两种术式矫正老年性白内障患者散光的疗效比较

目的:比较超声乳化白内障摘除联合Toric人工晶状体植入术与球面人工晶状体植入术联合周边角膜切开术矫正老年性白内障患者术前散光的疗效。方法:连续纳入老年性白内障住院手术患者54例54眼,男27例,女27例,平均年龄70.04±9.08(50～87)岁。A组(0.75D≤散光≤1.50D)30例,B组(1.75D≤散光≤2.50D)24例。每组患者随机分配进行周边角膜切开术(PCRIs)和Toric人工晶状体植入术矫正术前散光,比较两种手术方式术后6mo患者的裸眼视力(UCVA)、最佳矫正视力(BCVA)、残余散光(|EV|)、散光矫正量(|SIRC|)、散光矫正率(CR)。比较两种手术方式术后6mo与术后1mo的UCVA和|EV|的变化。结果:术后6mo,所有患者的BCVA均达0.6以上。PCRIs与Toric-IOL术后BCVA达到0.8以上者在A组中分别为86.7%vs93.3%(P>0.05),B组分别为75%vs91.7%(P=0.59),两种术式在两散光组中间差异均无统计学意义。术后6mo,PCRIs与Toric-IOL两种术式患者的UCVA、|EV|、|SIRC|、CR在A组患者中分别为0.70±0.21vs0.76±0.17(P=0.81)、0.48±0.22vs0.37±0.19(P=0.13)、0.87±0.30vs0.92±0.38(P=0.71)、0.75±0.16vs0.78±0.19(P=0.56),两种术式间各参数差异均无统计学意义;B组患者中分别为0.50±0.15vs0.78±0.11(P<0.01)、1.17±0.36vs0.54±0.33(P<0.01)、1.08±0.27vs1.68±0.32(P<0.01)、0.51±0.13vs0.81±0.14(P<0.01),两种术式间各参数差异均有统计学意义。A组中PCRIs术后1mo与术后6mo的UCVA、|EV|在分别为0.77±0.23vs0.70±0.21(P=0.09)、0.50±0.23vs0.48±0.22(P=0.58),Toric-IOL术后分别为0.77±0.223vs0.76±0.17(P=0.81)、0.40±0.18vs0.37±0.19(P=0.55),各参数间差异无统计学意义;B组患者中PCRIs术后1mo与术后6mo的UCVA、|EV|分别为0.63±0.17vs0.50±0.15(P<0.01)、0.81±0.34vs1.17±0.36(P<0.01),Toric-IOL术分别为0.81±0.12vs0.78±0.11(P=0.08)、0.48±0.31vs0.54±0.33(P<0.01),各参数间差异有统计学意义。结论:PCRIs与Toric-IOL两种手术方式矫正老年性白内障患者术前散光安全、有效。两种手术方式矫正低度数散光(0.75～1.50D)的疗效无差异,术后6mo内疗效稳定;Toric-IOL术矫正较高度数散光(1.75～2.50D)的疗效优于PCRIs;两种术式的疗效在术后6mo均有所回退,PCRIs回退较严重。     

Paired opposite clear corneal incisions to correct preexisting astigmatism in cataract patients

PURPOSE: To evaluate the astigmatic correcting effect of paired opposite clear corneal incisions on steep axis in cataract patients. SETTING: Sligo General Hospital, Sligo, Ireland. METHODS: Fifteen eyes of 14 cataract patients with a mean age of 78.4 years +/- 6.38 (SD) (range 69 to 90 years) were recruited for the study. Inclusion criterion was topographic astigmatism of more than 2 diopters (D) in the cataractous eye. Preoperative refraction, autokeratometry, and topography were performed. The steep axis was marked before sub-Tenon's anesthesia was given. Paired 3-step self-sealing opposite clear corneal incisions were made 1 mm anterior to limbus on the steep axis with a 3.2 mm keratome. One incision was used for standard phacoemulsification, and the other was left unused for astigmatic correction. All the patients had day-case surgery. The first follow-up was at 1 month. Postoperative topography, keratometry, and refraction were performed on all patients. RESULTS: Mean preoperative and postoperative topographic corneal astigmatism were 3.26 +/- 1.03 D (range 2.30 to 5.80 D) and 2.02 +/- 1.04 D (range 0.20 to 4.00 D), respectively. Mean astigmatic correction was 1.23 +/- 0.49 D (range 0.30 to 2.20 D). Mean surgically induced astigmatism by vector analysis was 2.10 +/- 0.79 D (range 0.80 to 3.36 D). There were no incision-related complications. CONCLUSION: Paired opposite clear corneal incisions on the steep axis is a useful way to correct astigmatism in cataract patients, requiring no extra skill or instrumentation.     

