飞秒激光联合对称弧形角膜切口对白内障合并角膜散光患者的治疗效果

目的 评估飞秒激光联合对称弧形角膜切口对白内障合并角膜散光患者的治疗效果。方法 前瞻性研究。收集43例(57眼)白内障合并≥0.75 D角膜规则散光的患者,均行飞秒激光超声乳化白内障手术,术中同时采用对称弧形角膜切口矫正角膜散光。弧形切口设置在角膜直径中央8.0 mm处,深度为角膜厚度的85%,术中开口器分离弧形切口。术前及术后均采用Pentacam三维眼前节分析系统记录角膜散光。采用Alpins矢量法分析术后角膜散光变化,并分析散光类型、年龄与散光矫正效果的相关性。结果 术中及术后所有患者均未出现角膜穿透、上皮损伤、角膜上皮增生、切口感染等并发症。术前患眼角膜散光为(1.23±0.31)D,术后3个月患眼角膜散光下降到(0.85±0.34)D,差异有统计学意义(t=4.645,P=0.000)。对患者手术前后角膜散光的变化进行矢量分析,结果显示,目标诱导散光为0.80～2.10(1.23±0.31)D,手术诱导散光为0.00～1.80(0.68±0.45)D,差异向量为0.26～1.70(0.89±0.42)D,矫正指数为0.00～1.01(0.55±0.27),理想值为1,提示总体...     

非球面和球面人工晶状体植入术后视功能观察

目的 分析白内障患者术前角膜散光情况评估经不同位置透明角膜切口行超声乳化术后的角膜散光变化情况.方法 218例(295只眼)白内障患者分为三组,第一组选择颞侧切口,第二组选择颞上方切口,第三组选择上方切口,三组患者通过透明角膜切口行白内障超声乳化及折叠式后房型人工晶体植入术.术前及术后一周、一月、三月分别检测患者角膜散光情况,并通过Holladay-Cravy-Koch方法 计算术源性散光.结果 术前角膜散光0.5至1.5D的占60.68%,大于等于1.5D的占11.86%,顺归散光占29.49%,逆归散光占51.19%,其余为斜轴散光.术后三次随访颞侧切口组的术源性散光最低,上方切口组的术源性散光最高,具有统计学差异(P<0.05).另外,在上方切口组中发现患者术后角膜散光有向逆归散光转变的趋势.结论 白内障患者术前大多存在小于1.5D的角膜散光.在白内障术后早期阶段,颞侧透明角膜切口引起的术源性散光较小,而上方透明角膜切口不仅可引起较显著的术源性散光,并且术后角膜散光有向逆归散光转变的趋势.

Abstract：

Objective To analyze the corneal astigmatism before cataract surgery and evaluate the astigmatism changes after cataract surgery performed using clear corneal incisions with different locations.Methods: This randomized prospective clinical study comprised 295 eyes of 218 patients having phacoemulsification and implantation of foldable intraocular lens through a corneal tunnel incision. Patients were randomly divided into three groups depending on the different locations of the incision: temporal, superotemporal and superior. Corneal topography was performed preoperatively and 1 week, 1 month, and 3 months postoperatively. Surgically induced changes were calculated by vector analyses using the Holladay-Cravy-Koch method. Results: Preoperatively, in 60.68% of eyes, corneal astigmatism was between 0.5 and 1.5 diopters (D) and in 11.86%, it was 1.5 D or higher. Meanwhile, about 29.49 percent of eyes had with-the-rule (WTR) astigmatism, while 51.19% had against-the-rule (ATR) astigmatism, and the others had oblique astigmatism. At three follow-up visits postoperatively, the mean magnitude of surgically-induced astigmatism (SIA) was lowest in the temporal incision group and highest in the superior incision group. In addition, an ATR shift was found in the superior incision group. Conclusions: Corneal astigmatism less than 1.5 D was present in most cataract surgery candidates. Cataract surgery using temporal clear corneal incision induced significantly less SIA in the early postoperative period. Superior incision may lead to an ATR astigmatism shift.     

