切口位置对小切口非超声乳化术后角膜散光影响的观察

目的 比较小切口非超声乳化术不同位置的切口对角膜散光的影响.方法 将60例(60只眼)欲行小切口非超声乳化人工晶状体植入术的白内障患者随机分两组各30只眼,A组顺规散光者切口选在上方,逆规散光者切口选在颞侧;B组:切口全部选在上方.均采用距角巩膜缘2mm水平6.5mm的巩膜隧道切口,不缝合.观察术前及术后3个月的视力、角膜散光及手术源性散光的情况.结果 A组、B组手术源性散光分别是:(0.94±0.12)D、(0.98±0.12)D,差异无统计学意义.A组术前和术后3月散光为:(1.24±0.46)D、(0.24±0.26)D;B组为(1.25±0.36)D、(2.54±0.45)D;A组视力≥0.5:26只眼(87%):B组:19只眼(64%),A、B组差异有统计学意义.结论 白内障手术切口选在角膜曲率最大的子午线上.可矫正术前已有散光并获得更好地术后视力.     

小切口非超声乳化白内障术后的角膜散光变化

目的总结小切口非超声乳化人工晶状体植入术后的角膜散光变化.方法 39例44眼老年性白内障患者行小切口非超声乳化人工晶状体植入术,检查术前及术后3天,2周,1、2、3、6个月等不同时期的角膜散光情况;计算手术产生的角膜散光在各时期的变化.同期常规现代囊外手术的老年性白内障42例42眼作为对照.结果小切口非超声乳化组术后1、2、3、6个月的散光度接近于术前的散光值.对照组手术各时期的散光度明显高于术前的散光值.两组术后产生的角膜散光有显著性差异(P<0.05).结论小切口非超声乳化人工晶状体植入术能在术后早期减少角膜散光,获得较快的视力恢复,有利于基层医院推广.     

切口位置对晶状体超声乳化术后散光的影响

目的探讨晶状体超声乳化吸出手术中切口位置对术后散光的影响。方法白内障80例(98眼)分为两大组,其中第一大组,又根据术前角膜地形图再分为AB两组:A组为顺规性散光组,作上方巩膜隧道切口;B组为逆规性散光组,作颞侧透明角膜切口,分别行超声乳化术加折叠式人工晶状体植入术;第二大组均作上方切口。术后观察3天,1月、3月和6月的角膜平均散光和裸眼视力情况。结果两大组在术后不同时间内角膜散光度之间有显著性差异。术后1月分别为(0.57±0.30)D和(1.20±0.59)D。结论根据患者术前角膜地形图,顺规性散光患者采用上方巩膜隧道切口,逆规性散光采用颞侧透明角膜切口。早期视力以颞侧透明角膜切口者恢复佳。     

白内障超声乳化术中切口位置对角膜散光影响的观察

目的比较白内障超声乳化术中不同位置的切口对角膜散光的影响。方法53例（70只眼）施行超声乳化联合PMMA人工晶状体植入的白内障患者随机分为两组各35只眼：A组（实验组）根据角膜散光情况选择切口位置,顺规散光（WRA）及斜轴散光（OA）于最大曲率子午线上、逆规散光（ARA）于120°（右眼）或60°（左眼）轴向上、无散光者于颞上方;B组（对照组）切口位置始终选择在颞上方,均采用5．5mm巩膜隧道切口,切口术后不缝合。观察术前及术后3d、1个月、3个月的视力及角膜散光状态。结果A组术后3个月平均角膜散光度较术前减少0．3D（t=2．664,P〈0．01）,B组术后3个月平均角膜散光度与术前比较增加约0．48D（t=4．559,P〈0．01）,两者与术前相比较均有显著差异。结论白内障超声乳化术选择在角膜最大曲率子午线上做切口,可以矫正一定的术前散光。     

超声乳化术与小切口非超声乳化术治疗白内障疗效比较

目的：比较超声乳化术与小切口非超声乳化术治疗老年性白内障的临床疗效。

方法：白内障患者355例393眼分成A、B两组,其中A组180例193眼施行小切口非超声乳化白内障手术,B组175例200眼施行超声乳化白内障手术。术后观察视力、角膜散光、角膜内皮细胞计数情况。

