植入矫正白内障患者合并≤3 D的角膜散光效果更好。同时,Toric IOL在提高患者术后视力上略具优势,但其临床意义可能不大。二者在术后视功能及视觉相关生活质量方面无明显差异。

Objective:To systematically evaluate by meta-analysis the effectiveness,safety and visual function of toric intraocular lens(IOL)implantation and traditional IOL implantation combined with peripheral corneal relaxing incisions(PCRI)in the correction of age-related cataract with≤3 diopters(D)of corneal astigmatism.Methods:In this evidence-based medical research.PubMed,EMBASE,Cochrane library,Clinicalkey,Web of Science,CNKI,Wanfang,and VIP databases were searched for studies investigating the effect of the toric IOL in the treatment of cataract and corneal astigmatism.Meta-analysis was performed using RevMan 5.3 software to analyze the uncorrected distance visual acuity(UCDVA),residual astigmatism and astigmatism correction between the toric IOL and traditional IOL.Visual acuity was recorded in the form of the LogMAR visual acuity chart.Results:A total of 510 eyes of 352 cataract patients in 8 randomized,controlled trials were included.Meta-analysis results showed that:(1)the mean deviation(MD)of postoperative uncorrected distance visual acuity(logMAR UDVA)at 3 and 6 months was better in the toric intraocular lens group;(2)astigmatism correction at 3 and 6 months after implantation was better in the toric IOL group;(3)postoperative residual astigmatism at 1 month and;(4)at 3 and 6 months was lower for the toric intraocular lens;and(5)there was no significant difference in contrast sensitivity between the toric IOL group and the PCRI group at 3 months.The following data analyses support these findings:(1)MD=-0.04(95%CI:-0.07--0.01,P=0.005);(2)MD=0.56(95%CI:0.36-0.76,P<0.001),standard mean deviation(SMD)=0.94(95%CI:0.47-1.40,P<0.001);(3)at one month:MD=-0.13(95%CI:-0.21--0.04,P=0.003),SMD=-0.34(95%CI:-0.59--0.10,P=0.007);(4)at 3 and 6 months:MD=-0.30(95%CI:-0.51--0.10,P=0.004),SMD=-0.84(95%CI:-1.42--0.25,P=0.005);(5)MD=-0.01(95%CI:-0.08-0.11,P=0.77).Conclusions:Toric IOL is superior to traditional IOL implantation combined with PCRI in correcting≤3 D of corneal astigmatism in cataract patients.The toric IOL has a slight advantage in improving UCDVA,but the difference may not be clinically important.So far,there was no significant difference between the toric IOL and traditional IOL implantation combined with PCRI in postoperative visual function and vision-related quality of life.