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.

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.

Toric Intraocular Lens vs. Peripheral Corneal Relaxing Incisions to Correct Astigmatism in Eyes Undergoing Cataract Surgery

Purpose:.To compare toric intraocular lens implantation(ToricIOL).with peripheral corneal relaxing incisions(PCRIs) for astigmatism correction in patients undergoing cataract surgery.Methods: 54 patients(54 eyes) with more than 0.75 diopter(D).of preexisting corneal astigmatism were classified as group A(0.75-1.50D) or group B(1.75-2.50D). The patients were randomized to undergo Toric-IOL or PCRIs in the steep axis with spherical IOL implantation..Log MAR uncorrected visual acuity(Log MAR UCVA), Log MAR best corrected vi sual acuity.(Log MAR BCVA),.error of vector(|EV|), surgery induced refraction correction.(|SIRC |),.and correction rates(CR) were measured 1 month and 6 months postoperatively.Results: At 6 months postoperatively, all 54 eyes had LogMAR BCVA≤0.2. Patients who underwent PCRIs and ToricIOL with Log MAR BCVA≤0.1 showed no significant differences in group A(P=1.00) or in group B(P=0.59). Group A showed no significant differences in Log MAR UCVA(P =0.70), |EV|(P=0.13), |SIRC|(P=0.71), and CR(P=0.56)in patients underwent PCRIs and Toric-IOL. However, group B showed significant differences in Log MAR UCVA(P <0.01), |EV|(P<0.01)), |SIRC|(P<0.01), and CR(P<0.01).The Log MAR UCVA and |EV | between 1 and 6 months showed no significant differences in patients in group A. However, in group B, they are significant differences.Conclusion:.The efficacy and stability of Toric-IOL and PCRIs were equal in low astigmatic patients..Toric-IOL achieved an enhanced effect over PCRIs in higher astigmatic patients.PCRIs had the more refractive regression than Toric-IOL in 6months.

Posterior corneal astigmatism modifications after cataract surgery and its role on total corneal astigmatism

Background:In recent years posterior corneal astigmatism and its effect on total corneal astigmatism has been studied,with research showing that this can impact total astigmatism.This study aims to ascertain if there is significant change in the posterior corneal astigmatism after cataract surgery and its impact on the total astigmatism.Methods:Analysis of 76 eyes that underwent cataract surgery with monofocal intraocular lens implantation.Corneal topography was performed with Pentacam(OCULUS®)pre-and post-operatively.Total corneal astigmatism was calculated with the algorithm of vergence tracing.We compared preoperative and postoperative changes in the magnitude and axis differences of anterior corneal curvature astigmatism,posterior corneal curvature astigmatism and the calculated total corneal astigmatism.We calculated the correlation between the total preoperative astigmatism and the difference between total corneal astigmatism and anterior corneal astigmatism.Results:The mean preoperative and postoperative posterior astigmatism was 0.31±0.02 D,showing no significant differences before and after surgery(P=0.989).Statistically significant differences between the calculated total corneal astigmatism and anterior corneal astigmatism were registered preoperatively and postoperatively in the with-the-rule anterior(WTR)corneal astigmatism(P=0.004,P<0.0001);against-the-rule(ATR)anterior corneal astigmatism(P<0.0001,P<0.0001)and in the oblique(P=0.026,P=0.019)subgroups.The posterior corneal astigmatism and the total corneal astigmatism correlated positively with the differences between the total corneal and anterior corneal astigmatism(R=0.378,P=0.001).Conclusions:There were statistically significant differences between the magnitude of the total astigmatism and anterior corneal astigmatism,underlining the impact of posterior corneal astigmatism.A positive correlation between the preoperative posterior astigmatism and the difference between the total corneal and the anterior corneal astigmatism suggests a specially relevant role of posterior corneal astigmatism when evaluating patients with higher degrees of astigmatism.

