OCCI与TCCI手术切口植入Acrysof Toric人工晶状体的临床对比研究

目的 比较两种不同位置角膜切口对Acrysof Toric人工晶状体(IOL)植入准确性和散光矫正能力的影响.方法 前瞻性研究.选择年龄相关性白内障伴角膜散光患者25例(39只眼),散光度数为1.00～2.26 D,行超声乳化白内障吸除联合Acrysof Toric IOL植入术,术中分别采用陡峭轴(即角膜的最大曲率径线)角膜切口(OCCI)即OCCI组(20只眼)或颞侧角膜切口(TCCI)即TCCI 组(19只眼),比较两组患者术后3个月的裸眼视力、最佳矫正视力、角膜曲率、手术源性散光值、IOL 轴位偏差、散光矫正指数以及植入准确性.统计学方法采用t检验和Z检验.结果 术后角膜散光改变比较,OCCI组减小(0.31±0.26)D,而TCCI组增加(0.28±0.27)D,差异有统计学意义(t=5.756,F=0.000).IOL轴位偏差比较,OCCI组为0°±0°,而TCCI组为2.22°±2.99°,差异有统计学意义(t=3.860,P=0.000).手术矫正散光指数比较,分别为1.04±0.27和0.59±0.44,差异有统计学意义(t=3.187,P=0.004).散光矫正的准确性比较,分别为0.838和0.484,差异有统计学意义(Z=1.970,P=0.049).结论 与TCCl相比,OCCI提高了Acrysof Toric IOL植入的准确性和矫正散光的能力.

Comparison of clear corneal on-axis and temporal incisions for Acrysof Toric intraocular lens implantation

Objective To investigate whether there are some differences in the accuracy of Acrysof Toric intraocular lens(IOL)implantation and the ability to correct astigmatism between 2 types of clear Corneal incisions used in phacoemulsification:the on-axis (I.e on the steeper corneal meridian) and the temporal clear corneal incision (OCCI and TCCI,respectively).Methods In this prospective study,thirty-nine eyes with cataract and mild to moderate corneal astigmatism (1.00-2.26 diopters on corneal curvature) were recruited and divided into OCCI group (20 eyes) and TCCI group (19 eyes) respectively.All of these patients underwent phacoemulsification and an Acrysof Toric IOL implantation (single surgeon,3.2 mm incision).Main outcome measurements included uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),corneal curvature,surgically induced astigmatism (SIA),deviation of lens axis(LAD),index of corrected astigmatism (CAI) and accurace of astigmatism correction(ACA) at 3 months postoperatively.Results At 3 months postoperatively,simple algebraic difference showed a mean increase in the astigmatism magnitude of (0.28±0.27) D in the TCCI group and a mean reduction in the astigmatism magnitude of (0.31±0.26)D in the OCCI group(t=5.756,F=0.000).The average LAD wag 0°±0°in the OCCI group and 2.22°±2.99°in the TCCI group(t=3.860,P=0.000).The average CAI were 1.04 ±0.27 and 0.59±0.44 respectively (t=3.187,P=0.004).The ACA were 0.838 and 0.484 respectively (Z=1.970,P=0.049).Conclusions Compared with the TCCI,the OCCI could correct some corneal astigmatism and reduce IAD induced by the SIA shift. As a result,the OCCI could improve the accuracy of Acrysof Toric lens implantation and the ability to correct astigmatism.