后房型有晶状体眼散光型人工晶状体矫正高度复性近视散光的并发症观察

目的研究后房型有晶状体眼散光型人工晶状体（TICL）矫正高度近视散光的安全性。方法对27例（50只眼）高度近视散光患者行后房型有晶状体眼散光型人工晶状体植入术。术前近视-6.75～-23.0D,平均（-11.04±3.12）D。散光1.25～6.50D,平均（2.31±0.77）D。随访6～24个月,主要观察手术前后角膜内皮细胞计数、眼压、前房、人工晶状体柱镜轴位和自身晶状体等情况。结果术后12个月,TICL旋转大于30°者1只眼占2%,TICL重新调整轴位。7只眼眼压一过性升高,经降眼压治疗,1周内恢复正常。1例（2只眼）眼压持续升高。1例双眼眩光。未发现晶状体混浊、色素性青光眼病例。结论 TICL作为一种前沿性屈光手术,风险小,并发症少,安全可逆,是目前临床上非常理想的矫正散光的新方法 。     

TICL植入术治疗高度近视合并散光的临床观察

目的：研究后房型有晶状体眼散光型人工晶状体（toric implantabIe collamerlens,TICL）矫正高度近视合并散光的有效性、安全性。方法：回顾性系列病历研究。收集我院2010-02/2011-06经手术治疗高度近视合并散光22例40眼的病历资料,该手术均在局部麻醉下通过3mm透明角膜切口植入TICL。随访12mo,随访内容包括术前及术后1d;1wk;1,3,12mo的裸眼视力、术前最佳矫正视力、眼压、裂隙灯显微镜检查、屈光度数、角膜内皮细胞分析、人工晶状体柱镜轴位等。结果：术后3mo40眼裸眼视力均等于或高于术前最佳矫正视力,球镜度数均在-0.5～＋0.5D,柱镜度数均在-0.75～0D。术后1moTICL轴向偏差在10°以内者占95.0%（38/40）,TICL轴向偏差在10°～15°者占2.5%（1/40）,偏差大于30°者1眼（2.5%）;TICL旋转大于30°的1眼行人工晶状体调位术,术后TICL轴向偏差在10°以内。术后7眼眼压一过性升高,经降眼压治疗,1wk内恢复正常。未发现继发性青光眼、晶状体混浊等病例。结论：TICL植入术矫治高度近视合并散光具有有效性和安全性。     

有晶状体眼后房散光型IOL植入矫正高度近视散光

目的：评价有晶状体眼后房散光型人工晶状体(TICL)植入术矫治高度近视散光的临床效果。

方法：选自2009-10/2011-11接受TICL植入的高度近视散光患者30例50眼,术前平均屈光度球镜-10.75±2.65D,柱镜-2.85±0.75D。随访观察术后3mo～2a裸眼视力、最佳矫正视力、屈光度、内皮细胞计数等情况,分析并发症的发生情况。

结果：术后裸眼视力：0.5～1.2(平均0.75±0.34)。术前最佳矫正视力：0.3～1.0(平均0.58±0.35),术后最佳矫正视力0.6～1.2(平均0.78±0.35)。达到术前矫正视力20眼(40%),超过术前最佳矫正视力30眼(60%),随访3mo～2a,视力无明显变化。术后屈光度数平均球镜-0.52±0.35D,柱镜0.52±0.25D。角膜内皮细胞计数术前3 026±250个/mm²,术后3mo为3 023±246个/mm²,差异无统计学意义(P<0.05)。未见严重影响视力的并发症。