Clinical study of customized aspherical intraocular lens implants

AIM:To compare if there is an improvement in visual functions with age-related cataracts between patients receiving a aspherical intraocular lens(IOL) based on corneal wavefront aberration and patients randomly assigned lenses.METHODS:A total of 124 eyes of 124 patients with age-related cataracts were placed in experimental group and a group receiving randomly assigned(RA) lenses.The experimental group was undergone Pentacam corneal spherical aberration measurement before surgery; the targeted range for residual total spherical aberration after surgery was set to 0-0.3 μm. Patients with a corneal spherical aberration 【0.3 μm were implanted with a zero-spherical aberration advanced optics(AO) aspherical IOL and patients with an aberration ≥0.3 μm received a Tecnis Z9003 aspherical lens in experimental group. RA patients were randomly implanted with an AO lens or a Tecnis Z9003 lens. Three months after surgery total spherical aberration, photopic/mesopic contrast sensitivities, photopic/mesopic with glare contrast sensitivities, and logMAR vision were measured.RESULTS:Statistical analysis on logMAR vision showed no significant difference between two groups(P =0.413). The post-surgical total spherical aberration was 0.126 ±0.097 μm and 0.152 ±0.151 μm in the experimental and RA groups, respectively(P =0.12). The mesopic contrast sensitivities at spatial frequencies of 6,12 and 18 c/d in the experimental group were significantly higher than of the RA group(P =0.00; P =0.04;P =0.02). The mesopic with glare contrast sensitivity in the experimental group at a spatial frequency of 18 c/d was also significantly higher vs the RA group(P =0.01).CONCLUSION:Pre-surgical corneal spherical aberration measurement in cataract patients followed bycustomized selection of aspherical IOL implants improved mesopic contrast sensitivities at high spatial frequencies, and thus is a superior strategy compared to the random selection of aspherical intraocular lens implants.

人工晶状体保护下超声乳化白内障吸除术疗效及安全性评价:一项随机对照临床研究

目的观察人工晶状体(IOL)保护下超声乳化手术(PHACO)对硬核白内障患者的治疗效果。方法采用随机对照临床研究方法,连续纳入2019年1月至2022年5月于延边大学附属医院收治的Emery分级Ⅳ~Ⅴ级的硬核白内障患者120例120眼,按照随机数字表法分为PHACO组、IOL保护PHACO组和囊外白内障摘除术(ECCE)组,分别行常规PHACO、IOL保护下的PHACO和ECCE,每组40例40眼。最终99例受试者完成随访,其中PHACO组30例30眼,IOL保护PHACO组35例35眼,ECCE组34例34眼。记录各组总手术时间、术中超声乳化时间、累计释放能量。术后随访3个月,检测并比较3个组患眼角膜内皮细胞密度(ECD)、角膜内皮细胞面积变异系数(CV)、角膜六角形内皮细胞比率(6A)、角膜散光值,不同等级裸眼远视力的眼数分布;记录术中和术后并发症发生情况。结果IOL保护PHACO组与PHACO组超声能量及超声时间比较差异均无统计学意义(P=0.691、0.982)。IOL保护PHACO组和PHACO组总手术时间分别为(38.81±2.73)和(36.45±3.45)min,明显短于ECCE组的(69.60±4.35)min,差异均有统计学意义(均P<0.001)。术前3个组患者年龄、性别、晶状体核硬度等基本资料比较,差异均无统计学意义(均P>0.05)。术后3个月,PHACO组和IOL保护PHACO组裸眼视力较高的人数较ECCE组高(P=0.006、0.007);IOL保护PHACO组的ECD和6A分别为(2155.57±177.88)/mm^(2)和(41.31±5.18)%,均显著高于PHACO组的(1912.64±224.11)/mm^(2)和(36.18±3.27)%,IOL保护PHACO组的CV为(50.34±5.90)%,低于PHACO组的(55.67±3.30)%,差异均有统计学意义(P=0.007、0.003、0.005)。术后1周和3个月,IOL保护PHACO组的角膜散光度数均显著低于ECCE组,且高于PHACO组,差异均有统计学意义(均P<0.05)。结论IOL保护下的PHACO相对常规PHACO可有效减少超声能量对角膜内皮的损伤,相对ECCE能明显缩短手术时间,减轻术后炎症反应,且并未明显增加术后角膜散光。IOL保护下的PHACO是硬核白内障患者一种有效的改良手术方式。

