Rotational stability of plate haptic toric intraocular lenses after combined 25-gauge vitrectomy and cataract surgery

AIM:To evaluate the postoperative intraocular lens(IOL)rotational stability and residual refractive astigmatism following combined 25-gauge vitrectomy and cataract surgery with implantation of a plate haptic toric IOL.METHODS:In this retrospective case series,32 eyes of 32 patients underwent a combined 25-gauge vitrectomy and phacoemulsification for vitreoretinal diseases and cataract with regular corneal astigmatism of at least 1 diopter(D).A plate haptic toric IOL(AT Torbi 709M,Carl Zeiss Meditec AG)was implanted in all eyes.The outcome measures were rotational stability and refractive astigmatism up to 6mo postoperatively as well as the best corrected visual acuity(BCVA).RESULTS:Preoperative refractive astigmatism was 2.14±1.17 D,which was significantly reduced to 0.77±0.37 D six to eight weeks postoperatively and remained stable throughout the observation period(0.67±0.44 D at three months and 0.75±0.25 D at six months;for all groups:P<0.0001 compared to baseline).BCVA improved significantly from 0.36±0.33 logMAR preoperatively to 0.10±0.15 logMAR following surgery(P=0.02).Mean IOL axis deviation from the target axis was 3.4°±2.9°after six to eight weeks and significantly decreased over time(2.4°±2.6°six months after surgery;P=0.04).In one patient IOL,re-alignment was performed.CONCLUSION:Corneal astigmatism is significantly reduced following combined 25-gauge vitrectomy and cataract surgery.The plate haptic toric IOL position and axis remain stable during the observation period of six months.

Comparison of trifocal toric and bifocal toric intraocular lens implantation in patients with cataract and high corneal astigmatism

AIM:To investigate and compare the quality of life,satisfaction,contrast sensitivity,glare,depth perception,and intraocular lens(IOL)rotation in patients who underwent trifocal toric and bifocal toric IOLs.METHODS:A total of 80 eyes of 40 patients were included in this prospective study.Twenty patients in each group were implanted with trifocal toric and bifocal toric IOL,respectively.Preoperative and postoperative 6-month measurements were recorded for both patient groups.Comprehensive anterior and posterior segment examinations,distance-intermediate-near visual acuity values and the visual function scale questionnaire results were evaluated at these examinations.Patient satisfaction,contrast sensitivity,glare,intermediate-near and distance stereopsis and IOL rotation were also evaluated.RESULTS:No significant difference was found between the groups in terms of distance and near visual acuities(P=0.269,P=0.451).Intermediate visual acuity was significantly increased in the trifocal toric group(P<0.001).The visual function scale results were increased after surgery in both groups(P=0.001 and P<0.001),with no difference determined between them(P=0.158 and P=0.691).The number of patients wearing glasses was low in both groups and there was no significant difference between the groups(P>0.05).The overall satisfaction in the trifocal toric group was significantly higher than in the bifocal toric group(P=0.03).The highest sensitivity was observed at 6 cpd spatial frequency in all patients under photopic conditions(1.80±0.24 logU,1.74±0.20 logU).Distance-intermediate-near binocular depth perception results in both groups were higher in the trifocal toric group(P=0.02,0.048,0.003,respectively).Although there was no significant difference for 3 meters stereopsis,the trifocal toric group had higher depth perception(P=0.577).Mean rotation was 5.76°±3.93°in the trifocal toric group and 12°±7.1°in the bifocal toric group.CONCLUSION:Better results in the middle distance are obtained in the trifocal toric group and less IOL rotation due to digital system-coordinated surgery.Moreover,the overall satisfaction in the trifocal toric group is significantly higher than in the bifocal toric group.