结果：术后1d,患者视力恢复情况超声乳化手术组明显优于小切口非超声乳化手术组,但术后7d和30d两组无显著差异。术后7d,小切口非超声乳化组角膜散光度明显高于超声乳化组,但术后30d无显著性差异。对核硬度在Ⅳ～Ⅴ级的患者,超声乳化术后角膜内皮细胞计数少于小切口非超声乳化组,统计学分析有显著差异。

结论：应针对老年性白内障患者核硬度的具体情况,选择合适的手术方式进行治疗。     

选择性散光轴切口对白内障超声乳化术后角膜散光的影响

目的 探讨根据患者术前角膜散光不同,在不同部位选择性预设散光轴透明角膜切口行白内障超声乳化联合后房型折叠式人工晶状体植入术,对术后患者角膜散光的影响.方法 收集老年性白内障患者102例150只眼,分为选择性散光轴位的透明角膜切口(A组)、颞侧透明角膜切口(B组)和11点方位透明角膜切口(C组)3组,施行超声乳化联合折叠式人工晶状体植入术,比较术后视力及角膜散光的变化情况.结果 术后3月视力≥1.0,A组67%,B组56%,C组50%,差异有统计学意义(P＜0.01);A组术后3个月平均角膜散光低于B、C组(P＜0.05),较术前平均减少了0.32D(P＜0.05);且A组中19例术前角膜散光度≥1.00D的患者,术后3个月角膜散光度减少了0.71D(P＜0.05).术后3个月平均SLA,A组最小(P＜0.05).结论 选择在患者角膜屈光力最大轴向上行个体化的透明角膜切口,能减少患者术后角膜散光,有效控制白内障超声乳化手术源性角膜散光,进一步提高患者术后视力,尤其适用于术前角膜散光在≥1.00D的白内障患者.

Abstract：

Objective To investigate the surgically induced refractive change after phacoemulsification with selective maximum astigmatic axis clear incision. Methods Phacoemulsification was performed on 102 cases of 150 eyes with senile cataract through a clear corneal incision without suture. The changes of corneal astigmatism before and after operation in group A (incision at the maximum astigmatic axis) or B (incision at the temporal) and C (incision at the 11:00) were compared. Results Three months after the opera tion, the Best correction visual acuity more than 1.0, were 67% in group A, 56% in group B and 50% in group C (P ＜0.01). The mean postoperative astigmatism of group A decreased 0.32 D than the preoperative one (P ＜0.05) and was less than the postoperative one of group B or C. Postoperatively, the mean astigmatism of 19 patients who preoperative astigmatism more than 1.00D in group A decreased 0.71 D (P ＜0.05). Among the three groups, the mean postoperative surgically induced astigmatism (SIA) of group A was minimum (P ＜0.05).Conclusions The incision placed on the maximum astigmatic axis in phacoemulsification is worth to be recommended, because of the corneal astigmatism can be significantly reduced postoperatively, the SIA can be controlled effectively and patients can get a better visual acuity, especially to patients preoprative astigmatism more than 1.00D.     

不同切口位置白内障超声乳化吸出术后角膜散光变化的分析

目的:比较不同位置的透明角膜切口对白内障超声乳化吸出术后角膜散光及视力的影响。方法:将白内障患者44例(64眼)分成两组,A组患者采用上方10∶00～11∶00方位透明角膜切口,B组根据角膜最大屈光度子午线轴向方位透明角膜切口,所有患者均行白内障超声乳化吸出术联合折叠式人工晶状体植入术,分别于术后1wk;1,3mo随访患者,检查裸眼视力及行角膜地形图检查。结果:B组患者术后1wk;1,3mo视力好于A组。B组患者术后角膜散光度及术源性散光度在术后1wk;1,3mo时均小于A组。结论:根据角膜最大屈光度子午线轴向方位做透明角膜切口的白内障超声乳化吸出术,术后对角膜散光影响小,并可在一定程度上矫正术前已存在的角膜散光,能够使患者在术后更快、更好地恢复视力。     

不同超声乳化术切口对白内障患者术后角膜散光的影响

目的：比较不同超声乳化术切口对白内障患者术后角膜散光的影响。 方法：选取我院收治的白内障患者,将患者随机分为对照组（与角膜缘相反弧形巩膜隧道切口组）和观察组（角膜上方或颞上方透明角膜切口组）。比较分析两组患者术后1 wk;1,3 mo不同时间角膜散光度的变化情况及视力的变化情况。 结果：与对照组患者相比,观察组患者术后1 wk;1,3 mo平均角膜散光度及手术源性角膜散光度均明显降低,裸眼视力及矫正视力均明显提高,差异具有统计学意义（P〈0.05）。与对照组患者相比,观察组患者手术所用时间明显缩短,差异具有统计学意义（P〈0.05）。 结论：角膜中心远处的小切口超声乳化术,能够减少患者术后散光度,促进患者术后视力提高,为进一步加强患者的临床治疗效果提供了保障。     