Opposite clear corneal incisions to correct pre-existing astigmatism in cataract surgery

In cataract surgery, the clear corneal incision (CCI) has a small flattening effect on corneal curvature, which can be used to reduce pre-existing astigmatism (PEA). Adding an identical, penetrating CCI opposite the first one can enhance the flattening effect. The paired opposite CCIs (OCCIs) are placed on the steepest meridian axis to flatten it. One CCI is used to perform cataract surgery, and the opposite CCI is made to enhance the flattening effect on the cornea to modulate PEA. During the past 12 months, we have used 2.8 to 3.5 mm OCCIs in 33 eyes with PEA greater than 2.00 diopters (D) having cataract surgery. The mean astigmatism correction achieved with this technique was 2.06 D. This technique is simple and effective and yields stable results that rival those of arcuate keratotomy. The OCCI technique has a potential application for the correction of astigmatism in general refractive surgery. Opposite clear corneal incision nomograms with variables such as width, length, and distance from the limbus will be needed for future applications.     

白内障手术中植入散光型人工晶状体矫正角膜散光的效果评价

目的:评价白内障手术植入散光型人工晶状体(MS6116TU)的术后效果和人工晶状体轴位的稳定性.方法:对154眼进行回顾性总结分析.采用颞侧透明切口的白内障超声乳化法,植入折叠式散光型人工晶状体.术后向量分析借助双角图表,统计学处理采用T2检验.结果:主观验光的平均散光向量术前为1.51D×178°,术后为0.07D×121°.术后1d有11眼(7.1%)Toric IOL的轴向比预定方向偏差15°以上,随访中有12眼(7.8%)轴向偏离在15°以上;晶状体在囊袋内稳定性能好,本组未有二次手术再定位者.无论是高度(≥5D)或低度(≤2D)的散光晶状体均取得了预期的效果.结论:在白内障手术中植入散光人工晶状体矫正术前角膜的散光,临床效果准确、可靠,并有着较好的预测性,具有一定的推广前景.     

Limbal relaxing incisions to correct astigmatism in clear corneal cataract surgery.

PURPOSE: To prevent surgically induced astigmatism following clear corneal cataract surgery. METHODS: Limbal relaxing incisions of 6- or 8-mm length and 0.55-microm depth were performed in 52 patients (52 eyes) with a spherical cornea (20 eyes) or mean with-the-rule astigmatism (32 eyes) of 0.80 +/- 0.30 D after temporal corneal cataract incision. A control group (47 eyes; 19 spherical and 28 with-the-rule astigmatism) underwent the same surgical procedure without limbal relaxing incisions. RESULTS: Six months after surgery, mean with-the-wound change using the Holladay analysis was -0.08 +/- 0.50 D in spherical eyes with limbal relaxing incisions and +0.50 +/- 0.70 D in control eyes. Patients with preoperative with-the-rule astigmatism showed a mean with-the-wound change of -0.09 +/- 0.50 D after limbal relaxing incisions; in corresponding control eyes, mean change was +0.39 +/- 0.70 D. CONCLUSION: Limbal relaxing incisions are a reliable and safe procedure to reduce postoperative astigmatism.     

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＞25 mm).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1 d、1周、1个月和3个月充分散瞳后裂隙灯照相,采用Adobe Photoshop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 Toric IOL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.     

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。     

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.     

AcrySof IQ Toric人工晶状体植入矫正角膜散光的疗效

目的：评价白内障手术中植入AcrySof IQ Toric散光型人工晶状体矫正角膜散光的效果及人工晶状体在囊袋内的稳定性。

方法：对21例26眼伴有角膜规则散光的白内障患者,植入AcrySof IQ Toric散光型人工晶状体,观察术前及术后裸眼视力、最佳矫正视力; 术前角膜散光、预计散光、总散光,术后角膜散光及残余散光; 以及术后人工晶状体旋转度。