LenSx飞秒激光辅助白内障手术安全性和有效性的临床研究

目的：对LenSx飞秒激光辅助的白内障手术的安全性和有效性进行临床评价及观察。
　　方法：收集2014-07/2015-07于中国医科大学附属第四医院行飞秒激光辅助的白内障超声乳化摘除联合人工晶状体植入术的患者67例76眼进行临床研究,应用接触式LenSx飞秒激光白内障手术操作平台完成前囊膜截开、晶状体预劈核、主切口及辅助切口制作及角膜弧形切口制作,对激光截囊完成率、预劈核完成率、人工晶状体植入的完成率、角膜切口完成率、术前及术后1 mo最佳矫正远视力( corrected distance visual acuity, CDVA )达到20/20、20/25、20/40的患者比例、不良事件及器械缺陷发生率进行记录,对影响角膜切口完成率的可能因素(眼别、年龄、切口位置、角膜直径、周边角膜厚度、术前角膜散光)进行回归分析。
　　结果：所有患者均顺利完成LenSx飞秒激光辅助的白内障超声乳化手术过程。其中截囊完成率97%,预劈核完成率100%,人工晶状体植入完成率100%,角膜切口完成率83%。无不良事件(晶状体囊破裂、角膜水肿、黄斑水肿、视网膜脱离)及器械缺陷发生。术后1 mo CDVA较术前显著提高,差异存在统计学意义( P<0.05)。 Logistic回归分析结果显示,切口位置是角膜切口是否完成的影响因素,而眼别、年龄、角膜直径、周边角膜厚度、术前角膜散光与角膜切口是否完成无相关性。
　　结论：LenSx飞秒激光辅助的白内障手术具有临床安全性和有效性。     

Lamellar keratotomy to correct astigmatism in cataract surgery

Background For the correction of astigmatism in cataract surgery, several incisional procedures have been developed. In this study, a modification of lamellar keratotomy was evaluated to correct astigmatism in cataract surgery.Methods Prospectively 32 eyes of 25 patients with a preoperative astigmatism greater than 1.5 D were studied. All patients were treated with lamellar keratotomy with an incision width of 6 mm and a radial length of 1.5 mm placed at the limbus in the steep meridian. Phacoemulsification and IOL implantation were then performed through a 3.2-mm corneal tunnel incision. After 4 weeks, mean astigmatism, mean corneal power changes, and mean surgically-induced astigmatism derived from vector analysis in the central 3-mm optical zone were determined.Results The mean astigmatism decreased from 2.75±0.80 D preoperatively to 1.58±0.91 D after 4 weeks (P<0.001). There were no significant changes (P=0.614) of the mean corneal power. The mean surgically-induced astigmatism was 2.59±1.50 D. The induced changes were more accentuated in superior incisions. In corneal topography, 78% of the treated eyes revealed a characteristic threefold pattern of the mid-peripheral cornea postoperatively, which impaired the corneal optical performance in ray-tracing analysis.Conclusions Lamellar keratotomy effectively reduced high preoperative astigmatism in cataract surgery. This surgical approach was combined with a superior, temporal, or oblique corneal incision.Presented in part at the Annual Meeting of the Deutsche Ophthalmologische Gesellschaft in Berlin, September 2003.     

Effect on astigmatism of the location of clear corneal incision in phacoemulsification of cataract

PURPOSE: To investigate the refractive results of clear corneal incision performed at the steepest meridian of pre-existing corneal astigmatism. METHODS: One hundred eighty-two patients with astigmatism > 0.75 diopters (D) were evaluated. Superior, temporal, nasal, superotemporal, or superonasal clear corneal incisions were performed at the steep meridian. Refraction, visual acuity, and topography values were evaluated, and changes in surgically induced astigmatism were calculated by vector analysis using the Fourier formula. Paired t test was used to compare mean values. RESULTS: Postoperative cylinder values showed minor changes in all groups, except the nasal group. Nasal incision increased preoperative cylinder from 1.13 D to 1.83 D 6 months after surgery. Temporal and superotemporal incisions resulted only in small astigmatic changes. Conversely, superior, superonasal, and nasal incisions induced more pronounced astigmatism. CONCLUSIONS: Performing clear corneal incision for phacoemulsification of cataract at the steep meridian resulted in small changes with temporal incisions, whereas nasal incisions resulted in higher surgically induced astigmatism.     