Optical quality of toric intraocular lens implantation in cataract surgery

AIM: To analyze the optical quality after implantation of toric intraocular lens with optical quality analysis system.METHODS: Fifty-two eyes of forty-four patients with regular corneal astigmatism of at least 1.00 D underwent implantation of Acry Sof toric intraocular lens, including T3 group 19 eyes, T4 group 18 eyes, T5 group 10 eyes,T6 group 5 eyes. Main outcomes evaluated at 3mo of follow-up, included uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), residual refractive cylinder and intraocular lens(IOL) axis rotation.Objective optical quality were measured using optical quality analysis system(OQAS Ⅱ, Visiometrics, Spain),included the cutoff frequency of modulation transfer function(MTFcutoff), objective scattering index(OSI),Strehl ratio, optical quality analysis system value(OV)100%, OV 20% and OV 9% [the optical quality analysis system(OQAS) values at contrasts of 100%, 20%, and 9%].RESULTS: At 3mo postoperative, the mean UDVA and CDVA was 0.18 ±0.11 and 0.07 ±0.08 log MAR; the mean residual refractive cylinder was 0.50 ±0.29 D; the mean toric IOL axis rotation was 3.62 ±1.76 degrees, the mean MTFcutoff, OSI, Strehl ratio, OV 100%, OV 20% and OV9% were 22.862 ±5.584, 1.80 ±0.84, 0.155 ±0.038, 0.76 ±0.18,0.77±0.19 and 0.78±0.21. The values of UDVA, CDVA, IOL axis rotation, MTFcutoff, OSI, Strehl ratio, OV100%,OV20% and OV9% depending on the power of the cylinder of the implantation were not significantly different(P 】0.05), except the residual refractive cylinder(P 【0.05).CONCLUSION: The optical quality analysis system was useful for characterizing the optical quality of Acry Sof toric IOL implantation. Implantation of an Acry Sof toric IOL is an effective and safe method to correct corneal astigmatism during cataract surgery.

Comparison of two different methods of preoperative marking for toric intraocular lens implantation： bubble marker versus pendulum marker

AIM： To compare the accuracy of two different methods of preoperative marking for toric intraocular lens（IOL） implantation, bubble marker versus pendulum marker, as a means of establishing the reference point for the final alignment of the toric IOL to achieve an outcome as close as possible to emmetropia.·METHODS： Toric IOLs were implanted in 180 eyes of110 patients. One group（55 patients） had preoperative marking of both eyes done with bubble marker（ASICO AE-2791TBL） and the other group（55 patients） with pendulum marker（Rumex 誖 3-193）. Reference marks were placed at 3-, 6-, and 9-o＇clock positions on the limbus. Slit-lamp photographs were analyzed using Adobe Photoshop（version 7.0）. Amount of alignment error（in degrees） induced in each group was measured.· RESULTS： Mean absolute rotation error in the preoperative marking in the horizontal axis was 2.42±1.71 in the bubble marker group and 2.83 ±2.31 in the pendulum marker group（P =0.501）. Sixty percent of the pendulum group and 70% of the bubble group had rotation error ≤3（P =0.589）, and 90% eyes of the pendulum group and 96.7% of the bubble group had rotation error ≤5（P =0.612）.·CONCLUSION： Both preoperative marking techniques result in approximately 3 of alignment error. Both marking techniques are simple, predictable, reproducible and easy to perform.

Case report:simultaneous femtosecond laser astigmatic keratotomy and toric intraocular lens implantation in femtosecond laser-assisted cataract surgery in a patient with surgically induced high corneal astigmatism