结论：TICL植入矫治高度近视散光安全有效,是高度近视散光患者的理想治疗方法。对眼内的长期影响需要进一步观察。     

TICL治疗高度近视合并散光疗效分析

目的:研究T优化的后房型人工晶状体(toric implantable contactlens,TICL)矫正高度近视合并散光的效果。方法:本研究中高度近视合并散光患者7例13眼,术前屈光度-9.50～-24.00(平均-14.50±7.43)D,散光范围+1.0～+3.5(平均+2.59±0.38)D,眼轴长度26.20～32.85(平均29.38±3.01)mm。13眼均植入TICL。术后观察视力、屈光度、眼压、人工晶状体位置等。结果:所有病例均成功植入TICL,所有患者裸眼视力均有明显提高,术后1wk,所有术眼达到或超过术前最佳矫正视力,眼压正常,屈光度在术后6mo的随访中稳定。结论:TICL植入有晶状体眼治疗高度近视合并散光安全可靠,术后屈光度稳定,视觉质量提高。     

后房型有晶状体眼散光型人工晶状体植入术矫正散光的临床研究

目的研究后房型有晶状体眼散光型人工晶状体（TICL）植入术矫正散光的疗效和安全性。方法对57例（100只眼）近视散光患者行后房型有晶状体眼散光型人工晶状体植入术。术前近视（-4,75～-23．0）D,平均（-11．23±3．92）D。散光（1．25—6．50）D,平均（2．61±0．92）D。随访6—24个月,主要观察手术前后视力、屈光状态、角膜内皮计数、角膜曲率、眼压、前房、人工晶状体柱镜轴位和自身晶状体等情况。结果术后6个月,残余散光（0-2．5）D,平均（0．78±0．67）D,35只跟随访2年,散光度变化在0．5D以内。95％眼裸眼视力（UCVA）和99％眼最佳矫正视力（BCVA）均达到或优于术前BCVA。术后3个月,TICL旋转大于30。占9．09％。3只眼眼压一过性升高,经降眼压治疗,1周内恢复正常。结论TICL可提高患者视觉质量,矫正散光效果准确,可预测性强,并具有良好的旋转稳定性。     

有晶状体眼散光矫治型后房型人工晶状体植入矫治超高度近视并散光的临床观察

背景近年来随着屈光手术的不断进步,有晶状体眼人工晶状体植入手术在矫治超高度近视、散光、远视等方面逐步体现出其特有的优越性,其安全性、有效性在临床上越来越受到关注。目的观察有晶状体眼散光矫治型后房型人工晶状体（TICL）植入治疗超高度近视并散光的有效性、稳定性及安全性。方法回顾性系列病例研究。观察分析2008年5月-2009年2月经手术治疗的超高度近视并散光患者27例33眼的病例资料,均在眼球周围阻滞麻醉下经3mm颞侧透明角膜切口植入TICL,随访18个月,随访内容包括术前及术后1d,1周,2周,1、3、6、12、18个月的裸眼远近视力、最佳矫正视力、裂隙灯显微镜检查、TICL轴向、屈光度数、眼压、角膜内皮细胞分析等。结果术后96．97％眼裸眼视力等于或高于术前最佳矫正视力,术后球镜度数均在一1．00～＋0．25D,柱镜度数均在-1．00～0D,TICL轴向偏差在10°以内者占93．94％（31／33）,手术前后眼压及角膜内皮细胞计数的差异均无统计学意义（眼压：F=3．350,P=5．490;角膜内皮细胞计数：t=1．835,P=0．082）,术后1眼出现须手术调整的散光轴向旋转,1眼因TICL直径较大,发生术后高眼压,行TICL置换后眼压恢复正常,目前尚无白内障发生。结论TICL植入矫治超高度近视并散光具有有效性、安全性及稳定性。     

Toric人工晶状体植入矫正特殊角膜散光的疗效观察

目的：回顾分析Toric(环曲面)人工晶状体植入治疗合并特殊角膜散光的白内障患者的临床治疗效果。

方法：对10例12眼合并特殊角膜散光的白内障患者行超声乳化白内障吸出及人工晶状体植入术治疗,进行回顾性分析。其中4眼为翼状胬肉切除术后,3眼为外伤后角膜散光,5眼为角膜云翳或斑翳患者。术后随访6mo,分析不同时间点裸眼视力、术后残余散光、并发症等,观察Toric人工晶状体植入后的疗效,旋转稳定性。