白内障患者Lenstar与A型超声或角膜曲率计眼部生物学参数测量结果的比较

背景精确的眼部生物学参数对眼科疾病的诊断、治疗及预后有着重要的意义，筛选简便、准确测量眼部生物学参数的方法至关重要。目的比较LenstarLS900型光学生物测量仪与A型超声或角膜曲率计在测量眼轴长度、角膜曲率（K1、K2、Km）以及预测人工晶状体（IOL）度数方面的差异，为Lenstar光学生物测量仪的临床应用提供依据。方法共纳入年龄相关性白内障患者40例43眼，分别应用Lenstar、A型超声法或角膜曲率计测量受检眼眼轴长度及K1、K2、Km值，计算IOL度数。采用配对t检验对两种测量结果的差异进行比较，两种方法测量结果的一致性评价采用Bland—Ahamn分析。结果共有35眼完成测量。Lenstar与A型超声测量的眼轴长度分别为（23．3414-1．208）mm和（23．2684-1．157）mm，二者比较差异无统计学意义（t=0．260，P=0．796）。Lenstar与角膜曲率计测量Kl、K2、Km值的差异均无统计学意义（t=0．526，P=0．601；t：0．927，P=0．357；t=0．213，P=0．832）。两种方法预测的IOL度数分别为（20．3714-2．827）D和（20．729±2．672）D，二者比较差异无统计学意义（t=0．543，P=0．589）。Bland-Altamn一致性检验表明，Lenstar与A型超声或角膜曲率计测量的眼轴长度，K1、K2、Km值以及IOL度数分别有11％（4／35）、0％（0／100）、9％（3／35）、9％（3／35）、6％（2／35）的点位于95％的一致性界限以外，在一致性界限内最大差值的绝对值为0．39mm和1．31、1．30、0．77、1．00D。结论Lenstar能够检测多种测量指标，测量过程具有非侵人性、方便快捷、用时较短等优点，但本研究的结果认为Lenstar与A型超声或角膜曲率计的方法一致性不好，二者是否可以互相替代还需要进一步的大样本临床研究证实。

小切口囊外摘除术与超声乳化术分别联合人工晶状体植入术治疗白内障患者的效果比较

目的:比较小切口囊外摘除术与超声乳化术分别联合人工晶状体植入术治疗白内障患者的效果。方法:选取2020年1月至2022年12月该院收治的70例白内障患者进行前瞻性研究,按照随机数字表法分为研究组与对照组各35例。对照组采取超声乳化术联合人工晶状体植入术治疗,研究组采取小切口囊外摘除术联合人工晶状体植入术治疗,比较两组手术前后视力水平、角膜内皮细胞密度、六角形细胞占比和并发症发生率。结果:术后1 d、3 d、7 d、1个月,研究组视力水平高于对照组,差异均有统计学意义(P<0.05);术后3个月,两组角膜内皮细胞密度、六角形细胞占比均低于术前,但研究组高于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为8.57%,低于对照组的28.57%,差异有统计学意义(P<0.05)。结论:小切口囊外摘除术联合人工晶状体植入术治疗白内障患者可提高其术后视力水平和角膜内皮细胞密度、六角形细胞占比,降低其并发症发生率,效果优于超声乳化术联合人工晶状体植入术治疗。