Background:Femtosecond laser astigmatic keratotomy(FSAK)and toric intraocular lens(IOL)implantation have been studied individually for comparison to treat astigmatism at cataract surgery.We report a case of surgically induced high corneal astigmatism by laser thermal keratoplasty(LTK)in a patient with cataract who was successfully treated with simultaneous combination of FSAK and toric IOL implantation with femtosecond laser-assisted cataract surgery(FLACS).This is the first report of both procedures combined simultaneously,with or without history of LTK.Case Description:A 68-year-old male presented with a history of LTK with two enhancements each eye in 2004,with subsequent surgically induced high corneal astigmatism,and with age-related nuclear cataract of both eyes.IOL master demonstrated+7.71 diopters of astigmatism at 163 degree right eye and+3.29 diopters of astigmatism at 4 degree left eye.After extensive discussion of the risks and benefits,the patient agreed to undergo FLACS with FSAK with two 61 degrees of relaxation incisions(RIs)and toric IOL(Alcon SN6AT9)right eye;FLACS with toric IOL(Alcon SN6AT7)alone left eye.At 2-year follow-up,uncorrected visual acuity was 20/30 right eye,20/25 left eye.His best corrected visual acuity was 20/25(+0.25+1.00 axis 21)right eye and 20/20(plano+0.25 axis 90)left eye;his best corrected near visual acuity was J1+with add+2.50 diopters right eye and left eye.Conclusions:Patients with age-related cataract and LTK induced high corneal astigmatism can hardly be sufficiently treated with FSAK or toric IOL alone at the time of cataract surgery.An effective way is to combine large FSAK and toric IOL of the highest cylindrical power of T9,in our case,simultaneously,which can achieve an excellent long term visual outcome.

Clinical efficacy of femtosecond laser-assisted phacoemulsification in diabetic cataract patients

BACKGROUND Diabetic patients with cataracts encounter specific difficulties during cataract surgery due to alterations in microcirculation,blood supply,metabolism,and the microenvironment.Traditional phacoemulsification may not fully tackle these issues,especially in instances with substantial preoperative astigmatism.The utilization of femtosecond laser-assisted phacoemulsification,in conjunction with Toric intraocular lens(IOL)implantation,offers a potentially more efficient strategy.This research seeks to evaluate the efficacy and possible complications of this approach in diabetic cataract patients.AIM To investigate the clinical efficacy and complications of femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation in diabetic cataract patients,comparing it with traditional phacoemulsification methods.METHODS This retrospective study enrolled 120 patients with diabetes cataract from May 2019 to May 2021.The patients were divided into two groups:the control group underwent traditional phacoemulsification and Toric IOL implantation,while the treatment group received Len Sx femtosecond laser-assisted treatment.Outcome measures included naked eye vision,astigmatism,high-level ocular phase difference detection,clinical efficacy,and complication.RESULTS There were no significant preoperative differences in astigmatism or naked eyesight between the two groups.However,postoperative improvements were observed in both groups,with the treatment group showing greater enhancements in naked eye vision and astigmatism six months after the procedure.High-level corneal phase difference tests also indicated significant differences in favor of the treatment group.CONCLUSION This study suggests that femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation appears to be more effective in enhancing postoperative vision in diabetic cataract patients compared to traditional methods offering valuable insights for clinical practice.

Comparative evaluation of rotational stability of toric IOLs with four-eyelet vs two-eyelet capsular tension rings in eyes with high myopia

AIM:To compare the rotational stability of Toric intraocular lens(IOLs)implantation combined with foureyelet or two-eyelet capsular tension rings(CTRs)in eyes with high myopia and cataract.METHODS:This prospective randomized controlled interventional study in cluded 33 eyes which had preoperative corneal astigmatism≥1.5 D and ocular axial length≥25.5 mm.These eyes were randomly divided into two groups to undergo phacoemulsification and toric IOL implantation with either four-eyelet CTR implantation(group A,n=16)or two-eyelet CTR implantation(group B,n=17).Uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA),phoropter examination results,and toric IOL rotation degrees were tested 6 mo after the surgery.RESULTS:In both groups,the toric IOL was in the capsular sac 6 mo after surgery.The difference between the two groups in terms of visual outcome was not found to be statistically significant(P>0.05)at a follow-up of 6 mo.The mean residual astigmatism values were 0.56±0.22 D and 0.92±0.24 D in A and B groups,respectively(P<0.001).The mean rotation degree of IOL was 1.00°±0.73°in group A and 3.53°±1.46°in group B(P<0.001).CONCLUSION:In cataract patients with high myopia and astigmatism,four-eyelet CTR can effectively increase the rotation stability of toric IOLs,achieving the desired goal of correcting corneal astigmatism.