白内障超声乳化术不同子午线切口对术后角膜散光的影响

目的　评价在角巩缘切口白内障超声乳化术中不同子午线切口对术后角膜散光的影响。方法　 76例(10 2眼 )白内障患者被随机分为 A、B两组 ,A组根据手术者的习惯切口位置选择颞上方 (右眼 )或鼻上方 (左眼 )的切口 ,B组按照角膜曲率最大子午线轴向做手术切口。通过行角巩缘切口白内障超声乳化折叠式人工晶状体植入术 ,比较两组术后角膜散光的变化情况。结果　 A、B两组术后平均角膜散光度分别较术前减少 0 .13D和 0 .32 D,两者比较差异有显著性 (t=2 .185 ,P <0 .0 5 ) ;平均手术性角膜散光度为 (0 .95± 0 .89) D和 (0 .83± 0 .75 ) D,差异无显著性 (t=0 .314 ,P >0 .0 5 )。结论　在角巩缘切口白内障超声乳化术中结合术前角膜散光轴向选择切口位置可进一步降低术后角膜散光。     

晶状体超声乳化角膜缘松解切口对散光的影响

目的探讨晶状体超声乳化角膜缘松解切口对散光的影响。方法观察组在角膜曲率大的轴向上行角膜缘松解切口晶状体超声乳化术50例(58眼)。对照组行透明角膜切口晶状体超声乳化折叠人工晶体植入术46例(58眼)。结果观察组术后1周裸眼视力≥0.5者48眼(82.76%);术后3月视力≥0.5者55眼(94.83%),P<0.05,术后3月较术后1周视力显著提高;对照组术后1周、术后3月之间的差异无统计学意义。观察组角膜散光度数,术前(2.34±0.20)D、术后1周(2.24±0.04)D,术前与术后1周差异有统计学意义(t=3.73,P<0.05);术后3月(1.19±0.12)D,统计学分析(t=7.70P<0.05),差异有统计学意义;对照组,术前与术后1周、与术后3月散光度差异无统计学意义(t=1.16P>0.05)。结论角膜缘松解切口晶状体超声乳化术可降低散光程度。     

角膜地形图引导下白内障手术切口对角膜散光的矫正

目的:比较不同位置和形态的手术切口对白内障摘除术后角膜散光及裸眼视力的影响。方法:选取术前角膜散光值>1.00D的白内障患者43例52眼,将患者随机分成两组,A组患者采用超声乳化白内障吸除联合人工晶状体植入术,手术切口为位于上方10∶30～11∶30的透明角膜隧道切口。B组患者采用手法碎核白内障摘除联合人工晶状体植入术,其中角膜散光值为1.00～2.00D的患者,切口为位于角膜最大屈光度径线的直线形巩膜隧道切口,长度为6.0～7.0mm,角膜散光值>2.00D的患者,在上述直线形切口对侧角膜缘处,另作一弧形板层松解切口。分别于术后2wk,3mo随访患者,检查裸眼视力及行角膜地形图检查。结果:B组患者术后2wk,3mo裸眼视力好于A组。B组患者术后角膜散光度在术后2wk,3mo时均小于A组。结论:位于角膜最大屈光度径线的6.0～7.0mm直线形巩膜隧道切口,及此切口联合作对侧弧形板层松解切口均能有效矫正白内障术前存在的角膜散光,能够使患者获得更好的术后裸眼视力。     

手法小切口白内障摘出术后角膜散光变化的研究

目的:探讨手法小切口白内障摘出联合人工晶状体植入术后角膜散光的变化。方法:将57例86眼老年性白内障患者随机分成两组,A组42眼行手法小切口白内障摘出联合人工晶状体植入术,B组44眼行白内障超声乳化联合人工晶状体植入术。分别于术前、术后1,3mo用角膜地形图测量角膜散光度并计算手术源性散光。结果:术后1mo,A组与B组的平均手术源性散光分别为1.05±0.49,0.71±0.45,差异有统计学意义(P<0.05);术后3mo,A组与B组的平均手术源性散光分别为0.66±0.34,0.59±0.31,差异无统计学意义(P>0.05)。结论:术后早期白内障超声乳化术比手法小切口白内障摘出术引起的角膜屈光改变更小,术后3mo两者的屈光改变接近一致,均达到屈光稳定状态。     

