Refractive lens exchange

Advances in small incision surgery have enabled cataract surgery to evolve from being concerned primarily with the safe removal of the opaque crystalline lens to a procedure refined to yield the best possible postoperative refractive result. As the outcomes of cataract surgery have improved, the use of lens surgery as a refractive modality in patients without cataracts (clear lens extraction) has increased in popularity. The removal of the crystalline lens for refractive purposes, or so-called refractive lens exchange (RLE), offers distinct advantages over corneal refractive surgery in selected cases. Nevertheless, in some middle-aged patients with high refractive errors, corneal refractive surgery can be a safe and effective treatment. In addition, the use of multifocal lenses offers an alternative for the correction of presbyopia. A further advantage of RLE is that it simultaneously eliminates the need for cataract surgery in the future. The keys for success in RLE are effectiveness and consistency in the refractive outcome, providing at the same time surgical and postoperative safety. To achieve these goals, adequate indications following strict risk/benefit criteria and refractive precision based on accurate preoperative protocols for IOL calculation and selection are mandatory, together with an appropriate choice of surgical procedure based on the surgeon's skills, minimizing complications.     

Toric人工晶状体植入术后的远期临床疗效

目的评价AcrysofToric人工晶状体矫正白内障伴角膜散光患者的远期临床效果及其在囊袋内的旋转稳定性。方法回顾性非随机临床研究。选取在浙江大学医学院附属第一医院眼科已行白内障超声乳化吸除联合AcrysofToric人工晶状体植入术的白内障患者21例（23眼）,年龄53-84岁,均为术后24个月以上。观察术前术后的裸眼视力（UCVA）、最佳矫正视力（BCVA）,术前角膜散光、总散光,术后角膜散光、残留散光,人工晶状体轴位等。术前术后比较采用配对t检验。结果术后最后一次随访时,患眼的UCVA（10gMAR）为0．16±0．13,BCVA（10gMAR）为0．06±0．09。术前总散光（-2．98±1．22）D,术后残留散光（-0．57±0．78）D,两者比较差异有统计学意义（t=6．371,P〈0．05）。术前预留散光（-0．53±0．70）D,与术后残留散光比较差异无统计学意义。术前角膜散光（2．23＋1．17）D,术后角膜散光（1．89＋1．22）D,两者比较差异无统计学意义。AcrysofToric人工晶状体轴位偏离既定轴位度数平均为（2．84±2．66）°,1只术眼（4％）的人工晶状体轴位偏离7。,余术眼（96％）的人工晶状体轴位偏离均≤5°。结论白内障超声乳化术后植入AcrysofToric人工晶状体具有良好的远期临床效果和旋转稳定性,是一种安全、有效、预测性好的治疗伴角膜规则散光白内障的方法．     

Toric人工晶状体植入矫正角膜散光的疗效观察

目的：观察Toric人工晶状体(intraocular lens, IOL)植入用于治疗合并角膜散光的白内障患者的临床治疗效果。

方法：对41例47眼合并角膜散光的白内障患者行超声乳化白内障吸出及IOL植入术治疗,进行回顾性分析。其中22眼植入Toric IOL,25眼植入Acrysof IQ IOL。术后随访6mo,分析不同时间点裸眼视力、术后残余散光、并发症等,比较两种IOL的疗效。观察Toric IOL植入后的稳定性。

结果： 术后随访观察6mo,植入Toric IOL的试验组,术后裸眼视力平均0.73±0.37,明显优于植入Acrysof IQ IOL的对照组(平均0.47±0.18),结果有显著性差异。试验组术后裸眼视力0.5以上者占81.8%,优于对照组32.0%。试验组患者术后残余散光0.53±0.40D,明显低于对照组(2.13±0.76D),差异有统计学意义。植入Toric IOL组,随访6mo,术后平均旋转4.22±1.46度。

结论：对于合并角膜散光的白内障患者,行白内障超声乳化吸出联合Toric IOL植入,能够安全、有效的改善患者的散光,提高术后视觉质量,预测性好。     

Toric IOL植入术与PCRI联合传统IOL植入术矫正白内障患者角膜散光的Meta分析

目的：:系统评价Toric人工晶状体（Toric IOL）植入术与传统IOL植入联合角膜缘松解术（PCRI）在矫正年龄相关性白内障患者合并≤3 D角膜散光的有效性、安全性以及对视功能的影响。方法：:循证医学研究。采用Cochrane系统评价方法,计算机检索PubMed、EMBASE、Cochrane图书馆、Clinic...     