结果：术后所有患者裸眼视力及最佳矫正视力均明显提高; 术后残留散光0.55±0.33D,与术前总散光2.05±0.57D相比明显下降(t=13.574,P<0.05); 与术前预留散光0.47±0.19D比较无统计学意义(t=1.149,P>0.05)。术后3mo角膜散光-1.89±0.53D,与术前角膜散光2.01±0.58D相比无差异(t=1.908,P>0.05); 所有26眼的人工晶状体旋转度均<20°,平均旋转为(3.65±2.86)度。

结论：白内障超声乳化吸除联合AcrySof IQ Toric IOL植入矫正散光手术,能够有效的减少患者的散光,术后IOL旋转稳定性良好,是治疗白内障合并散光患者的有效的手术方法。     

Toric人工晶状体矫正外伤性白内障患者散光的观察

目的评价Toric人工晶状体矫正外伤性白内障患者散光的效果。方法前瞻性病例研究,收集我科散光大于1．0D的外伤性白内障患者17例（17只眼）,所有患者受伤后角膜缝线已拆除,屈光状态稳定3个月队上,施行白内障超声乳化联合Toric人工晶状体植入术。术后随访3～28个月,观察手术前后裸眼视力（uncorrected visual acuity,UCVA）、最佳矫正视力（best corrected visual acuity,BCVA）、散光（包括角膜源性散光及总合散光）、人工晶状体位置、术中及术后并发症等情况。结果术后UCVA及BCVA均较术前提高,差异有统计学意义（P〈0．05）,术后UCVA≥0．6者11例,所有患者BCVA≥0．6,BCVA≥1．0者8例;术后球镜度数及总合散光均较术前降低,差异有统计学意义（P〈0．05）;手术前后角膜源性散光变化无统计学意义。人工晶状体具有良好的居中性,随访末期,旋转度为（3．51±2．97）°,未见明显严重的术中及术后并发症。结论Toric人工晶状体可矫正部分外伤性白内障患者的散光,把握合适的手术适应证,可为患者提供更好的预后视力。     

AcrySof Toric IOL的临床应用研究

目的:评价AcrySof Toric IOL在囊袋内的稳定性及矫正角膜散光的效果。方法:选择2010-04/2012-04在我院接受白内障超声乳化及AcrySof Toric IOL植入并且完成6mo随访的患者20例23眼。观察术前、术后裸眼视力(UCVA)、术前角膜散光、术后残余散光、IOL旋转度、晶状体偏中心情况、晶状体倾斜情况及囊袋情况。结果:术后6mo,100%患眼UCVA≥0.6,69.6%(16/23)患眼UCVA≥0.8。术前角膜散光平均为2.31±0.70D,术后6mo残余散光为0.45±0.30D,二者差异有统计学意义(t=15.045,P=0.000)。术后6mo时17眼(73.9%)偏离预定轴位,平均偏差5.36°±0.32°,其中2例偏差>10°,最大偏差15°;术后6mo时12眼(52.2%)出现晶状体偏中心,8眼(34.8%)<0.5mm,3眼(13.0%)为≥0.5mm而≤1mm,1眼(4.3%)>1mm;术后6mo时20眼(87.0%)晶状体无倾斜,3眼(13.0%)出现倾斜,倾斜均少于5°。结论:AcrySofToricIOL可使患者获得良好的裸眼远视力,有效的矫正患者的角膜散光,同时具有良好的位置稳定性,预测性强,是一种有效的矫正角膜规则散光的治疗方法。     

白内障术中Toric人工晶状体植入矫正散光的长期临床疗效

目的：评价术前伴有较大角膜散光的白内障患者白内障超声乳化后植入AcrySof Toric IOL后的屈光效果及囊袋内的旋转稳定性。

方法：收集确诊为年龄相关性白内障并伴有角膜规则散光≥1.00D的患者28例32眼,采用白内障超声乳化、植入AcrySof Toric IOL手术。观察并比较术前、术后1a裸眼视力(UCVA)及最佳矫正视力(BCVA)、术前角膜散光、预计残余散光及术后1a残余散光、IOL旋转度。

结果：术后1a,85%患眼UCVA≥0.5,86%患眼BCVA≥0.8,BCVA≥0.6者达92%。相较术前角膜散光(2.20 ±0.65D),术后1a残余散光(0.54±0.13D)明显减少,两者差异有统计学意义(t=10.134,P<0.01); 术前预计残余散光0.52±0.14D,术后1a残余散光为0.54±0.13D,两者差异无统计学意义(t=0.364,P>0.05)。术后6mo晶状体旋转平均为3.4°±2.2°。术后1a晶状体旋转平均为3.82°±1.27°。