小切口白内障手术切口类型对患者角膜形态的影响

目的:探讨小切口手法碎核术不同切口类型对白内障患者角膜地形图的影响,为其临床治疗方案优选提供参考.方法:选取白内障患者71例94眼,随机分为A组和B组,分别以直线形和反眉弓形切口进行手术,将A组和B组进一步随机分为三组,控制切口至角膜缘距离分别为1.5 mm,2.0mm,2.5mm;对比各组手术前后的视力水平和角膜地形图指标ACP,CYL,SAI和SRI.结果:切口形态和切口至角膜缘距离对患者的术后视力和角膜地形图均有影响(P＜0.05),各检测时间术后视力和角膜地形图不全等(P＜0.05),且时间和组别之间不存在交互作用(P＞0.05).各组患者术后1wk的视力优于术前,术后3mo优于术后1wk,差异有统计学意义(P＜0.05);同时,术后1wk的ACP,CYL,SAI和SRI水平高于术前(P＜0.05),术后3 mo时逐渐降低,与术前水平无统计学差异(P＞0.05).术前,各组视力和角膜地形图无统计学差异(P＞0.05).术后1wk,2.0mm B组和2.5mm B组的视力水平明显高于其他各组(P＜0.05),且两组之间无统计学差异(P＞0.05);2.0mm B组和2.5mm B组的ACP,CYL,SAI和SRI水平明显低于其他各组,且2.5mmB组低于2.0mm B组(P＜0.05).术后3mo,各组视力、SAI及SRI水平均无统计学差异(P＞0.05);但2.0mm B组和2.5mm B组患者的ACP和CYL依然明显高于其他组(P＜0.05),且两组之间无统计学差异(P＞0.05).结论:小切口手法碎核术采用反眉弓形切口,并适当拉长切口至角膜缘的距离,可降低对白内障患者角膜地形图的影响,控制术后散光.     

Effect of lens style on postoperative refractive astigmatism after small incision cataract surgery

Purpose : To evaluate the astigmatic results of two popular foldable intraocular lenses when standard surgical approaches are used in rural private practice in Australia. Methods : Four hundred consecutive cataract operations were followed in a prospective study. The refractive results of patients receiving the Alcon Acrysof MA30 lens were compared to those receiving the Allergan silicone SI40 lens. All patients were over 60 years of age and had no intercurrent ocular disease. Refractive and keratometric astigmatism was analysed both by vector analysis and as an absolute measure. Results and conclusion : The Acrysof lens is associated with less postoperative astigmatism (P = 0.01), than the Silicone SI40 lenses.     

Comparison of surgically induced astigmatism in various incisions in manual small incision cataract surgery

AIM:To determine the surgically induced astigmatism (SIA) in Straight, Frown and Inverted V shape (Chevron) incisions in manual small incision cataract surgery (SICS).METHODS:A prospective cross sectional study was done on a total of 75 patients aged 40y and above with senile cataract. The patients were randomly divided into three groups (25 each). Each group received a particular type of incision (Straight, Frown or Inverted V shape incisions). Manual SICS with intraocular lens (IOL) implantation was performed. The patients were compared 4wk post operatively for uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and SIA. All calculations were performed using the SIA calculator version 2.1, a free software program. The study was analyzed using SPSS version 15.0 statistical analysis software.RESULTS:The study found that 89.5% of patients in Straight incision group, 94.2% in Frown incision group and 95.7% in Inverted V group attained BCVA post-operatively in the range of 6/6 to 6/18. Mean SIA was minimum (-0.88±0.61D×90 degrees) with Inverted V incision which was statistically significant.CONCLUSION:Inverted V (Chevron) incision gives minimal SIA.     

