两种不同设计Toric人工晶状体在高度近视白内障手术中的疗效研究

Efficacy of Two Different Designs of Toric Intraocular Lens in Cataract Surgery with High Myopia

目的研究两种不同设计的环曲面人工晶状体(Toric intraocular lens,Toric IOL)在高度近视白内障超声乳化手术的临床效果及稳定性。方法通过历史性队列研究,分析在武汉市第一医院行白内障超声乳化吸出+Toric IOL植入的高度近视(眼轴≥26mm)患者59例(70眼),其中A组31例(35眼)植入L型襻Toric IOL(Acrys of SN60AT IQ),B组28例(35眼)植入板状襻Toric IOL(AT TORBI 709M),术后随访6个月。观察两组患者术前及术后视力、残余散光度、人工晶状体旋转度,iTrace视觉质量分析仪测量术后Toric IOL在眼内的偏心量及像差。结果术后6个月,两组患者裸眼远视力(uncorrected distance visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)均显著高于术前,A组术后UCVA(LogMAR)(0.41±0.21)优于B组(0.57±0.28),差异有统计学意义(P<0.05)。术后1周、1月、3月及6月,A组散光分别为(0.59±0.28)D、(0.74±0.24)D、(0.96±0.39)D、(0.99±0.38)D,均明显低于B组各时间点[(0.86±0.29)D、(0.99±0.23)D、(1.13±0.20)D、(1.16±0.19)D],差异均有统计学意义(均P<0.05)。术后6月,A组IOL平均旋转(3.94±1.26)°,显著低于B组[(4.74±1.29)°,P<0.05]。A组全眼总像差、全眼总低阶像差(不包括离焦)、全眼总高阶像差及慧差低于B组,差异均有统计学意义(均P<0.05)。A组平均偏心量为(0.183±0.051)mm,低于B组[(0.275±0.064)mm],差异有统计学意义(P<0.05)。结论对于高度近视伴有角膜散光的白内障患者,选择L型襻以及更长直径的Toric IOL植入,能够实现较好的旋转稳定性,偏心程度小,从而获得更好的术后视觉质量。

Objective To investigate the clinical efficacy and stability of two different designs of Toric intraocular lens(Toric IOL)in high myopia cataract phacoemulsification.Methods In all,59patients(70eyes)with high myopia(axis≥26mm)who underwent phacoemulsification and Toric IOL implantation in Wuhan No.1Hospital were analyzed through a historical cohort study.Among them,31patients(35eyes)in group A were implanted with L-loop haptic Toric IOLs(Acrys of SN60AT IQ)and 28patients(35eyes)in group B were implanted with plate-haptic Toric IOLs(AT TORBI 709M).Postoperative follow-up was conducted in the following 6months.Preoperative and postoperative visual acuity,residual astigmatism,IOL rotation,and postoperative Toric IOL eccentricity and aberration measured by iTrace vision quality analyzer were observed in the two groups.Results Six months after surgery,uncorrected distance visual acuity(UCVA)and best corrected visual acuity(BCVA)were significantly improved in both groups when compared with those before operation(P<0.05).Postoperative UCVA(Log-MAR)in group A(0.41±0.21)was better than that in group B(0.57±0.28)(P<0.05).One week,1month,3months and 6 months after the surgery,the astigmatism results of group A were(0.59±0.28)D,(0.74±0.24)D,(0.96±0.39)D,(0.99±0.38)D,respectively,which were significantly lower than those of group B[(0.86±0.29)D,(0.99±0.23)D,(1.13±0.20)D,(1.16±0.19)D](all P<0.05).At the end of 6th month of follow-up,the mean rotation of IOL in group A was(3.94±1.26)°,which was significantly lower than that in group B(4.74±1.29)°(P<0.05).Total aberration,total low order aberration(excluding defocus),total high order aberration and coma aberration in group A were lower than those in group B(all P<0.05).The average eccentricity of group A was(0.183±0.051)mm,which was lower than that in group B[(0.275±0.064)mm](P<0.05).Conclusion For cataract patients with high myopia and corneal astigmatism,the implantation of L-loop haptic and Toric IOL with longer diameter has better rotational stability and less eccentricity,thus achieve better visual quality.