全飞秒激光角膜基质透镜植入术矫正中高度远视伴高度散光的矢量分析

Vector analysis of small-incision intrastromal lenticule implantation for the correction of moderate to high hyperopia with high astigmatism

目的探讨采用Alpins矢量分析法观察全飞秒激光角膜基质透镜植入术矫正中高度远视伴高度散光的临床效果.方法回顾性病例系列研究.纳入2021至2023年在济南明水眼科医院行同种异体全飞秒激光角膜基质透镜植入术矫正中高度远视伴高度散光的患者20例(21只眼).术后随访6个月,分析裸眼视力(UCVA)、最佳矫正视力(BCVA)、球镜度、柱镜度、等效球镜度(SE).采用Alpins矢量分析法分析术前及术后6个月的散光指标,包括目标矫正散光(TIA)、手术矫正散光(SIA)、差异矢量(DV)、误差大小(EM)、误差角度(EA)、矫正指数(CI)及成功指数(IOS).结果术后1周及1、3、6个月的BCVA依次为0.50±0.29、0.48±0.31、0.47±0.31、0.46±0.32均优于术前BCVA 0.52±0.31(F=2.44,P<0.05).术后6个月,所有患者术眼BCVA均无下降,其中有9只眼(42.9%)的BCVA提高1行及以上.术后1周及1、3、6个月的等效球镜度分别为(0.67±0.83)D、(0.64±0.50)D、(0.60±0.40)D、(0.52±0.49)D,与术前相比差异有统计学意义(F=272.65,P<0.05).术后6个月,矢量分析指标:TIA、SIA、DV平均值分别为2.21 D×2°、1.86 D×3°、0.35 D×2°,EM、EA分别为(-0.59±0.35)D、1.57°±8.13°,其中5只眼(23%)的EA为0°,12只眼(57%)的EA在5°内,19只眼(90%)的EA在15°内.CI及IOS值分别为0.79±0.14及0.30±0.11.结论全飞秒激光角膜基质透镜植入术能够安全有效地矫正中高度远视伴高度散光.

Objective To investigate the clinical efficacy of small-incision intrastromal lenticule implantation in the correction of moderate to high hyperopia with high astigmatism by Alpins vector analysis.Methods This was a retrospective case series study.Twenty-one eyes of 20 patients who underwent allogeneic corneal small-incision intrastromal lenticule implantation were enrolled in Jinan Mingshui Eye Hospital from 2021 to 2023.During the 6-month follow-up,the uncorrected visual acuity(UDVA),best corrected visual acuity(BCVA),spherical degree,cylindrical degree,spherical equivalent(SE)were analyzed.And vector analysis of astigmatism indexes before and 6 months after surgery was performed by Alpins’s vector analysis,including target induced astigmatism(TIA),surgically induced astigmatism(SIA),difference vector(DV),magnitude of error(EM),angle of error(EA),correction index(CI),and the index of success(IOS).Results BCVA was 0.50±0.29,0.48±0.31,0.47±0.31 and 0.46±0.32 at 1 week,1 month,3 months and 6 months after surgery,respectively,which was better than that before surgery(0.52±0.31)(F=2.44,P<0.05).At 6 months after surgery,BCVA of all patients did not decrease,and BCVA of 9 eyes(42.9%)increased by 1 line or more.The spherical equivalent degree was(0.67±0.83)D,(0.64±0.50)D,(0.60±0.40)D,and(0.52±0.49)D at 1 week,1 month,3 months and 6 months after surgery,respectively,and the difference was statistically significant compared with that before surgery(F=272.65,P<0.05).Vector analysis results showed that at 6 months postoperatively,the vector mean of TIA,SIA and DV were 2.21 D×2°,1.86 D×3°and 0.35 D×2°,respectively.The EM and EA were(-0.59±0.35)D and 1.57°±8.13°,respectively.Amongst all cases,EA of 5 eyes(23%)were at 0°,with 12 eyes(57%)within 5°and 19 eyes(90%)within 15°.The CI and IOS were 0.79±0.14 and 0.30±0.11,respectively.Conclusion Small-incision intrastromal lenticule implantation corrects moderate to high hyperopia with high astigmatism safely and effectively.