自动电脑验光仪Topcon KR-8900、LenstarLS900与角膜地形图Atlas 9000测量白内障患者术前角膜曲率的一致性分析

目的应用自动电脑验光仪Topcon KR-8900、Lenstar LS900与角膜地形图Atlas 9000三种仪器分别测量白内障患者术前的角膜曲率,对其一致性进行分析评估,指导白内障的术前检查。方法选取2017年8月份收治于佛山市第二人民医院眼科中心的白内障患者83例89眼,分别应用自动电脑验光仪Topcon KR-8900、Lenstar LS900与角膜地形图Atlas 9000测量患者受检眼的平坦角膜曲率(K1)、陡峭角膜曲率(K2)和角膜散光度数、轴位,并计算出平均角膜曲率(mean keratometry,Km)、散光矢量J0和J45,采用ANOVA方差分析方法对三者间的差异性作统计;采用配对t检验对两两之间的差异性作对比;一致性分析采用Bland-Altman检验。结果 (1)在测量K1、K2和Km时,三种仪器间的比较差异有统计学意义(P <0.001);两两间对比,除Lenstar LS900与Atlas 9000测量值之间的差异无统计学意义(P> 0.05)外,其余两两之间的比较差异均有统计学意义(P <0.05)。在测量J0时,三种仪器间的比较差异有统计学意义(F=3.371,P=0.037),主要为Lenstar LS900与Atlas 9000之间的差异有统计学意义(P=0.017)。在测量J45时,三种仪器组间比较和两两之间比较,差异均无统计学意义(P> 0.05))。(2)Bland-Altman检验,发现在测量角膜曲率及角膜散光中,三种仪器的一致性欠佳。结论自动电脑验光仪Topcon KR-8900、Lenstar LS900和角膜地形图Atlas 9000三种仪器,均能简单、快捷的地完成角膜曲率的测量。但三者间的一致性欠佳,临床上应加以重视及谨慎选择结果。

Lenstar LS900联合A型超声测量人工晶状体角膜曲率的研究进展

随着新型人工晶状体在白内障手术中的应用和超声乳化设备及手术技术的日趋完善,白内障手术已由复明手术逐渐向屈光手术转变,因此患者对术后裸眼视力恢复的期望值不断攀升,这就给眼科医师术前对人工晶状体度数的精确测量提出了更高的要求。拟就目前新型的生物测量仪Lenstar LS900和常用的A超联合角膜曲率计在白内障人工晶状体测量中的研究进行综述。

Analysis of Corneal Spherical Aberration in Patients before and after Phacoemulsification

Purpose:To investigate the distribution and changes in corneal four-order spherical aberration Z40 in patients with age-related cataract before and after phacoemulsification,and to direct the application of aspherical intraocular lens (IOL)in PHACO combined with IOL implantation.Methods:A total of 155 eyes in 93 patients with age-related cataract were included.All patients received a comprehensive ophthalmologic examination.Corneal Z40 at a pupil diameter of 6 mm was measured by using a Scheimpflug photography system (Pentacam) preoperatively and 3 months postoperatively.Results:The mean corneal Z40 before and after the PHACO at a diameter of 6 mm was(0.294 ±0.138)μm and(0.271 ± 0.130)μm,respectively,with statistical significance(P<0.05, t =4.384).There was no significant difference between male (n=45, 76 eyes) and female patients (n=48,79 eyes) regard- ing corneal Z40 (t=-0.418,P=0.676).The corneal Z40 for patients (35 eyes) aged from 50 to 59 years was (0.238±0.104) μm preoperatively;(0.308 ±0.104)μm for 60 to 69 years; (0.332±0.151)μm for 70 to 79 years; and (0.307±0.164) μm for 80 to 89 years.A significant difference in Z40 was observed among different age groups.A linear positive correlation was noted between corneal Z40 and ages (r=0.203,P<0.003). Conclusion:The corneal Z40 varied significantly among cataract patients. Patients' corneal Z40 , which should be considered when choosing aspherical IOL, increases slightly with age.Thus,customized aspheric IOLs are needed.

Intraocular lens power calculation in eyes with previous corneal refractive surgery

Background:This review aims to explain the reasons why intraocular lens(IOL)power calculation is challenging in eyes with previous corneal refractive surgery and what solutions are currently available to obtain more accurate results.Review:After IOL implantation in eyes with previous LASIK,PRK or RK,a refractive surprise can occur because (i)the altered ratio between the anterior and posterior corneal surface makes the keratometric index invalid;(ii)the corneal curvature radius is measured out of the optical zone;and (iii)the effective lens position is erroneously predicted if such a prediction is based on the post-refractive surgery corneal curvature.Different methods are currently available to obtain the best refractive outcomes in these eyes,even when the perioperative data(i.e.preoperative corneal power and surgically induced refractive change)are not known.In this review,we describe the most accurate methods based on our clinical studies.Conclusions:IOL power calculation after myopic corneal refractive surgery can be calculated with a variety of methods that lead to relatively accurate outcomes,with 60 to 70%of eyes showing a prediction error within 0.50 diopters.