Toric设计角膜塑形镜矫正近视伴高度散光对角膜高阶像差的影响

目的 分析Toric设计角膜塑形镜矫正近视伴高度散光后角膜高阶像差的变化.设计回顾性病例系列.研究对象2018年5月至2019年2月内江市第一人民医院配戴Toric设计角膜塑形镜患者35例(67眼),近视屈光度-1.00～-4.00 D,散光-1.50～-3.00 D.方法 测量戴镜前,戴镜后1、3、6、12个月的裸眼...     

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.     

Toric人工晶状体植入矫正老年性白内障合并角膜散光的疗效

目的：探讨老年性白内障合并角膜散光行超声乳化摘除联合Toric人工晶状体植入的临床效果,比较Acrysof Toric人工晶状体植入前后的视觉质量。

方法：选择老年性白内障合并角膜散光的患者34例为研究对象,进行白内障超声乳化摘除联合Toric人工晶状体植入,观察术前和术后3mo的临床效果,包括裸眼视力(UCVA),最佳矫正视力(BCVA),全眼残余散光,人工晶状体转动度数,视远脱镜情况。

结果：所有患者Toric人工晶状体均成功植入。术前UCVA 0.15±0.06,术后UCVA上升至0.65±0.15(P<0.01); 术前BCVA 0.37±0.13,术后BCVA上升至0.85±0.19(P<0.01); 全眼散光由术前2.14±0.69D降低至0.73±0.36D(P<0.01),97%的患者人工晶状体转位<5°,平均旋转2.6°±1.3°,术后3mo视远脱镜率达95%。

结论：Toric人工晶状体能够有效矫正白内障合并的角膜散光,晶状体在囊袋内具有良好的稳定性,提高了患者的术后视觉质量。     

囊袋张力环联合散光IOL植入在轴性近视散光白内障患者中的应用

目的对轴性近视散光白内障患者使用囊袋张力环联合散光IOL（Toric IOL）植入及单纯Toric IOL植入的临床效果进行量化对比。方法回顾性对照研究。2012年1月至2013年1月在大庆市油田总医院接受白内障超声乳化吸出联合Toric IOL植入术的轴性近视散光患者,入选术眼术前角膜散光≥1.5 D,眼轴长度＞25.5 mm,角膜地形图结果显示均为规则散光。联合组Toric IOL+CTR植入,共20例（20眼）;单纯组Toric IOL植入,共13例（13眼）。术前使用IOLMaster、主觉验光等分别测得术前角膜散光、全眼散光、UCVA、BCVA等,根据Alcon提供的在线计算器计算术眼所需Toric IOL球镜度数、晶状体型号及轴位、预计残留散光,术后6个月,使用主觉验光、裂隙灯显微镜测得术眼UCVA、BCVA、残余散光、Toric IOL轴位。采用t检验、秩和检验、χ2检验对数据进行分析。结果术后6个月,联合组Toric IOL均位于囊袋内,仅有2例发生轻微旋转,大约是2°～3°,余均未发生旋转。单纯组Toric IOL虽位于囊袋内,但IOL轴位均发生旋转,5眼旋转＜10°,7眼＜20°,1眼＜30°。联合组术后6个月残余散光（-0.40±0.15）D与预计残留散光（-0.36±0.11）D比较,差异无统计学意义（t=-1.647,P＞0.05）。单纯组术后6个月残余散光（-1.07±0.37）D高于预计残留散光（-0.40±0.12）D,差异有统计学意义（t=-8.490,P＜0.01）。术后6个月,联合组UCVA（4.6±0.1）高于单纯组UCVA（4.5±0.1）,差异有统计学意义（t=2.443,P＜0.05）。结论CTR植入可以有效提高轴性近视散光白内障患者术后Toric IOL囊袋内旋转稳定性,达到预期矫正角膜散光的目的,患者视力明显提高。