飞秒激光弧形角膜切开术与散光矫正型人工晶状体植入术矫正白内障合并低度数散光的远期效果比较

Comparison of long-term efficacy of femtosecond laser arcuate keratotomy and toric intraocular lens implantation in the correction of cataract combined with low degree astigmatism

目的比较飞秒激光弧形角膜切开术及散光矫正型人工晶状体植入术在矫正白内障合并低度数散光的远期临床效果。方法回顾性病例对照研究。连续纳入2020年1月至2021年1月在苏州大学理想眼科医院接受手术的白内障合并角膜散光患者共53例(53只眼), 根据手术方案不同分为A、B两组。A组27例(27只眼), 行飞秒激光辅助白内障超声乳化(FLACS)联合弧形角膜切开术, 术中植入区域折射多焦点人工晶状体(LS-313MF30);B组26例(26只眼), 行FLACS联合散光矫正型区域折射多焦点人工晶状体(LS-313MF30T)植入术。收集患者术前裸眼远视力(UDVA), 总高阶像差(HOAs), 角膜散光;术后UDVA、裸眼近视力(UNVA), 残余散光, 总高阶像差及术后主观视觉质量调查问卷并进行统计学分析。结果 UDVA:两组术后各时间点较术前均明显提高, 差异均具有统计学意义(均P<0.05);组间比较差异无统计学意义(P>0.05)。UNVA:术后1个月, 两组差异无统计学意义(P>0.05);术后1年, B组优于A组, 差异有统计学意义(P<0.05)。术后残余散光:术后1个月, 两组差异无统计学意义(P>0.05), 术后1年, B组小于A组, 差异有统计学意义(P<0.05)。术后HOAs:B组在术后各时间点均小于A组, 差异均具有统计学意义(均P<0.05)。术后1年, B组患者脱镜率96.15%(25/26)高于A组74.07%(20/27), 眩光、光晕发生率7.69%(2/26)低于A组29.62%(8/27), 差异均有统计学意义(均P<0.05)。结论飞秒激光弧形角膜切开术及散光矫正型人工晶状体植入术均能有效矫正白内障术前低度数散光, 植入散光矫正型人工晶状体的远期效果优于飞秒激光弧形角膜切开术且视觉质量更好。

ObjectiveeTo compare the clinical long-term efficacy of femtosecond laser arcuate keratotomy and toric intraocular lens(IOL)implantation in correcting cataract combined with low degree astigmatism.Methods This was a retrospective case control study.A total of 53 eyes of 53 consecutive patients with cataract and corneal astigmatism who underwent cataract surgery in the Li Xiang Eye Hospital Affiliated to Soochow University from Jan.2020 to Jan.2021 were collected.Based on the surgical methods,they were divided into group A and group B.In the group A 27 eyes of 27 cases received femtosecond laser assisted cataract surgery(FLACS)combined with femtosecond laser arcuate keratotomy,and the regional refractive multifocal IOL(LS-313MF30)was implanted in the operation.In the group B 26 eyes of 26 cases received FLACS combined with regional refractive multifocal toric IOL(LS-313MF30T)implantation.The uncorrected distance visual acuity(UDVA),higher-order aberrations(HOAs),corneal astigmatism before operation and the UDVA,uncorrected near visual acuity(UNVA),residual astigmatism,HOAs,the subjective visual quality questionnaire after operation were collected.Results UDVA:each postoperative time of the two groups was significantly higher than that before operation(all P<0.05).There was no significant difference between the two groups postoperatively(P>0.05).UNVA:there was no significant difference between the two groups at 1 month after operation(P>0.05),while that of group B was significantly better than that of group A at 1 year after operation(P<0.05).Postoperative residual astigmatism:there was no significant difference between the two groups at 1 month after operation(P>0.05),and that of group B was significantly smaller than that of group A at 1 year after operation(P<0.05).Postoperative HOAs:that of group B was significantly smaller than that of group A at each time points after operation(all P<0.05).At 1 year postoperatively:the rate of spectacle independence of group B[96.15%(25/26)]was significantly higher than that of group A[74.07%(20/27)],and the incidence of glare and halo of group B[7.69%(2/26)]was significantly lower than that of group A[29.62%(8/27)](all P<0.05).Conclusion Both femtosecond laser arcuate keratotomy and toric IOL implantation can correct low degree astigmatism before cataract surgery.However,the long-term efficacy of toric IOL implantation is better than femtosecond laser arcuate keratotomy and the former achieves better visual quality.