结果：术后随访观察6mo,术后裸眼视力平均0.62±0.31,最佳矫正视力0.70±0.35。裸眼视力≥0.8者2眼,占17%。裸眼视力≥0.5者9眼,占75%。术后残余散光0.51±0.36D。术后角膜源性散光未见明显改变,全眼总合散光得到明显改善,差异有统计学意义。术后全眼总合散光与术前预计残余散光值接近,无显著性差异。术后6mo旋转度为(3.80±1.46)°。末次随访时间点,植入Toric人工晶状体的12眼中,旋转度小于5°的11眼,占92%。仅1例术后旋转度为6°。

结论：对于某些特殊原因导致角膜散光的白内障患者,经过严格的手术前筛选,行白内障超声乳化吸出联合Toric人工晶状体植入,能够安全、有效的改善患者的散光,提高术后视觉质量,预测性好。     

Toric人工晶状体植入矫正规则性角膜散光的疗效观察

目的:观察Toric人工晶状体植入用于治疗合并角膜散光的白内障患者的临床治疗效果。方法:对41例47眼合并角膜散光的白内障患者行超声乳化白内障吸出及人工晶状体植入术治疗,进行回顾性分析。其中22眼植入Toric人工晶状体,25眼植入AcrySof IQ人工晶状体。术后随访6mo,分析不同时间点裸眼视力、术后残余散光、并发症等,比较两种人工晶状体的疗效。观察Toric人工晶状体植入后的稳定性。结果:术后随访观察6mo,植入Toric人工晶状体的实验组,术后裸眼视力平均0.73±0.37,明显优于植入AcrySof IQ人工晶状体的对照组平均0.47±0.18,结果有显著性差异。实验组患者术后残余散光0.53±0.40D,明显低于对照组2.13±0.76D,差异有统计学意义。植入Toric人工晶状体组,随访6mo内视力稳定,人工晶状体位置稳定,术后平均旋转4.22±1.46°。结论:对于合并角膜散光的白内障患者,行白内障超声乳化吸出联合Toric人工晶状体植入,能够安全、有效的改善患者的散光,提高术后视觉质量,预测性好。     

Toric工晶状体治疗白内障合并角膜散光疗效观察

目的：应用角膜曲率联合角膜地形图检查测量角膜曲率,采用个性化手术源性散光值,计算人工晶状体型号及轴位,在白内障手术中植入散光型人工晶状体来矫正角膜散光并观察疗效。 方法：收集白内障并伴有角膜规则散光的病例43眼,手术中采用白内障超声乳化术植入AcrySof Toric IOL,并放置IOL于目标轴位,观察术后屈光结果。 结果：术后随访3mo,33眼使用T5以下人工晶状体,85%患者裸眼视力＞0.5,70%患者裸眼视力＞0.8术后角膜散光由术前的1.64±0.53D降至0.63±0.32D,10眼应使用T6,T 7,但使用T5裸眼视力均＞0.5,残余散光接近预测值。术后3mo观察,43眼术后第1d平均轴位偏离465°±4.21°,84% IOL轴位偏离＜10°,3mo平均旋转116°±184°,100% IOL旋转＜10°。 结论：应用角膜曲率联合角膜地形图检查测量角膜曲率,采用个性化手术源性散光值,计算人工晶状体型号及轴位,植入AcrySof Toric IOL能有效地矫正角膜散光,并具有良好的囊袋内稳定性。     

矢量分析法评价TICL V4c植入术矫正中高度近视合并高度散光的临床疗效

目的：采用矢量分析法和屈光矫正者生活质量(QIRC)量表评估散光型中央孔型有晶状体眼后房型人工晶状体(TICL V4c)矫正中高度近视合并高度散光的临床疗效。

方法：回顾性病例系列研究。选取2019-01/2022-12在我院眼科近视手术中心行TICL V4c植入术的中高度近视合并高度散光患者55例90眼。术后随访1 a，观察裸眼视力(UDVA)、最佳矫正视力(BCVA)、屈光度等情况，采用Alpins矢量分析法评估散光矫正效果，并采用QIRC量表评估患者的生活质量。

