角膜缘松解切开术矫正白内障术前散光对角膜曲率的影响

目的　观察角膜缘松解切开术在白内障超声乳化术中对角膜散光的矫正效果,以及其对角膜前后表面的中央曲率、周边曲率的影响。方法　选取在我院诊治的白内障患者３５例３５眼,患者术前角膜散光均≥１．０Ｄ,行角膜缘松解切开术联合白内障超声乳化吸出＋人工晶状体植入术,所有患者均在术前及术后１ｄ、１周、１个月、３个月进行眼科常规检查,包括术眼裸眼视力（ｕｎｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＵＣＶＡ）、最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＢＣＶＡ）,进行显然验光,用Ｐｅｎｔａｃａｍ眼前节分析系统测量角膜前后表面中央３ｍｍ范围内的最大曲率、最小曲率,同一子午线上角膜前后表面周边７ｍｍ范围最大及最小曲率。比较患者术前及术后各时间点ＵＣＶＡ、ＢＣＶＡ、中央及周边角膜前后表面曲率的变化。结果　患者术后不同时间点的ＵＣ-ＶＡ及ＢＣＶＡ与术前比较均显著提高,术前ＵＣＶＡ＞０．５占０％,ＢＣＶＡ＞０．５占８．６％,而术后３个月ＵＣＶＡ ＞０．５占４２．９％,ＢＣ-ＶＡ＞０．５占７７．１％,差异均有统计学意义（均为Ｐ＜０．００１）;术后各时间点与术前相比,最佳矫正柱镜度数和角膜散光均减少,差异均有统计学意义（均为Ｐ＜０．００１）;前表面角膜中央和周边曲率与术前相比,早期均是陡峭轴曲率呈减小趋势,扁平轴曲率呈增加趋势,之后稳定（Ｐ＜０．０５）,中央陡峭曲率ＦＫ２减少了（１．０６±０．６６）Ｄ,周边陡峭曲率ＦＰＫ２减少了（０．７６±０．５０）Ｄ,中央平坦曲率ＦＫ１增加了（０．３３±０．２８）Ｄ,周边平坦曲率ＦＰＫ１增加了（０．３５±０．２６）Ｄ。角膜后表面中央及周边曲率与术前比较有变化,但没有明显规律性。结论　角膜缘松解切开术矫正白内障术前角膜散光是安全有效的,松解切开术会引起角膜前后表面中央曲率和周边曲率的变化,且前表面中央曲率变化对角膜散光的影响较大,后表面曲率变化对角膜散光的影响很小。     

松解性角膜切开术治疗术后中高度散光的临床观察

目的对人工晶体植入术和穿透性角膜移植术后一年以上,存在中高度散光的患者行松解性弧形角膜切开术,观察其临床疗效.方法10例(10眼),其中人工晶体植入术4例,穿透性角膜移植术5例,人工晶体、穿透性角膜移植联合术1例,均术后一年以上,3mm视区内的角膜散光≥2.00D,近视≤2.00D,患者的裸眼视力均可矫正.根据角膜地形图确定角膜最高屈折力的径线位置.用6.5mm环钻在角膜中央刻痕,在显微镜下用德国Martin Instrument单刃红宝石刀在屈折力最大的径线上,沿环钻的刻痕作一对弧形切口,深度为角膜厚度的1/2～2/3,切口长度为2～3个钟点.结果通过角膜地形图和检影验光发现术前3mm视区的平均角膜散光为3.46±0.99D,术后6个月为2.05±0.75D,统计学检验有显著性差异P＜0.01;术前10例患者的裸眼视力为4.05±0.12,术后6个月的视力明显提高为4.45±0.11.结论本文对手术适应证、技术、角膜散光变化和并发症进行讨论,从而证实弧形角膜切开术是一项简单安全、能快速提高视力的方法.     

角膜切开术治疗白内障人工晶体植入术后的散光

近年来，随着白内障手术技术的进步，术后散光已成为限制视力恢复的重要因素，降低术后散光已成为提高视力的关键，受到普遍关注，本文对散光的基本概念，散光的测定，影响白内障术后散光的因素，白内障术后屈光及角膜地形图变化，手术矫正角膜散光的历史，散光矫正术手术的原理，散光矫正手术的术式，角膜切开术矫正白内障术后散光的研究现状等进行了综述。     