白内障手法碎核折叠人工晶状体植入术治疗硬核白内障疗效及对患者角膜内皮细胞损伤的影响

目的:探讨白内障手法碎核折叠人工晶状体植入术治疗硬核白内障疗效及对患者角膜内皮细胞损伤的影响。方法:选取本院2020-05~2021-12收治的硬核白内障患者60例(均为单眼),按照不同手术方案分为观察组(n=32)和对照组(n=28)。对照组患者给予超声乳化白内障摘除术治疗,观察组患者给予白内障手法碎核折叠人工晶状体植入术治疗,比较术前、术后1天、1周和1个月视力情况、术前和术后2h、12h、24h、1周眼压变化情况、角膜内皮细胞损伤程度。结果:观察组治疗效果明显优于对照组(P<0.05)。术后1个月、3个月观察组角膜内皮细胞密度明显低于对照组(P<0.05),而六角形细胞比率差异不大(P>0.05)。结论:白内障手法碎核折叠人工晶状体植入术治疗硬核白内障疗效较好,对硬核白内障患者角膜内皮细胞损伤较大,但是角膜内皮细胞丢失率不大。

白内障术前眼球生物学参数测量和应用专家共识(2023)

白内障是全球主要的可治疗性致盲眼病, 目前手术摘除混浊晶状体并植入人工晶状体(IOL)是治疗白内障的主要方法, IOL屈光力的准确计算是提高术眼术后视觉质量的关键, 其计算涉及术眼术前眼球生物学参数的准确测量。白内障术前应重点关注眼球生物学参数的测量和应用, 主要包括精准的眼球生物学参数测量设备的选择和IOL屈光力计算公式的选择等。为了更好地满足术眼术后视觉质量和生活质量的需求, 本专家共识依据国际上的重要文献和循证证据对白内障术前眼球生物学测量参数的选择和测量方法提出推荐意见, 既包括传统的眼轴长度、角膜曲率、前房深度、晶状体厚度、角膜直径及中央角膜厚度等眼球结构参数, 还纳入了Kappa角、Alpha角及波前像差等视光学参数。本共识同时还推荐了IOL屈光力计算公式需要的参数, 旨在规范临床医生对白内障患者实施白内障手术术前眼球生物学测量参数的选择、测量和应用, 从而提高白内障手术后的屈光效果和视觉质量。

不同浓度的人工泪液对合并中重度干眼的白内障患者角膜曲率测量和人工晶状体度数计算的影响

目的探讨不同浓度的人工泪液对合并中重度干眼的白内障患者角膜曲率测量和人工晶状体度数计算的影响。方法本研究共纳入合并中重度干眼的白内障患者80例80眼,依据患者所用人工泪液玻璃酸钠滴眼液的浓度将患者分为低浓度组和高浓度组各40例40眼。低浓度组患者采用1 g·L^(-1)玻璃酸钠滴眼液滴眼;高浓度组患者采用3 g·L^(-1)玻璃酸钠滴眼液滴眼。于用药前和用药后1、5、15 min测量受试眼平坦轴角膜曲率(K 1),计算患者所需人工晶状体度数,对比其变化情况。结果用药后1 min和5 min,低浓度组受试眼K 1均较用药前减小,差异均有统计学意义(均为P<0.05);用药后15 min,低浓度组受试眼K 1与用药前比较,差异无统计学意义(P=0.556)。高浓度组受试眼用药前后K 1变化情况与低浓度组相似。用药前两组受试眼K 1差异无统计学意义(P>0.05)。用药后1 min,低浓度组受试眼K 1较高浓度组升高(P<0.05)。用药后1 min和5 min,低浓度组受试眼人工晶状体度数均较用药前增大,差异均有统计学意义(均为P<0.05);用药后15 min,低浓度组受试眼人工晶状体度数与用药前比较,差异无统计学意义(P=0.160)。高浓度组受试眼人工晶状体度数变化情况与低浓度组相似。用药后1、5、15 min,两组受试眼人工晶状体度数差异均无统计学意义(均为P>0.05)。结论合并中重度干眼的白内障患者使用人工泪液短时间内会显著减小患眼K 1,增大人工晶状体度数;建议使用人工泪液后应超过15 min再进行白内障术前生物测量。