2.2 mm透明角膜切口飞秒激光辅助白内障超声乳化手术术源性散光的临床研究

目的观察飞秒激光辅助白内障超声乳化手术中2.2 mm透明角膜切口引起的术源性散光（SIA）的影响因素。方法前瞻性研究。纳入2014年3月至2016年4月期间,在山西省眼科医院白内障一科行飞秒激光辅助白内障超声乳化手术的患者84例（105眼）,测量并记录患者术前,术后1、3、6个月的裸眼视力（UCVA）,球镜度和角膜地形图数据。视力记录为logMAR视力,使用Alpins矢量分析法计算SIA。并从术后随访时间（术后1、3、6个月3个时间点）、晶状体核硬度（分Ⅱ、Ⅲ、Ⅳ级核3组）、角膜散光类型（分顺规组、逆规组、斜轴组）、眼别（左眼组、右眼组）4个方面分析SIA。符合正态性分布的数据的比较使用重复测量的方差分析。结果84例（105眼）患者UCVA术前为0.65±0.24,术后1、3、6个月为0.07±0.02、0.06±0.01、0.06±0.01;手术前后比较差异有统计学意义（F=321.14,P<0.01）;术后各时间点比较差异无统计学意义。术后1、3、6个月SIA分别为（0.28±0.11）D、（0.25±0.13）D、（0.24±0.10）D;3个时间点比较差异无统计学意义。按晶状体核硬度分组从时间上及组别间比较差异均无统计学意义;顺规组、逆规组、斜轴组3组从时间上及组别间比较差异均无统计学意义;右眼组与左眼组从时间上及组别间比较差异均无统计学意义。结论2.2 mm透明角膜切口飞秒激光辅助白内障超声乳化术后SIA稳定,术后UCVA显著提高,且SIA与UCVA于术后1个月趋于稳定。     

白内障术中飞秒激光弧形角膜切开术矫正角膜散光的疗效

目的：研究白内障术中飞秒激光弧形角膜切开术（FSAK）矫正术前角膜散光的临床疗效。方法：回顾性病例对照研究。连续纳入北京爱尔英智眼科医院2017年3月至2021年12月术前规则角膜散光为0.75~2.00 D且接受飞秒激光辅助白内障手术的患者89例（89眼）。所有患者按照术前角膜散光轴位分为顺规散光组（90°±30°）、逆规散光组（180°±30°）及斜轴散光组（45°±15°、135°±15°）。飞秒激光辅助白内障手术及弧形角膜切开术使用Lensx平台。观察患者总体和顺规、逆规散光组术前及术后3个月角膜散光的变化及分布情况。使用配对样本t检验或Wilcoxon符号秩检验比较总体及各亚组术前、术后的散光差异；使用独立样本t检验或Mann-Whitney U检验比较顺规散光组及逆规散光组的差异；散光变化的分析采用Alpins矢量分析法。结果：纳入的89例（89眼）患者中，顺规散光组38例，逆规散光组44例，斜轴散光组7例。所有患者角膜水平径为（11.48±0.57）mm，垂直径为（10.66±0.60）mm。患者总体术后裸眼远视力、最佳矫正远视力相比术前有显著改善（Z=8.01、-7.49，P<0.001）。总体术前角膜散光为（1.28±0.33）D，术后3个月残余散光（0.67±0.37）D，散光矫正量为（0.61±0.33）D。顺规及逆规散光组角膜散光矫正量分别为（0.48±0.27）D、（0.74±0.34）D。总体及顺规、逆规散光组术后平坦轴角膜曲率均有明显升高，而陡峭轴角膜曲率则出现明显下降。矢量分析法显示总体散光矫正指数为0.63±0.30，平坦指数为0.58±0.30，成功指数为0.51±0.25，误差角为-1.83°±12.59°。逆规散光组矫正效果最佳，矫正指数为0.81±0.25，平坦指数为 0.75±0.26，成功指数为0.40±0.24；顺规散光组次之，矫正指数为0.42±0.21，平坦指数为0.39±0.21，成功指数为0.63±0.21。结论：白内障术中FSAK矫正术前角膜散光具有良好的有效性和安全性，相同的弧形切口设计方式在逆规散光中取得了更好的疗效，角膜直径可能是产生影响的重要因素。     