干眼对白内障术后角膜散光的影响

目的了解干眼与白内障手术的关系,术前干眼对术后角膜散光的影响,以及术后干眼的发生与转归。方法将84例96眼患者随机分成2组,为44例51眼和40例45眼,分别行白内障囊外摘出术(I组)和小切口囊外摘出术(II组),并植入人工晶状体。所有患者于术前进行干眼检查,按积分分级,分别列入A、B、C3组,并于术后1月、3月随访远视力、干眼状况、角膜散光、轴位及非球面指数等指标。结果在I组中,C组术后1月角膜散光值为2·41±1·23,术后3月为2·12±0·89,与A组(1·94±1·01,1·51±0·72)和B组(2·03±1·08,1·60±0·75)角膜散光值的差异均有显著性意义(P<0·01);在II组中,C组术后1月角膜散光值为1·90±0·83,术后3月为1·12±0·71,与A组(1·28±0·62,0·82±0·54)和B组(1·34±0·64,0·86±0·55)角膜散光值的差异也均有显著性意义(P<0·01);而2组中A组和B组之间差异无显著性意义(P>0·05)。在I组和II组中,术前、术后1月、3月,角膜非球面指数值在各组患者中差异均有统计学意义(P<0·01)。I组中,术后1月、3月C组视力分别为0·43±0·30、0·54±0·33,较A组(0·62±0·24、0·70±0·28)和B组(0·58±0·21、0·65±0·26)低(P<0·01);II组中,术后1月、3月,C组视力分别为0·65±0·32、0·76±0·30,亦较A组(0·85±0·26、0·90±0·29)和B组(0·84±0·24、0·88±0·25)低(P<0·01);而A组和B组之间差异无显著性意义(P>0·05)。2组中术后1月C组患者数均较术前增加,术后3月则基本恢复至术前水平,且I组术后发生中重度干眼的比率高于II组。结论白内障术前干眼的程度与术后角膜散光、角膜非球面指数及术后视力的恢复都存在正相关,术前中重度干眼的存在及术后干眼的发生直接影响患者的手术效果。治疗术前干眼及预防术后干眼对提高手术预后都是至关重要的。     

小切口白内障摘出术后角膜散光的临床观察

目的评价小切口普通器械劈核法囊外摘出白内障及人工晶状体植入术后角膜散光的变化，探讨其临床应用效果。方法将76例80眼白内障患者以手术切口大小分作A、B2组：A组为小切口普通器械劈核法治疗组，B组为采用大切口囊外白内障摘出法治疗组；分别观察术后角膜散光变化及视力恢复情况。结果术后3个月A、B2组裸眼视力≥1．0者分别为78．6％、65．4％，2组比较差异有显著性（x^2=46．08，P〈0．01）。A组术前平均角膜散光度为（0．92±0．87）D，术后3个月为（0．53±0．56）D，平均角膜散光度减少0．39D，两者差异有显著性（u=2．267，19〈0．05）。B组术后3个月为（0．62±0．67）D，2组比较，差异有显著性（u=2．016。P〈0．05）。结论小切口白内障摘出术后角膜散光度小．视力恢复快．简便安全．不需特殊器械．便于推广。     

Optimal incision sites to reduce corneal aberration variations after small incision phacoemulsification cataract surgery

AIM: To analyze the effect of steep meridian small incision phacoemulsification cataract surgery on anterior, posterior and total corneal wavefront aberration. METHODS: Steep meridian small incision phacoemulsification cataract surgery was performed in age-related cataract patients which were divided into three groups according to the incision site: 12 o’clock, 9 o’clock and between 9 and 12 o’clock (BENT) incision groups. The preoperative and 3-month postoperative root mean square (RMS) values of anterior, posterior and total corneal wavefront aberration including coma, spherical aberration, and total higher-order aberrations (HOAs), were measured by Pentacam scheimpflug imaging. The mean preoperative and postoperative corneal wavefront aberrations were documented. RESULTS: Total corneal aberration and total lower-order aberrations decreased significantly in three groups after operation. RMS value of total HOAs decreased significantly postoperatively in the 12 o’clock incision group (P<0.001). Corneal spherical aberration was statistically significantly lower after steep meridian small incision phacoemulsification cataract surgery in BENT incision group (P<0.05) and Pearson correlation analysis indicated that spherical aberration changes had no significant relationship with total astigmatism changes in all three corneal incision location. CONCLUSION: Corneal incision of phacoemulsification cataract surgery can affect corneal wavefront aberration. The 12 o’clock corneal incision eliminated more HOAs and the spherical aberrations decreased in BENT incision group obviously when we selected steep meridian small incision. Cataract lens replacement using wavefront-corrected intraocular lens combined with optimized corneal incision site would improve ocular aberration results.