结果：术后1 a，98%术眼UDVA达到甚至优于术前BCVA，手术安全性指数为1.11±0.14，有效性指数为1.11±0.15； 97%术眼散光的误差角度在±15°以内，散光的矢量分析结果显示散光矫正指数为0.83±0.13，误差角度为1.00°±4.49°，成功指数为0.21±0.15。术后1 a，纳入患者6 mm瞳孔直径下角膜总高阶像差较术前明显增加(P<0.05)，QIRC量表总分明显高于术前(P<0.001)，且QIRC量表总分的增加量与术前球镜度数呈正相关(r_s=0.215，P<0.05)，提示术前近视程度越高，TICL植入术后生活质量提高越显著。

结论：TICL V4c植入术矫正中高度近视合并高度散光安全有效，且术后生活质量显著提高。     

Outcomes and possible risk factors associated with axis alignment and rotational stability after implantation of the Toric implantable collamer lens for high myopic astigmatism

AIM: To assess the visual outcomes and possible risk factors associated with axis alignment and rotational stability after implantation of Toric implantable collamer lens (TICL) for the correction of high myopic astigmatism. METHODS: In this prospective, nonrandomized clinical study, 54 consecutive eyes of 29 patients with high myopic astigmatism received TICL implantation. To evaluate postoperative axis deviation from the intended axis, a digital anterior segment photograph was taken. The ultrasound biomicroscopy(UBM) was used to observe footplate-position. RESULTS: After mean follow-up of 8.6 months, mean manifest refractive cylinder (MRC) decreased 79.3% from (-1.88±1.49)D preoperatively to (0.39±0.61)D postoperatively. MRC within 1.00 D occurred in 68.5% (37/54) of eyes, whereas 48.1% (26/54) had MRC within 0.50 D. Mean manifest refraction spherical equivalent (MRSE) changed from (-12.08±4.22)D preoperatively to (-0.41±0.61)D postoperatively. Uncorrected binocular vision of 20/20 or better occurred in 72.2% (39/54) of patients compared with binocular best-corrected visual acuity (BCVA) of 20/20 or better in 44.4% (24/54) preoperatively. The mean difference between intended and achieved TICL axes was (6.96±8.37)°. Footplates of TICLs were in the ciliary sulcus in 22 eyes (46.3%), below the ciliary sulcus in 32 eyes (53.7%). The angle of TICL rotation had significant correlation with the footplates-position (t=2.127; P=0.045) and the postoperative TICL vaulting (r=-0.516; P=0.000). CONCLUSION: The results of our study further support the safety, efficacy and predictability of TICL for the correct high myopic astigmatism. The footplate-position of TICL and vault value should be taken into consideration as two possible risks factors for TICL rotation.     

TICL矫治高度近视并散光的临床研究

目的:探讨散光矫正型植入性眼内接触镜(TICL)矫治高度近视并散光的安全性、有效性、稳定性。方法:高度近视并散光的患者15例30眼接受散光矫正型眼内接触镜植入术,观察术后1,3,6,12mo时裸眼视力、矫正远视力、屈光状态、眼压、角膜内皮细胞计数及并发症情况等。结果:术后裸眼视力均有明显提高,术后12mo裸眼视力达到1.0以上的有27眼(90%),等效球镜±0.5D以内28眼(93%)。术后无1例矫正远视力下降1行或1行以上。术后1mo与术后12mo相比,30眼(100%)等效球镜变化均在0.5D之内。手术前后角膜内皮细胞计数比较无显著性差异(P=0.31)。术后12mo未见并发性白内障、继发性青光眼等并发症。结论:散光矫正型植入性眼内接触镜(TICL)矫治高度近视并散光安全、有效。     