One year follow-up of astigmatism after 4.0 mm temporal clear corneal and superior scleral incisions

PURPOSE: To compare the effect of 2 contemporary sutureless cataract surgery incisions on corneal astigmatism 1 year after surgery. SETTING: Outpatient Clinic, Department of Ophthalmology, Vejle Hospital, Denmark. METHODS: Sixty-nine patients who had cataract surgery in 1997 with a 4.0 mm temporal clear corneal (n = 32) or superior scleral (n = 37) incision were examined 1 year postoperatively. Surgically induced astigmatism was analyzed by vector analysis, vector decomposition, and polar values using preoperative and postoperative keratometric readings. RESULTS: Vector analysis revealed a slightly lower median induced cylinder in the clear corneal patients; 0.41 diopter (D) (95% confidence limits [CL] 0.24 to 0.67 D) versus 0.61 D (95% CL 0.49 to 0.73 D) (P < .05). Decomposition of the induced cylinder (against the rule/total) showed statistically significant differences in the direction of the cylinder; 0.21 (95% CL 0.03 to 0.41) versus 0.90 (95% CL 0.82 to 0.95) (P < .00001). The directional difference was confirmed by polar values. CONCLUSION: Both incisions induced low and comparable amounts of astigmatism. The directional differences were modest. Findings in previous studies of a poor outcome after clear corneal incisions were not confirmed in this long-term follow-up.     

Astigmatism outcomes of horizontal temporal versus nasal clear corneal incision cataract surgery

PURPOSE: To compare the short- and long-term astigmatism outcomes after cataract surgery using temporal clear horizontal corneal incisions and nasal horizontal clear corneal incisions. SETTING: Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA. METHODS: This retrospective study included a consecutive series of eyes having phacoemulsification with implantation of a 6.0 mm foldable acrylic intraocular lens through a 3.5 mm horizontal clear corneal incision at 180 degrees (temporal incision in right eyes, nasal incision in left eyes). Astigmatism was measured by keratometry readings before surgery and 6 weeks and 12 months postoperatively. RESULTS: The mean preoperative astigmatism in the 178 eyes (94 right, 84 left) of 161 patients was 0.78 diopter (D); 54.5% of eyes had against-the-rule (ATR) astigmatism, 22.5% had with-the-rule (WTR) astigmatism, and 14.0% were astigmatically neutral. A significant shift toward WTR astigmatism occurred postoperatively. At 6 weeks, 48.3% of eyes had WTR astigmatism and 23.0% had ATR astigmatism. At 12 months, 43.8% had WTR astigmatism and 25.8% had ATR astigmatism. Vector analysis revealed a mean surgically induced astigmatism (SIA) of 1.17 D at 6 weeks and 1.04 D at 12 months. The side of the incision significantly affected SIA. At 6 weeks, temporal incisions yielded a mean SIA of 0.74 D and the nasal incisions, of 1.65 D. This trend in SIA persisted at 12 months: 0.71 D for temporal incisions and 1.41 D for nasal incisions. CONCLUSIONS: Cataract surgery using a horizontal clear corneal incision induced WTR astigmatism 6 weeks and 12 months postoperatively. Temporal incisions induced significantly less astigmatism than nasal incisions.     