Comparative clinical outcomes of Tecnis toric IOL implantation in femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery

AIM: To compare the short-term visual outcomes, residual refractive cylinder, and rotation stability after Tecnis toric intraocular lens(IOL) implantation during femtosecond laserassisted cataract surgery(Femto phaco) and conventional phacoemulsification surgery(Conventional phaco).METHODS: In a prospective cohort study, Conventional phaco and Femto phaco(anterior capsulotomy and lens fragmentation by a femtosecond laser) with Tecnis toric IOL implantation were performed in 40 eyes from 36 patients and 37 eyes from 33 patients, respectively. The uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), and manifest refraction were assessed during 1 d, 1 wk, and 1 mo follow-ups. The orientation of the Tecnis Toric IOL was evaluated during 1 wk and 1 mo follow-ups.RESULTS: There were no significant differences in UDCA or CDVA between two groups at 1 mo postoperatively, though relatively more subjects had UDVA values of 20/25 or better in Femto phaco group than in the Conventional group(P>0.05). A lower but not significantly lower rate of having more than 5° of IOL rotation was observed in Femto phaco group at the 1-month follow-up, while a significant lower rate of residual astigmatism of ≤1 D was observed in Femto phaco group.CONCLUSION: The Femto phaco group has significantly more subjects with the residual astigmatism of ≤1 D, but there are no significant differences in rotation stability and visual outcomes as compared with the Conventional phaco group after the application of the Tecnis toric IOL in this cohort.

The impact of posterior corneal astigmatism on the surgical planning of toric multifocal intraocular lens implantation

Purpose:To investigate the influence of posterior corneal astigmatism on the prediction accuracy of toric multi­focal intraocular lens(IOL)calculation.Methods:The keratometric astigmatism measured by Lenstar LS 900(KCA_(L)),keratometric astigmatism(KCAp)and total corneal astigmatism(TCA)measured by Scheimpflug camera(Pentacam HR)were documented and analyzed accordingly.Three deduction models using different parameters were compared.Model 1:KCA_(L)+keratometric comeal surgically induced astigmatism(KCSIA,0.30 D@50°);Model 2:KCA_(P)+KCSIA);Model 3:TCA 4-total CSIA(TCSIA,0.23 D@50°).The prediction errors of each model as the difference vector between the actual and the intended residual astigmatism were compared.Results:Seventy-six eyes implanted with toric multifocal IOLs were included in this study.The vector differences of the actual KCSIA and TCSIA were statistically significant in the total sample and against-the-rule(ATR)sub­group(both P<0.05).Model 1 deduced the smallest mean values of prediction error,while that of Model 3 were smaller than that of Model 2,both in the total sample and the ATR subgroups(all P<0.05).Meanwhile,in the total sample and ATR subgroups,the centroid vector magnitudes of Model 3 were smaller than that of Model 1(0.31±0.76 D and 0.39±0.76 D).Conclusions:The calculation of toric multifocal IOL should be individualized especially in the ATR eyes for the impact of PCA on the estimation of the preoperative comeal astigmatism and the CSIA.

Image-guided lens extraction surgery: a systematic review

A systematic review of the recent literature regarding the current image-guided systems used for cataract surgery or refractive lens exchange was performed based on the PubMed and Google Scholar databases in March 2018. Literature review returned 21 eligible studies. These studies compared image-guided systems with other keratometric devices regarding their accuracy, repeatability and reproducibility in measurement of keratometric values, astigmatism magnitude and axis, as well as in IOL power calculation. Additionally, the image-guided systems were compared with conventional manual ink-marking techniques for the alignment of toric IOLs. In conclusion, image-guided systems seem to be an accurate and reliable technology with measurements of high repeatability and reproducibility regarding the keratometry and IOL power calculation, but not yet interchangeable with the current established and validated keratometric devices. However, they are superior over the conventional manual inkmarking techniques for toric IOL alignment.

