飞秒激光辅助超乳联合Toric IOL植入术矫正高度近视白内障合并角膜规则散光

Femtosecond laser-assisted cataract phacoemulsification combined with Toric intraocular lenses implantation in correction of high myopia cataract and corneal astigmatism

目的:通过飞秒激光技术,量化撕囊口直径,测量高度近视白内障合并角膜散光患者术后远、中、近视力,近立体视功能等指标,评估Toric IOL在高度近视的可行性及必要性。方法:前瞻性病例对照研究。选择我院双眼高度近视白内障合并角膜规则散光,并双眼均接受飞秒激光辅助白内障手术的患者,按人工晶状体不同分为两组:A组:Toric IOL组20例40眼,B组:IQ IOL组20例40眼。对比两组患者术前角膜散光、等效球镜及术后7d,1、3mo最佳矫正远视力、裸眼中视力、近视力、实际残留散光、近立体视锐度、全眼高阶像差、全眼球差等指标。结果:高度近视白内障合并角膜散光患者植入Toric IOL,较IQ组,显著改善了术后7d,1、3mo裸眼中、近视力,Titmus近立体视锐度及残留散光度(均P<0.05),减少了术后对眼镜的依赖程度;而术后7d,1、3mo两组最佳矫正远视力、全眼高阶像差及全眼球差无差异(均P>0.05)。结论:高度近视白内障合并角膜散光患者植入Toric IOL,能有效矫正角膜规则散光,提高术后裸眼中、近视力及近立体视功能,减少高度近视患者术后对眼镜的依赖程度,提升双眼立体视功能。

AIM:To measure the indexes including postoperative distance,middle,near visual acuity and near stereopsis vision of patients with high myopia cataract and corneal astigmatism by femtosecond laser,which can quantify the diameter of capsulorhexis opening,and to evaluate the availability and necessity of Toric intraocular lenses(IOL)in high myopia.METHODS:Prospective case-control study.Patients with binocular high myopia cataract and corneal astigmatism who undergone femtosecond laser-assisted cataract surgery in our hospital were selected,and they were divided into two groups,with 20 cases(40 eyes)in group A(Toric IOL)and 20 cases(40 eyes)in group B(IQ IOL).Indexes,including preoperative corneal astigmatism and spherical equivalent and best-corrected distance visual acuity,uncorrected middle visual acuity,uncorrected near visual acuity,residual refractive astigmatism,near stereopsis acuity,total high-order aberration and total spherical aberration,were measured postoperatively at 7d,1 and 3mo.RESULTS:The uncorrected middle and near visual acuity,Titmus near stereopsis acuity and residual astigmatism at 7d,1 and 3mo after surgery were significantly improved in the Toric IOL group than the non-Toric group(all P<0.05).The dependence on glasses was reduced.The postoperative best-corrected distance visual acuity,total high-order aberration and total spherical aberration of the two groups showed no statistically significant differences(all P>0.05).CONCLUSIONS:The implantation of Toric IOL in patients with high myopia cataract and corneal astigmatism can effectively correct corneal astigmatism,improve postoperative uncorrected middle and near visual acuity and near stereopsis visual function,reduce postoperative dependence on glasses and enhance binocular stereopsis visual function.