Site of Incision and Corneal Astigmatism in Conventional SICS versus Phacoemulsification

Introduction High astigmatism is an important cause of poor uncorrected visual acuity after cataract surgery. Purpose The aim of the study is to compare the astigmatism induced by a superior and temporal incision in manual SICS, and to compare the astigmatism induced by clear corneal incision versus scleral tunnel in phacoemulsification surgery. Methods A total of 64 eyes of 64 patients (34 male/30 female) with a mean age of 62.10 years (range 45–82 years) were included in the study. The cases were randomly divided into two groups. One group (Group I) had undergone manual SICS and the other group (Group II) had undergone phacoemulsification. The manual SICS group patients were randomly allotted into two subgroups depending on the site of incision. Group Ia received superior incision while group Ib received temporal incision. The Phacoemulsification group (Group II) patients were randomly divided into two groups depending on the location of the incision. Group IIa received clear corneal incision and group IIb received scleral pocket incision. Informed consent was obtained from all the patients undergoing study. Surgically induced astigmatism is calculated by the substraction method. Results and Conclusion We found significantly against the rule shift in stigmatism in the phacoemulsification group and the manual SICS superior incision group. The manual SICS group with temporal incision (Ib) had with-the-rule shift in astigmatism. Synopsis At 90 days, conventional SICS superior incisions gave 1.92 ± 0.53 D against the rule and temporal incisions 1.57 ± 0.24 D with the rule astigmatism. Phacoemulsification clear corneal incisions showed 1.08 ± 0.36 D and scleral pocket 1.23 ± 0.71 D astigmatism. Dr. Reddy is a Senior Resident, Dr. Raj is a Resident, and Dr. Singh is a Reader in the Department of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Correction of pre-existing astigmatism during cataract surgery: comparison between the effects of opposite clear corneal incisions and a single clear corneal incision

Background Opposite clear corneal incisions (OCCIs) have been reported to reduce pre-existing astigmatism (PEA) during cataract surgery. Our goal was to evaluate the effect of OCCIs on correcting PEA in cataract surgery.Methods Non-randomized prospective study. Thirty-four patients with PEA of greater than 1.5 diopters (D) underwent clear cornea phacoemulsification cataract extraction with 3.2-mm OCCIs (OCCI group). The control group consisted of 23 successive patients with PEA <1.5 D who underwent cataract extraction without OCCI. Best-corrected visual acuity, keratometry and refraction were recorded for all patients pre-operatively and post-operatively.Results Using keratometric findings, mean astigmatism correction was 1.3 D (±0.9 SD; decreased from 2.6 D pre-operatively to 1.4 D post-operatively) in the OCCI group but only 0.4 D in the control group (P<0.005), 8 months post-operatively. Vector analysis of astigmatism correction showed greater change for OCCI patients (1.8 D vs 1.0 D, P=0.002). Using the Holladay method for calculating surgically induced refractive change (SIRC), the OCCI group showed a higher value of SIRC (–1.6 D vs –0.97 D), but this was not statistically significant. The OCCI patients showed a greater and significant change in refraction spherical equivalent than the controls. No complications related to OCCI or cataract surgery occurred during the follow-up period.Conclusions Opposite clear cornea incision seems to be a simple, predictable, safe and effective procedure in reducing pre-existing corneal astigmatism in cataract surgery. It has an enhanced effect in correcting astigmatism compared to a single clear cornea incision when using keratometric findings value but not when using refractive data. Future studies are needed to document the long-term effect of OCCI and to evaluate the correlation between incisions of different size and astigmatism correction.     

Clinical utility of femtosecond laser-assisted astigmatic keratotomy after cataract surgery

Purpose

To examine the clinical utility of femtosecond laser-assisted astigmatic keratotomy (FSL-AK) for eyes after cataract surgery.

Methods

Eight eyes of 6 patients with an intraocular lens and corneal astigmatism of 2.0 diopters (D) or more underwent FSL-AK. The mean preoperative manifest cylindrical refraction was 2.88 ± 0.64 D and the mean corneal astigmatism was 2.84 ± 0.83 D. Paired symmetrical arcuate incisions were created with the same settings, except for the incision depth. Uncorrected distance visual acuity (UDVA), manifest cylindrical power, and surgically induced astigmatism (SIA) were measured at 1 day, 1 week, and 1 month postoperatively. Fourier analysis of corneal topography and incision depths measured with anterior-segment optical coherence tomography were evaluated 1 month postoperatively.