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。     

白内障手术切口对角膜原有散光的影响

目的评价小切口常规白内障手术联合角膜缘松解切口矫正散光的效果。方法对角膜散光>1.00D的30例(37眼)老年性白内障患者进行研究,以散光度数≥2.00D为A组,共11例(13眼);散光度数小于2.00D为B组,共19例(24眼)。两组患者均在角膜最大屈光径线上行角膜缘切口白内障囊外摘出联合人工晶状体植入术,A组患者再在白内障手术切口对侧角膜缘处行4mm穿透性切口。检测术前、术后1周、1个月、3个月角膜散光度数和视力变化。采用SPSS17.0统计学软件进行分析。结果术后1周、1个月、3个月,A组平均视力分别为0.57±0.07、0.67±0.07、0.67±0.06,B组分别为0.52±0.07、0.56±0.06、0.59±0.06,A组术后各时间段均优于B组。A组患者术前平均散光度数为(3.06±0.89)D,术后1周、1个月、3个月平均散光度分别为(1.58±0.18)D、(1.18±0.17)D、(1.03±0.22)D,手术前后散光度数差异均有统计学意义(均为P<0.05)。B组患者术前平均散光度数为(1.69±0.17)D,术后1周、1个月、3个月平均散光度数分别为(0.67±0.04)D、(0.47±0.05)D、(0.26±0.13)D,手术前后散光度数差异有统计学意义(均为P<0.05)。术后3个月,A组患者角膜散光平均矫正量为(2.08±0.08)D,B组患者角膜散光平均矫正量为(1.42±0.02)D,A、B两组患者手术散光矫正量差异有统计学意义(P<0.05)。结论小切口常规白内障手术联合对侧角膜缘穿透性松解切口可以更大范围地矫正术前已存在的角膜散光,提高患者裸眼视力和减少患者的不适。     

不同术式矫正年龄相关性白内障合并角膜散光的临床疗效观察

目的比较两种不同术式矫正年龄相关性白内障合并角膜散光的临床疗效。方法将34例(34只眼)年龄相关性白内障合并角膜散光(散光≥1.50 D)患者分为两组,分别行超声乳化摘除联合Toric人工晶状体植入术Toric组20例(20只眼)和人工晶状体植入联合角膜缘松解切开术LRIs组14例(14只眼)。观察术前、术后1d、1个月、3个月的临床效果,包括裸眼视力(UCVA)、最佳矫正视力(BCVA)、眼压、残余散光、角膜散光及相关并发症情况等。结果两组术后3个月UCVA、BCVA均显著提高,UCVA在Toric组和LRIs组分别为0.64±0.15、0.48±0.17,Toric组的UCVA优于LRIs组(P<0.01)。两组术后3个月BCVA无明显差异(P=0.120)。两组在术后散光量均显著减少(P<0.01),术后3个月残余散光在Toric组和LRIs组分别为(-0.69±0.31)D、(-1.14±0.83)D。Toric组术后3个月残余散光量较LRIs组相比较小,差异有统计学意义(P<0.01)。Toric组术后角膜散光与术前相比差异无统计学意义(P=0.525)。LRIs组术后3个月角膜散光与术前相比有明显差异(P=0.001),平均减少1.04 D。Toric人工晶状体在术后3个月时平均旋转度数为(3.78±1.96)°,术后1个月与术后3个月之间的晶状体旋转度相比差异无统计学意义(P=0.897)。结论两种手术方法均是矫正年龄相关性白内障合并散光的安全有效的方法,超声乳化摘除联合Toric IOL植入术的疗效优于人工晶状体植入联合LRIs。     

选择性拆线控制白内障术后角膜散光疗效观察

随着人工晶状体植入术成功率的提高和手术并发症的减少,由缝线引起的术后角膜散光已引起许多学者注意.作者自1997年5月开始用选择性拆线来矫正术后角膜散光,获得了满意的效果,报告如下.     

飞秒激光弧形角膜切开术对白内障合并角膜散光患者的矫正效果

目的　探讨飞秒激光弧形角膜切开术对白内障合并角膜散光患者的矫正效果。方法　选取33例（36眼）白内障合并角膜散光≥0.75 D的患者作为研究对象,均行飞秒激光弧形角膜切开术来矫正角膜散光。术前测患者裸眼远视力、最佳矫正远视力,用Pentacam三维眼前节分析系统测量角膜散光。行飞秒激光辅助的超声乳化白内障手术,术中弧形切口直径为9 mm,深度为90%。术后3个月时复查患者角膜散光、裸眼远视力、最佳矫正远视力,并用Alpins矢量分析法进行散光分析,主要观察以下矢量数据,即目标诱导散光向量、手术诱导散光向量、差异向量和矫正指数。结果　术前患者角膜散光为（1.16±0.35）D,术后3个月下降到（0.54±0.22）D,差异有统计学意义（P＜0.01）。术前裸眼远视力为0.81±0.42,术后3个月提高到0.26±0.24,差异有统计学意义（P＜0.01）。术前最佳矫正远视力为0.76±0.30,术后3个月提高到0.09±0.12,差异有统计学意义（P＜0.01）。对患者术前术后角膜散光的变化进行矢量分析显示,目标诱导散光向量为0.80～2.20（1.16±0.35）D,手术诱导散光向量为0.40～1.80（1.07±0.40）D,差异向量为0.20～1.00（0.54±0.22）D。矫正指数为0.89±0.35,理想值为1,提示总体为少许欠矫。大部分患眼（32眼）角度误差在15°范围内。成功指数平均值为0.47,提示还残留部分散光未得到矫正。通过公式计算可以得到散光矫正的成功率为53.0%。变平效果平均值为0.94,变平指数平均值为0.83。结论　飞秒激光弧形角膜切开术能有效矫正白内障合并角膜散光患者的角膜散光。     

