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.

Paying attention to precision correcting surgery for cataract associated with corneal astigmatism

Corneal astigmatism in patients with cataract is very common,but it could not be accurately corrected during previous cataract surgery,which usually affects the visual quality seriously.The accurate measurement of corneal astigmatism power and meridian before surgery is key to the effective correction of astigmatism during the cataract surgery by either the determination of astigmatic keratotomies or the selection and implantation of toric intraocular lenses (IOL).The combination of IOL Master for sphere,the Pentacam for the total corneal refractive power and VERION Digital Marker for surgical orientation can provide promising refractive examination,treatment and good postoperative outcomes.Preexsisting astigmatism can be corrected during cataract surgery by modifying incision,performing arcuate keratotomy,or implanting a toric IOL.Femtosecond laser arcuate keratotomy combined with phacoemulsification is an effective,safe and precise method for the correction of low to moderate corneal astigmatism power,and it can improve visual acuity in cataract surgery candidates.Further work is required to establish corneal biomechanics numerical simulation and nomography protocol for cataract refractive surgery so as to improve the predictability and accuracy of femtosecond laser-assisted astigmatic keratotomy during refractive cataract surgery.