Results

In all eyes, the UDVA improved at 1 week and 1 month postoperatively, and the manifest cylinder also decreased postoperatively, while the SIA showed overcorrections in 6 eyes. Fourier analysis showed decreases in spherical and regular astigmatic components and increases in higher-order irregularity. The mean incision depth was measured as 60 µm deeper than the intended depth.

Conclusion

The FSL-AK effectively reduced corneal astigmatism and improved the UDVA, although it was demonstrated that the deeper incisions led to overcorrection.

     

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.     

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.     

Femtosekundenlaser-assistierte Kataraktchirurgie

Employing a femtosecond laser as an initial step in cataract surgery has the clear potential to provide more precise capsulotomies and full lens fragmentation in cases of pre-existing astigmatism in conjunction with relaxing corneal incisions. In the long run femtosecond laser-assisted cataract surgery might replace phacoemulsification which has been the standard in cataract surgery over the last 20 years. Besides precision and predictability, the low rate of complications impresses surgeons working with the technology, particularly those employing a laser with a fluid-filled interface which seems to prevent major complications including increases in intraocular pressure.     

个性化复合式切口在基层扶贫白内障手术中的临床应用

目的: 探讨根据角膜散光轴位选择复合性手术切口以降低术前角膜散光度在基层扶贫白内障手术中的作用。方法: 根据角膜曲率计选择角膜散光度数≥1.50D的白内障患者100例100眼,以角膜最大屈光力径线方向为中心做巩膜隧道主切口并在主切口的对侧做辅助切口,行白内障小切口囊外摘除联合人工晶状体植入术。分别测量术前、术后3d;1,3,6,12mo的角膜散光及裸视视力。结果: 术前、术后3d;1,3,6,12mo的平均角膜散光分别为+2.08±0.666,-1.06±0.75,+0.67±0.71,+1.11±0.77,+1.20±0.88,+1.30±0.68D;术前、术后3d;1,3,6,12mo的裸眼视力分别为0.30±0.19,0.55±0.25,0.69±0.21,0.66±0.18,0.65±0.20,0.60±0.22。结论: 个性化复合式手术切口这一技术适合在基层大批量扶贫白内障手术中广泛应用,具有疗效确切、操作简单、手术时间短、费用低廉等优点。     

重视白内障合并角膜散光的精准手术矫正问题

临床上白内障合并角膜散光患者较为常见,而以往白内障超声乳化术中散光并未得到精准矫正,严重影响术眼术后的屈光功能和视觉质量.术前精确测量角膜散光的大小和轴向是白内障屈光手术术中确定角膜切开位置或植入Toric人工晶状体(IOL)的关键.联合应用IOLMaster计算IOL球镜度数、利用Pentacam测定全角膜曲率、采用VERION导航系统可提供精准的术前检查数据和良好的术后效果,使得白内障术中可以通过改进手术切口、弧形角膜切开和植入适宜的Toric IOL来矫正角膜散光.飞秒激光弧形角膜切开联合白内障超声乳化可有效、安全和精准地矫正中低度角膜散光,改善视功能.为提高白内障屈光手术的准确性,我们应进一步研究建立角膜生物力学数字化模型、改良手术量计算方案,以增进飞秒激光角膜切开矫正角膜散光的可预测性和精准性.     

白内障手术同时矫正散光的方法研究进展

目前,散光矫正已成为屈光性白内障手术的重要内容,白内障手术同时矫正散光的方法主要包括:利用角膜切口、松解性角膜切开、植入散光型人工晶状体和飞秒激光白内障手术.散光矫正效果受多种因素影响,这些方法各有其适应证及优缺点.术后残余散光将会不断减小,白内障术后获得更为完美的屈光状态必将成为现实.本文就以上内容对白内障手术同时矫正术前散光方面的研究进展作一综述.     