Correction of low corneal astigmatism in cataract surgery

AIM: To evaluate and compare aspheric toric intraocular lens (IOL) implantation and aspheric monofocal IOL implantation with limbal relaxing incisions (LRI) to manage low corneal astigmatism (1.0-2.0 D) in cataract surgery.METHODS:A prospective randomized comparative clinical study was performed. There were randomly recruited 102 eyes (102 patients) with cataracts associated with corneal astigmatism and divided into two groups. The first group received toric IOL implantation and the second one monofocal IOL implantation with peripheral corneal relaxing incisions. Outcomes considered were:visual acuity, postoperative residual astigmatism, endothelial cell count, the need for spectacles, and patient satisfaction. To determine the postoperative toric axis, all patients who underwent the toric IOL implantation were further evaluated using an OPD Scan III (Nidek Co, Japan). Follow-up lasted 6mo.RESULTS: The mean uncorrected distance visual acuity (UCVA) and the best corrected visual acuity (BCVA) demonstrated statistically significant improvement after surgery in both groups. At the end of the follow-up the UCVA was statistically better in the patients with toric IOL implants compared to those patients who underwent implantation of monofocal IOL plus LRI. The mean residual refractive astigmatism was of 0.4 D for the toric IOL group and 1.1 D for the LRI group (P<0.01). No difference was observed in the postoperative endothelial cell count between the two groups.CONCLUSION: The two surgical procedures demonstrated a significant decrease in refractive astigmatism. Toric IOL implantation was more effective and predictable compared to the limbal relaxing incision.     

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。     

透明角膜切口联合对侧单切口角膜缘松解术矫正散光的临床效果

目的动态观察透明角膜切口联合对侧单切口角膜缘松解术对角膜散光的矫正效果。方法选取就诊于我院的白内障患者共68例(76眼),患者术前散光均≥1.5D,随机分为观察组32例(36眼)和对照组36例(40眼),术中观察组在最陡散光轴行透明角膜切口联合对侧单切口角膜缘松解术;对照组在角膜最陡散光轴做成对的角膜缘松解切口,然后按照常规方法进行超声乳化手术。结果所有患者术后散光有了明显的减少,术前与术后的散光值比较,差异有统计学意义(均为P<0.05);术后裸眼视力均有明显的改善,观察组术后3个月视力>0.8的患者占61.1%,对照组占65.0%;观察组与对照组术前散光在1.5～3.0D的患者,术后1d、1周、1个月、3个月的散光值之间比较,差异无统计学意义(均为P>0.05);术前散光>3.0D患者,术后3个月观察组的散光值(1.44±0.41)D与对照组的散光值(1.05±0.36)D比较,差异有统计学意义(t=2.195,P<0.05)。结论采用最陡散光轴的透明角膜切口联合对侧单切口角膜缘松解术与成对的角膜缘松解矫正术前中、低度散光患者具有同样的临床效果,但对于术前高度散光患者后者的效果优于前者。     

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.     

超声乳化联合人工晶状体植入治疗老年白内障合并角膜散光

目的：对老年性白内障合并角膜散光患者采用超声乳化白内障摘除术联合散光型人工晶状体(intraocular lens,IOL)植入的临床疗效进行评估。

方法：采用随机数字表法将本院眼科中心收治的64例84眼老年性白内障合并散光患者分为散光型IOL组33例42眼和球面IOL组31例42眼,散光IOL组采用超声乳化白内障摘除术联合散光型人工晶状体植入术治疗,球面IOL组采用常规颞侧透明角膜切口超声乳化白内障摘除球面人工晶状体植入联合陡峭轴位上一对角膜缘松解切口治疗。观察两组手术前、术后3mo的视力分布、角膜散光度、球镜及柱镜指标(曲率、轴向、小瞳验光球镜、小瞳验光柱镜、散光轴向)的变化情况。