Correction of low corneal astigmatism in cataract surgery

· AIM: To evaluate and compare aspheric toric intraocular lens(IOL) implantation and aspheric monofocal IOL implantation with limbal relaxing incisions(LRI) to manage low corneal astigmatism(1.0-2.0 D) in cataract surgery.· METHODS: A prospective randomized comparative clinical study was performed. There were randomly recruited 102 eyes(102 patients) with cataracts associated with corneal astigmatism and divided into two groups. The first group received toric IOL implantation and the second one monofocal IOL implantation with peripheral corneal relaxing incisions. Outcomes considered were: visual acuity, postoperative residual astigmatism, endothelial cell count, the need for spectacles, and patient satisfaction. To determine the postoperative toric axis, all patients who underwent the toric IOL implantation were further evaluated using an OPD Scan III(Nidek Co, Japan). Follow-up lasted 6mo.· RESULTS: The mean uncorrected distance visual acuity(UCVA) and the best corrected visual acuity(BCVA) demonstrated statistically significant improvement after surgery in both groups. At the end of the follow-up the UCVA was statistically better in the patients with toric IOL implants compared to those patients who underwent implantation of monofocal IOL plus LRI. The mean residual refractive astigmatism was of 0.4 D for the toric IOL group and 1.1 D for the LRI group(P 【0.01). No difference was observed in the postoperative endothelial cell count between the two groups.· CONCLUSION: The two surgical procedures demonstrated a significant decrease in refractive astigmatism. Toric IOL implantation was more effective and predictable compared to the limbal relaxing incision.

Acrysof toric人工晶状体植入矫正白内障患者角膜散光的疗效评估

目的 比较术前存在角膜散光的白内障患者植入Acrysof toric （Acrysof SN60TT）人工晶状体（IOL）和Acrysof SA60AT球面IOL后的视觉效果.方法 前瞻性病例对照研究.收集术前角膜散光大于1.0 D的白内障患者96例（104眼）,其中56眼植入Acrysof toric IOL（Toric组）,48眼植入Acysof SA60AT球面IOL（对照组）.术后3个月观察裸眼视力、最佳矫正视力、残余散光度、脱镜率、全眼总低阶和高阶像差、调制传递函数（5、10、15、20、25、30 cpd）以及Toric IOL轴位.采用配对设计t检验、独立样本t检验对数据进行分析.结果 术后Toric组裸眼视力（logMAR）0.22±0.12、最佳矫正视力0.05±0.07、残余散光度为0.36 D；对照组裸眼视力0.36±0.20、最佳矫正视力0.06±0.08、残余散光度为1.19 D;两组比较,裸眼视力和残余散光度差异均有统计学意义（t=4.526、4.275,P＜0.01）,最佳矫正视力差异无统计学意义.术后3个月,视远脱镜率Toric组为59％,对照组为32％.3 mm瞳孔直径下,Toric组术后低阶像差低于对照组,差异有统计学意义（t=11.146,P＜0.01）,但两组术后高阶像差差异无统计学意义,且术后Toric组MTF值于各空间频率均高于对照组,差异均有统计学意义（t=8.894、5.750、4.573、4.475、2.968、4.756,P＜0.01）.Toric组术后散光轴平均偏移5.84°±4.12°（0°～l8°）.结论 AcrySof toric IOL植入后可获得令人满意的术后裸眼视力、脱镜率、视觉质量,可预测性强,且具有良好的旋转稳定性.