飞秒激光辅助白内障手术与传统白内障手术联合Toric人工晶状体植入术治疗长眼轴白内障患者的临床疗效比较

目的　比较飞秒激光辅助白内障手术与传统白内障手术联合Toric人工晶状体植入术治疗长眼轴白内障患者的临床疗效。方法　选取在我院行白内障手术眼轴长度大于24 mm的白内障患者49例49眼,按患者主观意愿选择术式;飞秒组患者20例20眼,均行飞秒激光辅助白内障手术;传统组患者29例29眼,均行传统白内障手术。两组患者术中眼内均植入 Toric人工晶状体。每例患眼均行IOL-Master、OPD-SCAN Ⅲ视觉质量分析仪检测,获得患者散光度、最佳矫正视力（best corrected visual acuity,BCVA）、角膜规则指数、表面不对称指数、不规则散光指数、角膜球差及像差与斯特列尔比值。角膜规则指数、表面不对称指数、不规则散光指数、角膜球差及眼高阶像差与斯特列尔比值相关情况采用Spearman相关分析。结果　术后3个月,两组患者BCVA均较术前显著提高,差异均有统计学意义（均为P<0.05）;飞秒组患者BCVA为0.09±0.09,传统组为0.13±0.10,两组相比差异无统计学意义（P>0.05）。术前飞秒组患者散光度为（1.84±0.57）D,传统组为（2.17±0.83）D,两组比较差异无统计学意义（P>0.05）。术后3个月,飞秒组患者总残余散光度为（0.50±0.50）D,传统组为（0.55±0.37）D,两组间比较差异无统计学意义（P>0.05）。术后3个月,飞秒组患者斯特列尔比值为0.18±0.15,传统组为0.15±0.12,两组比较差异无统计学意义（P>0.05）。术后3个月,飞秒组患者斯特列尔比值与角膜规则指数、表面不对称指数、不规则散光指数、角膜球差之间均无相关性（均为P>0.05）;传统组亦均无相关性(均为P>0.05）。飞秒组患者斯特列尔比值与全眼人工晶状体倾斜棱镜、3-8阶所有项高阶像差总和、高阶球面像差呈负相关（均为P<0.05）。传统组患者斯特列尔比值与角膜0-8阶所有项高阶像差总和、人工晶状体倾斜棱镜,眼内人工晶状体倾斜棱镜、3-8阶所有项高阶像差总和、高阶彗差、高阶球面像差,全眼人工晶状体倾斜棱镜、3-8阶所有项高阶像差总和、高阶彗差、高阶球面像差均呈负相关（均为P<0.05）。结论　飞秒激光辅助白内障手术与传统白内障手术联合Toric人工晶状体植入术均能显著提高长眼轴白内障患者术后视力。     

飞秒激光辅助屈光性白内障手术效果的初步观察

目的：比较飞秒激光辅助屈光性白内障手术与常规屈光性白内障手术术后视力及角膜散光的差异。

方法：将老年性白内障合并角膜散光患者60例60眼,按随机自愿原则分为飞秒组及常规组。飞秒组将患者术前角膜散光陡峭轴、平坦轴轴向及屈光度数输入在线矢量计算器,得出相关切口位置、切口宽度后,利用飞秒激光做角膜松解切口、主切口及辅助切口,再按常规行白内障超声乳化+非球面多焦点人工晶状体(multifocal intraocular lenses,IOL)植入术。常规组利用角膜穿刺刀于角膜散光陡峭轴向上做角膜全层松解切口、辅助切口,然后行白内障超声乳化+非球面多焦点IOL植入术。分别于术后1d,1wk,1mo观察两组术眼的角膜散光情况及裸眼远视力(uncorrected distance visual acuity,UCDVA)、裸眼近视力(uncorrected near visual acuity,UCNVA),并进行统计分析。

结果：飞秒组和常规组术后裸眼视力均较术前提高,且飞秒组远、近视力均高于常规组; 而各时期角膜散光飞秒组均低于常规组。

结论：飞秒激光辅助下屈光性白内障手术较传统白内障手术术后角膜散光更小、视力更好,能给患者带来更好的视觉质量。