结果：散光型IOL组和球面IOL组在术后第3mo复查裸眼视力,与同组术前比较视力均提高(P<0.05),术后散光型IOL组和球面IOL组裸眼视力比较,散光型IOL组裸眼视力分布优于球面IOL组(Z=-2.172,P=0.030<0.05)。术后3mo散光型IOL组、球面IOL组患者的角膜散光度与同组患者术前比较减小,差异具有统计学意义(P<0.05)。散光型IOL组和球面IOL组的小瞳验光球镜、小瞳验光柱镜较术前均减小(P<0.05),散光轴向较术前变化无统计学差异(P>0.05); 术后3mo散光型IOL组的小瞳验光球镜、小瞳验光柱镜值显著低于球面IOL组(P<0.05)。

结论：老年性白内障合并散光患者采用超声乳化白内障摘除术联合散光型人工晶状体植入具有较好的临床效果。     

Surgical approaches to correct corneal astigmatism at time of cataract surgery: a mini-review

Among refractive errors, astigmatism is the most common optical aberration, where refraction changes in different meridians of the eye. It causes blurred vision at any distance and includes corneal, lenticular, and retinal astigmatism. Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism, for example, a large size surgery incision. The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery. Nowadays, three surgical approaches can be used. By placing a sutureless clear corneal incision on the steep meridian of the cornea, a preoperative corneal astigmatism less than 1.0 D can be corrected. Single or paired peripheral corneal relaxing incisions (PCRIs) provide 1.0-3.0 D corneal astigmatism correction. PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism, if more than 2.0 D, the risk of overcorrection and irregular astigmatism is increased. When toric intraocular lenses (IOLs) are unavailable in markets, PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism. Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism. Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D. These approaches can be used alone or in combination.     

Limbal relaxing incisions for primary mixed astigmatism and mixed astigmatism after cataract surgery

PURPOSE: To evaluate the effect of limbal relaxing incisions (LRIs) in the treatment of primary mixed astigmatism and mixed astigmatism after cataract surgery. SETTING: Department of Ophthalmology, In?nü University, Malatya, Turkey. METHODS: Limbal relaxing incisions were performed to correct astigmatism in 37 eyes of 26 patients with mixed astigmatism. Twenty-four eyes had primary astigmatism, and 13 eyes had astigmatism after cataract surgery. The length, number, and depth of the incisions were determined using the Gills and Gayton nomogram. The manifest refractive astigmatism was measured preoperatively and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Surgically induced astigmatism using the vector method, preoperative and postoperative uncorrected visual acuity (UCVA), and best spectacle-corrected visual acuity (BSCVA) were evaluated. Follow-up was at least 6 months in all cases. RESULTS: The mean preoperative and postoperative refractive astigmatism was 3.31 diopters (D) +/- 1.50 (SD) and 1.59 +/- 1.28 D, respectively (P <.001). The mean absolute change in refractive astigmatism was 1.72 +/- 0.81 D. No patient lost lines of UCVA or BSCVA. The safety index was 1.21 and the efficacy index, 0.88. The mean preoperative and postoperative UCVA was 0.29 +/- 0.22 and 0.54 +/- 0.31, respectively (P =.0001) and the mean BSCVA, 0.61 +/- 0.30 and 0.74 +/- 0.30, respectively (P =.0001). The mean vectorial magnitude was 2.32 +/- 1.36 D at the last follow-up. There were no serious postoperative complications. CONCLUSION: Limbal relaxing incisions are a simple, safe, and effective method to correct primary mixed astigmatism and mixed astigmatism after cataract surgery.     

Study of changes in pre-existing against-the-rule astigmatism after temporal manual small-incision cataract surgery using frown,straight, and smile incisions

Purpose:To assess the change in the amount of astigmatism caused by frown, straight, and smile incision in patients with pre-existing against-the-rule (ATR) astigmatism of more than and equal to 1 diopterMethods:This is a prospective, comparative study conducted over 18 months on 60 patients. Twenty patients were allocated to each incision using simple random sampling. Demographic details, best-corrected visual acuity (BCVA), intraocular pressure (IOP), anterior and posterior segment evaluation, and A-scan were done. An average of three measurements of K horizontal (Khavg), K vertical (Kvavg), and difference between the two (Khavg − Kvavg) were taken using manual keratometry. All surgeries were performed by a single surgeon. All the data analyses were performed by using IBM Statistical Package for the Social Sciences (SPSS) version 20 software. Frequency distribution and cross tabulation were performed to prepare the tables.Results:In frown incision, Khavg − Kvavg was significantly decreased on day 45 from the preoperative value (P < 0.001), followed by straight incision (P < 0.001), and smile incision (P < 0.001). Maximum decrease was observed in frown incision (49.15%) followed by straight (37.75%) and smile (28.57%) incisions.Conclusion:Our results are consistent with reduction of pre-existing ATR astigmatism with temporal incisions, and frown incision seems to be the best approach.