角膜缘松解切开在有晶状体眼后房型人工晶状体植入术中的应用

目的:探讨在有晶状体眼后房型人工晶状体植入术(implantable collamer lens,ICL)中应用角膜缘松解切开矫正散光的安全性和有效性。方法:高度近视合并散光患者105例185眼,随机分为角膜缘松解切开组(A组)60例105眼,角膜缘松解切开联合ICL植入术;手术对照组(B组)45例80眼,仅施行常规ICL植入术。分别于术前,术后1wk;1,3mo进行裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best-corrected visual acuity,BCVA)、眼前节分析仪Pentacam检查,观察角膜散光变化。结果:术后1,3mo UCVA比较,两组差异具有统计学意义(P<0.05);术后1wk;1,3mo BCVA比较,两组差异无统计学意义(P>0.05)。A组术前平均角膜散光度为1.52±0.55D,B组术前平均角膜散光度为1.48±0.57D,两组差异无统计学意义(P>0.05)。A组术后1wk;1,3mo平均角膜散光度数分别为0.55±0.41,0.60±0.38,0.51±0.32D,B组术后1wk;1,3mo平均角膜散光度分别为1.20±0.48,0.93±0.47,0.96±0.40D,两组差异具有统计学意义(P<0.05)。术前与术后1wk;1,3mo角膜散光差值变化,两组间差异有统计学意义(P<0.05)。LRIs组术前与术后各时间点平均角膜散光度变化差异均有统计学意义(P<0.05)。结论:在ICL术中应用角膜缘松解切开矫正散光,可安全有效的减少角膜散光,提高UCVA、改善视觉质量。

Clinical research of limbal relaxing incision during implantable collamer lens surgery

AIM: To evaluate the efficacy and safety of limbal relaxing incision(LRI)for correcting corneal astigmatism during implantable collamer lens(ICL)surgery.

METHODS: A total of 185 eyes of 105 patients with high myopia and corneal keratometric astigmatism were included in the study. ICL surgery with concomitant relaxing incision was performed in 105 eyes of 60 patients in LRIs group(Group A). Eighty eyes of 45 patients only underwent ICL surgery were in control group(Group B). All patients undergone ophthalmic examination that included uncorrected visual acuity(UCVA), best-corrected visual acuity(BCVA), Pentacam analysis system to observe the changes of corneal astigmatism before and 1wk, 1 and 3mo after surgery.

RESULTS: Respectively comparing UCVA between two groups in 1 and 3mo postoperatively, the P values were considered statistically significant(P<0.05). But, respectively comparing BCVA between two groups in 1wk, 1 and 3mo postoperatively, the P values were considered no statistically significant(P>0.05). Preoperative corneal astigmatism was 1.52±0.55D in group A and 1.48±0.57D in group B, there was no statistically significant difference(P>0.05). One week postoperatively, the astigmatism was 0.55±0.41D in group A and 1.20±0.48D in group B. One month postoperatively, the astigmatism was 0.60±0.38D in group A and 0.93±0.47D. Three months postoperatively, the astigmatism was 0.51±0.32D in group A and 0.96±0.40D in group B. The difference between the two groups were statistically significant(P<0.05). The difference value of corned astigmatism before surgery and 1wk, 1 and 3mo after surgery had statistical significance(P<0.05). In LRIs group, at preoperative and postoperative time points, the average corneal astigmatism changes were also considered statistically significant difference(P<0.05).

CONCLUSION: LRIs performed during ICL surgery appeared to be an effective and safer procedure to reduce pre-existing corneal astigmatism and improve UCVA as well as the visual quality.