结论：AcrySof Toric IOL植入术是一种矫正角膜规则散光的有效的、可预测性好、角膜损伤小、无角膜损伤的方法。谨慎的选择患者,准确的角膜曲率的测量和IOL轴位的精确调整是影响其屈光效果和旋转稳定性的因素。     

Toric人工晶状体在合并高度角膜散光白内障中的应用

目的：评估Bi-Flex toric人工晶状体在合并散光的白内障中的应用。

方法：回顾性研究包括16例22眼合并2.50D以上散光的白内障患者。测量了术前与术后的裸眼视力、最佳矫正视力、客观及主观验光、角膜散光仪和角膜地形图测量的散光值。术后人工晶状体屈光轴位置使用向量进行分析。

结果：术后,主观验光散光值从4.05D±1.53D显著降低至1.35D±0.86D,(P<0.05)。屈光轴位置指标J₀,从术前的-0.81±2.02D降至 -0.12±0.62D(P<0.05)。裸眼视力和最佳矫正视力术后1mo时均显著改善(P<0.05),分别为0.24±0.19和0.06±0.08。人工晶状体屈光轴旋转程度平均为2.95±5.25度,86.36%的患眼旋转程度小于10度。术前、术后角膜散光计测量值未见显著差异(J₀ 和J₄₅均有P>0.05)。

结论：对于合并大于2.50D散光的白内障患者,Bi-Flex toric人工晶状体植入是安全有效的治疗方法。     

Toric intraocular lens for correction of high corneal astigmatism in cataract patients

AIM: To evaluate the efficacy of Bi-Flex toric intraocular lens (T-IOL; Medicontur, Medical Engineering, Ltd., Inc.) implantation to correct preexisting astigmatism in patients having cataract surgery. METHODS: This retrospective consecutive study included 22 eyes of 16 patients with more than 2.50 diopters (D) of corneal preexisting astigmatism having cataract. Preoperative and postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), objective and subjective refraction and keratometric and topographic cylinder were measured. Postoperative the toric IOL axis was evaluated using vector analysis. RESULTS: Postoperatively, subjective refractive cylinder was reduced significant (P<0.05) from 4.05±1.53 D to 1.35±0.86 D. The component J0 reduced in magnitude from -0.81±2.02 D to -0.12±0.62 D (P<0.05). Both, UCVA and BCVA improved significantly at 1mo after surgery (P<0.05 in both cases). After the surgery, the UCVA and BCVA were 0.24±0.19 and 0.06±0.08, respectively. The mean toric IOL axis rotation was 2.95±5.25 degree, with rotation less than 10 degrees in 86.36% of eyes. No differences in mean keratometric values obtained before and after surgery were found (P>0.05 for J0 and J45). CONCLUSION: Implantation of the Bi-Flex toric IOL is a safe and effective method to correct the preexisting regular astigmatism (greater than 2.50D).     

同轴微切口超声乳化联合复曲面人工晶状体植入术治疗白内障合并角膜散光

目的:评价同轴微切口超声乳化术联合复曲面人工晶状体(Toric intraocular lenses,Toric IOL)植入治疗白内障合并角膜散光的临床效果,及其有效性和安全性。方法:本研究为临床病例系列研究。年龄相关性白内障合并角膜散光(≥0.75D)患者58例69眼行同轴微切口超声乳化手术联合Acrysof Toric人工晶状体植入治疗,记录术前视力、角膜散光及理论残留散光等,观察术后第1d;1,3mo;1a的裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)、术后残留散光、IOL轴位等。结果:术后1a,平均裸眼视力为0.70±0.11,最佳矫正视力为0.73±0.20,均显著高于术前最佳矫正视力0.21±0.01,差异有统计学意义(χ2=86.67,χ2=82.23,P<0.05),术前角膜平均散光为2.25±0.73D,术前预计残留平均散光为0.34±0.09D,术后1a残留散光为0.51±0.21D,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1a实际散光比较差异无统计学意义(t=1.69,P>0.05)。术后1a,IOL定位和预测轴位差值为3.79°±1.21°,96%旋转<5.00°。未发现1例手术并发症。各个时间段最佳矫正视力、残留散光及IOL轴位旋转无明显差异(P>0.05)。结论:对术前合并角膜散光的白内障患者,行同轴微切口超声乳化联合Toric人工晶状体植入治疗能有效地提高视力、矫正术前角膜散光,而且稳定性较好。