微切口白内障术后波前像差及泪膜变化研究

目的:探讨白内障超声乳化联合人工晶状体植入术角膜切口的大小对角膜总均方根值、角膜散光、球差、彗差、三叶草及泪膜变化的影响。方法:选择年龄相关性白内障156例196眼,按角膜切口大小分为两组进行超声乳化联合人工晶状体植入术,其中透明角膜切口1.8mm组94眼;3.0mm组102眼。比较术后1wk;1,3mo角膜总均方根值、角膜散光、球差、彗差、三叶草及泪膜变化。结果:术后1wk,两组之间角膜总均方根值、角膜散光、球差、彗差、三叶草及泪膜变化的比较均有显著性差异(P<0.05);术后1mo,组间比较亦有差异(P<0.05),术后3mo,组间比较无差异(P>0.05)。结论:切口大小对白内障超声乳化联合人工晶状体植入术后角膜高阶像差的影响不同。其中微切口角膜总均方根值、角膜散光、球差、彗差、三叶草及泪膜变化的影响相对小,而3.0mm透明角膜切口影响大。

Effect of micro-incision on corneal wavefront aberration and tear film in phacoemulsification

AIM: To investigate the effect of endocapsular phacoemulsification cataract extraction and intraocular lens(IOL)implantation with a 1.8mm or 3.0mm clear corneal incision on total root mean square(RMS)value of the cornea, corneal astigmatism, spherical aberration, coma, trefoil and tear film.

METHODS:In a prospective study, 156 age-related patients(196 eyes)were randomly distributed into two groups. 1.8mm-group comprised 94 eyes that had a silicone IOL inserted through a 1.8mm sutureless clear corneal incision, while, 3.0mm-group comprised 102 eyes through a 3.0mm clear corneal incision. Postoperatively, the changes in the total RMS value of the cornea, corneal astigmatism, spherical aberration, coma, trefoil and tear film at 1wk, 1 and 3mo were determined respectively.

RESULTS: In both groups, postoperatively at 1wk,there were statistically significant differences(P<0.05)in the total RMS value of the cornea, corneal astigmatism, spherical aberration, coma, trefoil and tear film, while, there were statistically minimal differences(P<0.05)between 1.8mm-group and 3.0mm-group at 1mo, but were not statistically significantly different(P>0.05)between two groups at 3mo postoperative.

CONCLUSION:This study confirms that incision size has strong impact on the corneal higher-order aberrations, especially, 3.0mm incision caused significant differences in the total RMS value of cornea, corneal astigmatism, spherical aberration, coma, trefoil and tear film compared with 1.8mm micro-incision, therefore, micro-incision is very beneficial for clinical use in phacoemulsification.