2.8mm颞侧切口术源性散光对ICL术后视力的影响

Effect of surgically induced astigmatism from 2.8 mm temporal incision on visual acuity after implantable col-lamer lens surgery

目的分析2.8mm颞侧透明角膜切口的手术源性散光对有晶状体眼后房型人工晶状体植入术(ICL术)后视力的影响.方法回顾性分析行ICL术的患者21例(39眼),测得患者术前及术后1个月的裸眼视力、最佳矫正视力、综合验光、角膜曲率.比较术前及术后角膜散光值、散光矢量J_(0)及J_(45)的差异,比较预期散光与实际散光的差异;使用手术源性散光(SIA)矢量分析软件评估SIA的大小及分布;观察SIA对术后裸眼视力及实际残余散光的影响.结果术前及术后角膜散光值分别为(0.90±0.43)D、(1.03±0.42)D,差异有统计学意义(P<0.05);术前及术后角膜散光J_(45)分别为(0.002±0.17)D、(0.08±0.15)D,差异有统计学意义(P<0.05).预期残余散光(-0.12±0.19)D,实际残余散光(-0.25±0.28)D,差异有统计学意义(P<0.05).2.8mm颞侧透明角膜切口SIA大小(0.32±0.21)D,Centroid SIA0.17D@122°.结论角膜切口能改变散光的大小及轴向,建议使用2.8mm以下透明角膜切口,尽可能减少SIA的影响.

Objective To study the effect of surgically induced astigmatism from 2.8 mm temporal clear corneal incision on visual acuity after posterior chamber phakic intraocular lens implantation.Methods A total of 21 patients(39 eyes) who underwent non-astigmatic posterior chamber phakic intraocular lens implantation(ICL) were retrospectively analyzed.The uncorrected visual acuity, best corrected visual acuity, manifest refraction and corneal curvature were measured pre-operatively and 1 month after surgery.Preoperative and postoperative corneal astigmatism values, astigmatism vectors J_(0) and J_(45), and expected astigmatism and actual astigmatism were compared.Surgically induced astigmatism(SIA) analysis software was used to evaluate the values and distribution of SIA.The effect of SIA on postoperative uncorrected visual acuity and actual residual astigmatism were observed.Results There was significant difference between preoperative corneal astigmatism(0.90±0.43)D and postoperative corneal astigmatism(1.03±0.42)D(P<0.05).There was significant difference in preoperative and postoperative corneal astigmatism J_(45)(0.002±0.17)D and(0.08±0.15)D respectively(P<0.05).The expected residual astigmatism(-0.12±0.19)D and the actual residual astigmatism(-0.25±0.28)D were statistically significant(P<0.05).The SIA of the 2.8 mm temporal clear corneal incision was(0.32±0.21)D, the Centroid SIA was 0.17 D@122 °.Conclusion Corneal incision can change the values and axis of astigmatism.It is recommended to use clear corneal incision less than 2.8 mm to reduce the effect of SIA.