高度近视白内障合并角膜散光患者植入Toric人工晶状体效果评估

目的观察术前伴有规则角膜散光的高度近视合并白内障患者行超声乳化白内障吸除术联合Toric人工晶状体（IOL）植入术后的临床效果及囊袋内旋转稳定性。方法前瞻性研究。收集32例（47眼）角膜散光均大于1D的高度近视白内障患者（眼轴长度〉25mm）。术前通过生物测量及软件计算确定IOL型号及放置轴位，行超声乳化白内障吸除术，术中将IOL准确放置于目标位置。术后1d、1周、1个月和3个月充分散瞳后裂隙灯照相，采用AdobePhotoshop软件行IOL轴位分析，记录各组术前、术后裸眼视力（UCVA）、最佳矫正视力（BCVA）、术前角膜散光、预计残留散光、术后实际散光、IOL旋转度数及其他并发症。采用单项有序资料列联表分析和配对t检验。结果术后3个月，91％患者UCVA大于0．5，显著高于术前BCVA，差异有统计学意义（x2=80．67，P〈0．05）。术前平均角膜散光为（2．11±0．83）D，预计残留散光为（0．31±0．26）D，术后3个月残留散光为（0．44±0．35）D，术前、术后散光比较差异有统计学意义（t=12．48，P〈0．05）。预计残留散光与术后3个月实际散光度数比较差异无统计学意义（t=1．69，P〉0．05）。术后3个月IOL旋转度数为（3．75±1．39）°，其中旋转度数〉5°的有3例（占6％），无旋转度数超过10°的病例。结论ToricIOL能有效地矫正高度近视白内障患者的角膜散光，预测性强，且植入后具有良好的旋转稳定性，患者术后获得更好的裸眼远视力。

Acrysof Toric人工晶状体植入术后旋转稳定性观察

目的评价Acrysof Toric SA60TT型系列人工晶状体植入术后3个月在囊袋内位置(旋转)的稳定性。方法31例(39眼)白内障超声乳化Acrysof Toric SA60TT型系列人工晶状体植入术,其中11眼角膜散光度小于1.50D者植入SA60T3型(A组),18眼散光度为1.50D^2.00D者植入SA60T4型(B组),10眼散光度大于2.00D者植入SA60T5型(C组)。观察术前及术后3个月的视力、角膜散光及人工晶状体的旋转度,并观察人工晶状体的旋转度与角膜散光等的关系。结果术后3月,3组人工晶状体旋转度之间无统计学意义,术后3月全部患者人工晶状体旋转的绝对平均值为2.5°±1.9°,15眼(38.46%)为顺时针旋转,最大值为10°,16眼(41.03%)为逆时针旋转,最大值为5°,8眼(20.51%)无旋转。36眼(92.31%)旋转小于5°,25眼(65.10%)旋转小于2°,旋转的度数与眼轴长、术前角膜散光度均无相关性。结论Acrysof Toric SA60TT系列人工晶状体在囊袋内有较好的旋转稳定性。