Laser in situ keratomileusis for myopic astigmatism

PURPOSE: To evaluate the refractive results of laser in situ keratomileusis (LASIK) for myopic astigmatic eyes, and to assess the efficacy, accuracy, stability, and safety of the procedure. METHODS: LASIK was performed on 113 eyes of 73 patients for correction of myopic astigmatism ranging from 1.00 to 5.00 D, as measured by manifest refraction, with a mean baseline refractive astigmatism of 2.09 +/- 1.12 D. The Chiron Automated Corneal Shaper was used to create a corneal flap, and laser ablation was performed using the Chiron-Technolas Keracor 116 excimer laser. Follow-up time was 12 months for all eyes. RESULTS: Refractive astigmatism was stable by 3 months after surgery. At 1 year after LASIK, refractive astigmatism was reduced to a mean of 0.25 +/- 0.31 D (range 0 to 1.00 D). Sixty-one eyes (54%) had no residual astigmatism and 98 eyes (86.7%) had 0 to 0.50 D of refractive astigmatism. The mean percent reduction of preoperative astigmatism was 87.9 +/- 14.9%. The mean axis deviation of the surgically induced astigmatism was 2.1 +/- 3.1 degrees, with 96 eyes (84.9%) within 5 degrees of the desired axis. The percent correction of preoperative astigmatism in the proper axis was 97.1 +/- 15.5%. Spectacle-corrected visual acuity improved by 2 lines in 11 eyes (9.7%), and was reduced by 1 line only in 1 eye. There were no other significant complications. CONCLUSION: LASIK with the Chiron-Technolas Keracor 116 excimer laser was effective for correction of myopic astigmatism, with good stability after 3 months. The results were predictable with an acceptable degree of accuracy. LASIK is a safe procedure with very few complications.     

Safety and efficacy of toric implantable collamer lens V4c model – A retrospective South Indian study

Purpose:The aim of this study was to evaluate the safety, efficacy, and complications of V4c Toric implantable collamer Lens (TICL) implantation for myopic astigmatism in the south Indian population.Methods:In this retrospective observational case series, a total of 109 eyes of 67 patients who underwent V4c TICL implantation (ICL, V4C Staar Surgical, Nidau, Switzerland) between January 2012 and August 2019 were studied with a minimum follow-up period of 6 months (mean 24 months). The main outcome measures were objective and subjective refraction, uncorrected distance visual acuity, corrected distance visual acuity (CDVA), safety, predictability, adverse events, and postoperative complications.Results:At 6 months, mean manifest refractive spherical equivalent (SE) decreased from - 10.90 ± 3.7D preoperatively to - 0.02 ± 0.13D postoperatively (P < 0.001) and mean cylinder decreased from - 2.3 ± 1.3 D preoperatively to - 0.04 ± 0.2 D postoperatively (P < 0.001). Postoperatively, SE within ± 0.5 D and ± 1.0 D of attempted correction were achieved in 96.3 (105 eyes) and 100% (109 eyes), respectively. Manifest refractive cylinder within ± 0.5 D and ± 1.0 D of attempted correction were achieved in 97.2 (106 eyes) and 100% (109 eyes), respectively. Sixty-two percent (68 eyes) showed no change in CDVA postoperatively, and no eye had lost lines of CDVA. The safety index was 1.12, and the efficacy index was 1.10. Complications were seen in two eyes (1.8%) due to high postoperative vault requiring secondary surgical interventions.Conclusion:V4c TICL is a highly effective, safe, and predictable option in treating myopic astigmatism with excellent improvement in vision and spectacle independence.     

