飞秒激光辅助与传统超乳手术联合Toric人工晶状体植入治疗白内障的对比研究

Comparative Study of Femtosecond Laser Assisted and Traditional Phacoemulsification Combined with Toric Intraocular Lens Implantation in the Treatment of Cataract

目的 对比研究飞秒激光辅助下白内障手术和传统超乳手术联合Toric人工晶状体(intraocular lens, IOL)植入治疗白内障的临床效果。方法 选取2023-01~06月于作者医院就诊的正常眼轴白内障患者(22 mm≤眼轴长<24 mm)48例,按随机数字表法分成飞秒组(n=16)和传统组(n=32)。观察手术前后最佳矫正视力(best corrected visual acuity, BCVA)、散光分布,应用OPD-SCANⅢ视觉质量分析仪检测斯特列尔比(strchl)、表面不对称指数(surface asymmetry index, SAI)、角膜规则指数(surface regularity index, SRI)、球差(sphericalaberration, SA)、不规则散光指数(irregular astigmatism index, IAI)及眼高阶相差,应用TOPCON KR-1W视觉质量分析仪检测4 mm直径瞳孔内3阶相差(4s3)、4 mm直径瞳孔内4阶相差(4s4)、4 mm直径瞳孔下总相差(4Total)、6 mm直径瞳孔内3阶相差(6s3)、6 mm直径瞳孔内4阶相差(6s4)、6 mm直径瞳孔内5阶相差(6s5)、6 mm直径瞳孔内6阶相差(6s6)、6 mm直径瞳孔下3阶及5阶相差之和(6s3+s5)、6 mm直径瞳孔内4阶及6阶相差之和(6s4+s6)、6 mm直径瞳孔内总相差(6Total)。并对术后角膜指数及眼高阶相差与strchl进行相关性分析。结果 术后3个月,飞秒组BCVA为(0.06±0.07)logMAR,传统组为(0.16±0.21)logMAR,较术前显著提高(P<0.05)。术后3个月散光分布,飞秒组为(0.83±0.53)D,传统组为(0.67±0.46)D,较术前明显减少(P<0.05)。术后3个月,两组患者BCVA、散光分布及strchl值比较差异均无统计学意义(P均>0.05)。术后3个月,飞秒组患眼strchl值与角膜Total相差呈负相关,与眼内Total、High相差呈负相关(P<0.05);传统组患眼strchl值与角膜s3+s5+s7相差呈负相关,与全眼High、s3+s5+s7相差呈负相关(P<0.05)。两组患者术后角膜、全眼各项高阶相差情况比较差异均无统计学意义(P均<0.05)。术后3个月,飞秒组患者strchl值与全眼4s3、4s4及4Total呈负相关(P<0.05);传统组患眼strchl值与全眼4s3、4s4及4Total呈负相关,与6s3、6s4、6s6、6s3+s5、6s4+s6、6Total呈负相关(P<0.05)。结论 飞秒激光辅助下白内障手术和传统超乳手术联合Toric IOL植入治疗白内障临床效果确切。对于合并规则角膜散光的白内障患者,飞秒激光辅助下白内障手术联合Toric IOL植入是安全有效的,在解决患眼白内障的同时还能矫正患者角膜散光,术中保持Toric IOL的囊袋居中性、IOL光学面不倾斜以及减少术源性损伤是保障术后视觉质量的前提。

Objective To compare the clinical effects of femtosecond laser assisted cataract surgery and traditional phacoemulsification combined with Toric intraocular lens(IOL)implantation in the treatment of cataract.Methods A to-tal of 48 patients with normal axial cataract(22 mm≤axial length<24 mm)in author's hospital were randomly divided into femtosecond group(n=16)and traditional group(n=32)according to random number table method.The best cor-rected visual acuity(BCVA)and distribution of astigmatism were observed before and after the surgery,strchl,surface asymmetry index(SAI),surface regularity index(SRI),spherical aberration(SA),irregular astigmatism index(IAI)and higher order aberrations were measured by OPD-SCANⅢvisual quality analyzer,the TOPCON KR-1W visual quality ana-lyzer was used to detect the 3rd-order aberrations within a 4 mm pupil(4s3),4th-order aberrations within a 4 mm pupil(4s4),total aberrations within a 4 mm pupil(4Total),3rd-order aberrations within a 6 mm pupil(6s3),4thorder aberrations within a 6 mm pupil(6s4),5th-order aberrations within a 6 mm pupil(6s5),6th-order aberrations within a 6 mm pupil(6s6),the sum of 3rd and 5thorder aberrations within a 6 mm pupil(6s3+s5),the sum of 4th and 6th-order aberrations within a 6 mm pupil(6s4+s6)and total aberrations within a 6 mm pupil(6Total).Correlation analysis was also performed among postoperative corneal indices and higher order aberrations and strchl.Results Three months after surgery,the BCVA in the femtosecond group was(0.06±0.07)logMAR,and in the traditional group was(0.16±0.21)logMAR,both showing significant improvement compared to preoperative levels(P<0.05).The astigmatism distribution 3 months after surgery was(0.83±0.53)D in the femtosecond group and(0.67±0.46)D in the traditional group,both significantly reduced compared to those before surgery(P<0.05).The comparison of BCVA,astigmatism distribution and strchl values between the two groups 3 months after surgery showed no statistically significant differences(all P>0.05).Three months after surgery,in the femtosecond group,the strchl value was negatively correlated with corneal Total aberrations and negatively correlated with intraocular Total,High aberrations(P<0.05);in the traditional group,the strchl value was negatively correlated with corneal s3+s5+s7 aberrations and negatively correlated with whole-eye High,s3+s5+s7 aberrations(P<0.05).There were no statistically significant differences in corneal and whole-eye higher order aberrations after surgery between the two groups(all P<0.05).Three months after surgery,in the femtosecond group,the strchl value was negatively correlated with whole-eye 4s3,4s4 and 4Total aberrations(P<0.05);in the traditional group,the strchl value was negatively correlated with whole-eye 4s3,4s4 and 4Total aberrations,as well as with 6s3,6s4,6s6,6s3+s5,6s4+s6 and 6Total(P<0.05).Conclusion Cataract surgery assisted by femtosecond laser and traditional phacoemulsification combined with the implantation of Toric IOL are both effective in treating cataract.For cataract patients with regular corneal astigmatism,femtosecond laser-assisted cataract surgery combined with the implantation of Toric IOL is safe and effective.It not only treats the cataract but also corrects the patient's corneal astigmatism.Maintaining the centration of the Toric IOL in the capsular bag,preventing tilting of the IOL optical surface and reducing surgically induced damage are prerequisites for ensuring postoperativevisual quality.