Verion导航与手动标记对Toric人工晶状体植入术后角膜散光矫正的影响

目的：比较Verion导航系统与手动标记对散光矫正型人工晶状体（Toric IOL）植入术矫正角膜散光效果的影响。方法：前瞻性随机对照研究。选取2015 年2 月至2017 年2 月在江苏省常州市第三人民医院就诊的白内障合并规则性角膜散光〉 1.0 D的患者80例（80眼）。使用随机数字表法将患者随机分配到观察组（40例）和对照组（40例）。观察组使用Verion数字导航系统引导术中Toric IOL的植入，对照组术前在裂隙灯显微镜下手动标记用于指导Toric IOL的植入。2 组患者均行超声乳化白内障吸除联合Toric IOL植入术，观察患者术前及术后3个月的裸眼远视力（UCDVA）（ LogMAR）、最佳矫正远视力（BCDVA）（ LogMAR）、角膜散光以及术后3个月的实际与预期残余散光、Toric IOL轴位。计量资料组间比较采用独立样本t检验，计数资料组间比较采用卡方检验。结果：对照组术后平均UCDVA为0.13±0.13，观察组术后平均UCDVA为0.11±0.11，2 组间差异无统计学意义（t=-0.96，P=0.34）。实际与预期残余散光的偏差绝对值对照组为（0.21±0.12）D，观察组为（0.12±0.11）D，2 组间差异有统计学意义（t=-3.71，P=0.001）。术后对照组裂隙灯显微镜下Toric IOL实际轴位与预期安放轴位偏差绝对值为4.6°±3.0°，观察组为2.2°±1.6°，2组间差异有统计学意义（t=-3.69，P=0.001）。结论：在Toric IOL植入术中应用Verion数字导航系统相较于传统手动标记技术可明显减小术后实际与预期散光的差值，减少术后Toric IOL轴位与预期轴位的偏离。

Toric人工晶状体植入术后的远期临床疗效

目的评价AcrysofToric人工晶状体矫正白内障伴角膜散光患者的远期临床效果及其在囊袋内的旋转稳定性。方法回顾性非随机临床研究。选取在浙江大学医学院附属第一医院眼科已行白内障超声乳化吸除联合AcrysofToric人工晶状体植入术的白内障患者21例（23眼），年龄53-84岁，均为术后24个月以上。观察术前术后的裸眼视力（UCVA）、最佳矫正视力（BCVA），术前角膜散光、总散光，术后角膜散光、残留散光，人工晶状体轴位等。术前术后比较采用配对t检验。结果术后最后一次随访时，患眼的UCVA（10gMAR）为0．16±0．13，BCVA（10gMAR）为0．06±0．09。术前总散光（-2．98±1．22）D，术后残留散光（-0．57±0．78）D，两者比较差异有统计学意义（t=6．371，P〈0．05）。术前预留散光（-0．53±0．70）D，与术后残留散光比较差异无统计学意义。术前角膜散光（2．23＋1．17）D，术后角膜散光（1．89＋1．22）D，两者比较差异无统计学意义。AcrysofToric人工晶状体轴位偏离既定轴位度数平均为（2．84±2．66）°，1只术眼（4％）的人工晶状体轴位偏离7。，余术眼（96％）的人工晶状体轴位偏离均≤5°。结论白内障超声乳化术后植入AcrysofToric人工晶状体具有良好的远期临床效果和旋转稳定性，是一种安全、有效、预测性好的治疗伴角膜规则散光白内障的方法．

Toric人工晶状体轴向错位的相关因素

随着白内障手术技术提升,不同设计的人工晶状体面世,白内障手术逐渐趋向屈光矫正性手术,患者对视觉质量有更高的要求。角膜散光是影响患者术后视觉质量的原因之一,Toric人工晶状体植入是常用的散光矫正方式,其轴向错位是影响患者术后散光矫正效果最重要的原因。为了减少轴向错位对术后矫正效果的影响,需要重视术前的眼球生物学测量、人工晶状体度数及轴位计算、角膜标记,熟练术中的操作技巧,了解各类型人工晶状体及患者眼轴对术后人工晶状体旋转稳定性的影响。

Toric人工晶状体植入术后的残余散光

散光矫正型人工晶状体(toric intraocular lenses, Toric IOL)可稳定有效地矫正白内障患者的角膜散光,但部分患者仍会出现非预期的术后残余散光,降低视觉质量。术后残余散光常见的原因包括仪器测量误差、计算误差、手术操作相关因素及人工晶状体旋转等,需根据术后残余散光的程度和成因采用相应治疗手段,矫正残余散光可使用方法包括:框架眼镜、角膜接触镜及飞秒激光辅助的准分子激光角膜原位磨镶术等,必要时行人工晶状体调位术。