Randomized prospective comparison of visian toric implantable collamer lens and conventional photorefractive keratectomy for moderate to high myopic astigmatism

PURPOSE: To compare the Visian Toric Implantable Collamer Lens (TICL), a toric phakic intraocular lens (IOL), and photorefractive keratectomy (PRK) in the correction of moderate to high myopic astigmatism. METHODS: This prospective, randomized study consisted of 43 eyes implanted with the TICL (20 bilateral cases) and 45 eyes receiving PRK with mitomycin C (22 bilateral cases) with moderate to high myopia (-6.00 to -20.00 diopters [D] sphere) measured at the spectacle plane and 1.00 to 4.00 D of astigmatism. All patient treatment and follow-up occurred at the Naval Medical Center San Diego. Study follow-up was 1 day, 1 week, 1, 3, 6, and 12 months postoperative. RESULTS: Mean best spectacle-corrected visual acuity (BSCVA), change in BSCVA, proportion of cases with improvement of 1 or more lines of BSCVA, proportion of cases with BSCVA and uncorrected visual acuity (UCVA) 20/12.5 or better, proportion of cases with BSCVA and UCVA 20/16 or better (6 months, 88% vs 54%, P=.002), and predictability +/-1.00 D (6 months, 100% vs 67%, P<.001) were all significantly better in the TICL group than the PRK group at all time periods studied postoperatively. Similarly, contrast sensitivity, tested at both the 5% photopic level and the 25% mesopic level, was significantly better at all postoperative time points in the TICL group. Mean spherical equivalent refraction was closer to emmetropia (0.28+/-0.41 vs 0.76+/-0.86, P=.005), and predictability +/-0.50 D and stability of manifest refraction (+/-0.50 D and +/-1.00 D) were significantly better in the TICL group at all postoperative visits through 6 months. Mean astigmatism correction at 6 months was not significantly different between the two groups (0.52+/-0.33 vs 0.46+/-0.35, P=.450). CONCLUSIONS: The TICL performed better than PRK in all measures of safety (BSCVA), efficacy (UCVA), predictability, and stability in this comparison, supporting the TICL as a viable alternative to existing refractive surgical treatments.     

Toric laser in situ keratomileusis for myopic astigmatism using an ablatable mask

BACKGROUND: To assess the results of toric laser in situ keratomileusis (LASIK) correction of myopic astigmatism. METHODS: A prospective study was performed over a 20 week period for consecutive patients treated for myopic astigmatism. Spectacle-corrected visual acuity, uncorrected visual acuity, spectacle refraction, videokeratography, and complications were recorded. Vector analysis was performed by the ASSORT program. RESULTS: Sixty-five eyes of 42 patients underwent toric LASIK with a Summit Technologies Apex Plus excimer laser. Mean preoperative spherical equivalent refraction at the spectacle plane was -6.24 +/- 2.42 D (range, -1.63 to -14.63 D) and mean pre-operative refractive cylinder magnitude was 1.99 +/- 1.35 D (range, 0.75 to 7.00 D); mean attempted refractive cylinder correction was 1.90 +/- 1.00 D. Six months after LASIK (43 eyes followed), mean spherical equivalent refraction at the spectacle plane was -0.40 +/- 0.55 D and 31 eyes (72.1%) were within +/- 0.50 D of emmetropia. At 6 months, mean refractive cylinder magnitude was 0.74 +/- 0.70 D, mean surgically induced astigmatism was 1.46 +/- 0.86 D, mean absolute angle of error was 10.33 degrees, mean astigmatic correction index was 0.93 +/- 0.36 D, and mean index of success was 0.46 +/- 0.39. Uncorrected visual acuity was 6/12 or better in 34 eyes (79.1%) and 6/6 in 15 eyes (35%); spectacle- corrected visual acuity was 6/9 or better in 41 eyes (95.35%). Six eyes (14.0%) lost 1 line of spectacle-corrected visual acuity at 6 months and one eye (2.3%) lost 2 lines. Ten eyes (23.3%) gained 1 line at 6 months. CONCLUSION: Toric LASIK with an ablatable mask using the Summit Apex Plus excimer laser is a safe and relatively accurate procedure for the correction of myopic astigmatism.