改良四点固定人工晶状体悬吊术后角膜曲率及散光的变化

目的比较改良四点固定与传统两点固定人工晶状体悬吊植入术后角膜曲率及散光的变化,以寻求提高人工晶状体悬吊术后视觉质量的更佳手术方式。方法回顾性病例研究。选取2020年7月至2021年10月于保定市第一中心医院眼二科行改良四点固定人工晶状体悬吊植入术患者28例(28只眼)为A组,行传统两点固定人工晶状体悬吊植入术患者29例(29只眼)为B组,两组患者术前术后应用Sirius角膜地形图仪测量角膜曲率K1、K2值及散光值,术后3个月随访,比较两种手术方式术后角膜曲率及散光的差异性。结果A组术前K1(43.57±0.63),术后3个月K1(43.58±0.70),与术前相比差异无统计学意义(t=-1.20,P>0.05);术前K2(44.19±0.68),术后3个月K2(44.46±0.63),与术前相比差异有统计学意义(t=-3.16,P<0.05);术前角膜散光(-0.81±0.30)D,术后3个月角膜散光(-1.10±0.32)D;与术前相比差异有统计学意义(t=5.26,P<0.05)。B组术前K1(43.50±1.04),术后3个月K1(42.98±1.24),与术前相比差异有统计学意义(t=4.95,P<0.05);术前K2(44.12±1.13),术后3个月K2(44.71±1.03),与术前相比差异有统计学意义(t=-6.12,P<0.05);术前角膜散光(-0.76±0.41)D,术后3个月角膜散光(-2.08±0.94)D;与术前相比差异有统计学意义(t=14.28,P<0.05)。A组术前术后角膜散光差值(-0.29±0.29)D,B组术前术后角膜散光差值(-1.31±0.50)D,两组相比差异有统计学意义(t=-9.46,P<0.05)。结论与传统两点固定法相比,改良四点固定人工晶状体悬吊植入术后角膜散光变化更小。

新型彩色LED角膜分析仪Cassini测量角膜曲率及计算人工晶状体度数的准确性

目的:评估新型角膜分析仪Cassini测量角膜曲率和角膜散光的重复性,及其与人工晶状体生物测量仪IOLMaster的一致性。进一步分析该设备在IOL度数计算上的精确性。方法:本研究共纳入了77例白内障患者的77眼。由一名操作者使用Cassini角膜分析仪和IOLMaster生物测量仪分别测量患者角膜曲率和角膜散光相关参数各3次,包括平坦角膜曲率(Kf)、陡峭角膜曲率(Ks)、角膜散光(Ast)、总角膜屈光力(TCP)和总角膜散光(TCA)。采用组内标准差(Sw)、重测度(TRT)和组内相关系数(ICC)评估数据的重复性。采用Bland-Altman图和95%一致性区间(LoA)评估一致性。通过比较术后3个月IOLMaster和Cassini使用4种不同IOL计算公式时的平均绝对预测误差(MAE)和术后误差分布范围进一步分析Cassini预测IOL度数的准确性。结果:Cassini测量Kf、Ks和TCP的TRT值均≤0.55 D,且ICC值均≥0.966。在散光相关参数方面,Ast的TRT值和ICC值分别为0.47 D和0.973,TCA的TRT值和ICC值分别为0.75 D和0.953,Ast的矢量分解J_0和J_(45)以及TCA的矢量分解J_0-TCA和J_(45)-TCA的TRT值均≤0.48 D,且ICC值均≥0.893。Bland-Altman图显示Cassini和IOLMaster测量Kf和Ks的95%LoA分别为0.73 D和0.63 D。IOLMaster和Cassini在各公式下的MAE均小于0.43 D。不同屈光度的分布情况也显示,两种设备使用不同公式计算的IOL度数术后屈光误差在±0.25 D、±0.50 D、±0.75 D和±1.00 D以内的患者分别超过了28%、62%、85%和94%。结论:除了TCA外,新型彩色LED角膜分析仪Cassini测量正常人角膜曲率和角膜散光的重复性良好,且与IOLMaster生物测量仪测量的Ks和Kf一致性好。在IOL度数预测误差上,Cassini和IOLMaster相似,能够保证其在临床应用的可行性。