散光矫正型多焦点人工晶状体植入术后临床效果

目的:评价白内障超声乳化联合散光矫正型多焦点人工晶状体(MIOL)植入术后患者的长期临床效果。方法:前瞻性自身前后对照研究。选择在大庆油田总医院行白内障超声乳化联合散光矫正型多焦点IOL植入术患者50例(82眼),术后随访1年,分别观察术前,术后3个月、6个月、1年的裸眼远中近视力(LogMAR)、最佳矫正远中近视力(LogMAR)、离焦曲线、对比敏感度(CS)、全眼像差、预计残留散光和IOL轴位偏差分析及脱镜率。对手术前后各参数进行重复测量的方差分析,两两比较采用Bonferroni法及t检验。结果:散光矫正型MIOL植入术后,所有患者术后3个月、6个月、1年时远、中、近距离均可获得优于0.3的较好视力。术后3个月、6个月、1年时各距离视力较术前显著提高(远距离:F=26.39,P<0.001;中距离:F=13.68,P<0.001;近距离:F=12.90,P<0.001)。矫正远距离视力较裸眼视力略有提高,但差异无统计学意义,矫正前后近距离视力差异无统计学意义。术后6个月时,所有患者裸眼远视力接近0.0,且-4.0^+1.2D离焦下视力均可优于0.3LogMAR。术后1年时明视带眩光CS最好,明视、暗视的CS比明视眩光有所下降,暗视眩光分辨率最差,而在高频区(18c/d),CS随时间推移有显著提高,差异有统计学意义。术后1年全眼总散光(0.24±0.15)D,与术前[(1.56±0.38)D]相比,差异有统计学意义(t=3.31,P=0.023)。术后全眼总散光与术前预计残留散光[(0.15±0.07)D]接近,差异无统计学意义(t=2.31,P=0.102)。术后1年,IOL轴位平均偏离(3.12±1.51)°。术后脱镜率为100%。结论:散光矫正型MIOL能为白内障患者提供满意的全程视力、视觉质量和脱镜率,可预测性好,并有良好的旋转稳定性。

多焦点散光型与单焦点散光型人工晶状体植入术后视觉质量对比

目的比较多焦点散光型人工晶状体（IOL）和单焦点散光型IOL植入术后的视觉质量。方法回顾性非随机对照研究。角膜散光大于1．0D的白内障患者27例（32眼），其中8例（10眼）植入非球面多焦点散光型IOL（Acrys of IQ Res tortoric IOL，SND1T，SND1T组），19例（22眼）植入非球面单焦点散光型IOL（Acrys of IQtoric IOL，SN6AT，SN6AT组）纳人本研究。术后1、3、6个月观察2组远近裸眼视力（UCVA）、最佳矫正视力（BCVA），残余散光，IOL旋转度，对比敏感度，调制传递函数（MTF）以及全眼波前像差等。采用独立样本t检验及重复测量方差分析对数据进行分析。结果术后各时间点，SND1T组近UCVA均明显优于SN6AT组（t=11．683、8．252、7．384，P〈0．01）；术后6个月，SND1T组在有眩光低空间频率（3c／d）的对比敏感度低于SN6AT组（t=2．086，P〈0．05），其余空间频率差异无统计学意义；3mm瞳孔下，SND1T组在低空间频率（5、10c／d）的MTF值低于SN6AT组（t=2．050、2．078，P〈0．05）．其余空间频率差异无统计学意义。术后各时间点，2组间远UCVA、远近BCVA差异均无统计学意义：术后6个月，2组间术前术后角膜散光差值、IOL旋转度差异均无统计学意义；2组在无眩光所有空间频率的对比敏感度、5mm瞳孔下各空间频率的MTF值以及3mm和5mm瞳孔下的全眼总像差、总高阶像差、球差、彗差的差异均无统计学意义。结论与单焦点散光型IOL相比，多焦点散光型IOL可获得良好的全程视力。并能有效矫正散光，同时提供理想的视觉质量。