散光矫正型人工晶状体植入在白内障低角膜散光中的应用进展

在我国,白内障是一种十分常见的致盲眼病,其中约20%的患者术前有角膜散光。随着患者对术后视力要求的不断提高,白内障手术正逐步向屈光性方向发展,目的是提高术后视觉质量。散光矫正型人工晶状体(toric intraocular lens,Toric IOL)植入是当前最常见的矫正角膜散光的术式,对术前角膜散光进行矫正,并控制手术源性散光,从而降低术后角膜散光,对提高患者的术后视力有积极作用。基于此,本文将对Toric IOL在白内障低角膜散光中的应用作一简要综述。

不同角膜曲率白内障患者三种人工晶状体屈光度计算公式的准确性比较

目的探讨Barrett UniversalⅡ、Haigis和Olsen三种公式在不同角膜曲率的白内障患者人工晶状体度数计算中的准确性。方法前瞻性临床研究。选取2020年1月至2021年10月收治于南京同仁医院眼科中心的86例(86眼)白内障患者作为研究对象,根据患眼角膜曲率不同分为3组,分别为A组26例,角膜曲率为>42~44 D;B组28例,角膜曲率为>44~46 D;C组32例,角膜曲率>46 D,比较3组患者一般资料;收集患眼术前分别依据Barrett UniversalⅡ、Haigis和Olsen公式计算的预留屈光度和术后3个月患者的实际屈光度,计算并比较各个公式的平均屈光误差,分析平均屈光误差在不同屈光域的占比;采用Pearson相关分析角膜曲率分别与三种计算公式获得的平均屈光误差之间的相关性。结果3组患者间性别、年龄、视力、病程及术前眼压、眼轴长度和前房深度相比,差异均无统计学意义(均为P>0.05)。依据Barrett UniversalⅡ、Haigis、Olsen三种公式计算后患眼的屈光误差A组、B组、C组3组组间比较时,差异均无统计学意义(均为P>0.05);依据Haigis、Olsen公式计算的患眼屈光误差A组、B组、C组组内均高于依据Barrett UniversalⅡ公式计算的患眼屈光误差,差异均有统计学意义(P<0.05)。依据Barrett UniversalⅡ公式计算后屈光误差≤0.50 D的患眼占比显著高于依据Haigis、Olsen公式计算后患眼的占比,差异均有统计学意义(均为P<0.05)。Pearson相关分析结果显示,依据Barrett UniversalⅡ、Haigis和Olsen公式计算的患眼屈光误差与角膜曲率均无明显相关性(均为P>0.05)。结论依据Barrett UniversalⅡ、Haigis和Olsen三种公式计算的人工晶状体度数在不同角膜曲率的白内障患者中都较为准确,Barrett UniversalⅡ公式的准确率更高。

不同眼轴长度白内障患者散光矫正型人工晶状体植入术后相关指标的差异

目的:探究不同眼轴长度白内障患者散光矫正型人工晶状体(TIOL)植入术后视力恢复、角膜散光及TIOL旋转稳定性的差异。方法:回顾性分析。选取2021-02/2022-09于我院眼科行超声乳化白内障吸除联合TIOL植入术的年龄相关性白内障合并角膜散光患者132例132眼,依据眼轴长度分为眼轴≤24mm组(79例79眼)和眼轴>24mm组(53例53眼)。术后3mo,对比两组患者最佳矫正远视力(BCDVA)、角膜散光及TIOL旋转情况。结果:术后3mo,两组患者BCDVA均较术前改善,角膜散光度数均较术前显著降低(P<0.001),但两组间BCDVA、角膜散光度数均无差异(P>0.05),且两组间TIOL旋转度数也无明显差异[(5.24±3.72)°vs(6.36±4.21)°,P=0.110]。结论:不同眼轴长度白内障患者TIOL植入术后视力恢复、角膜散光及TIOL旋转稳定性无明显差异。