5．5mm上方巩膜隧道切口对Artisan人工晶状体植入术后散光的影响

背景在Artisan人工晶状体（IOL）植入矫正高度近视眼的手术中采用5．5ITIm上方巩膜隧道切口导致的术后散光是影响手术效果的主要原因。目的评价5．5mm上方巩膜隧道切口对有ArtisanIOL植入术后角膜散光的影响。方法对2004年10月-2008年10月在广东省人民医院眼科接受虹膜固定型IOL（PIOL）植人术矫治高度近视的患者111例202眼进行回顾性病例观察研究，随访期为12个月。观察比较患者术前，术后1、3、6、12个月术眼的裸眼视力、最佳矫正视力、球镜度、柱镜度、散光轴等指标，按照术前患者散光轴向分为顺规组与逆规组。应用Holladay十步向量分析法计算手术源性散光量。结果术后1年复诊，94．1％（190眼）患者术后裸眼视力达到或高于0．5，85．1％（172眼）达到或超过术前最佳矫正视力。术眼术后1、3、6、12个月的平均柱镜度数均较术前减少，差异均有统计学意义（t=-4．30，P=0．00；t=-2．27，P：0．01；t=-2．04，P=0．04；t=-2．79，P=0．01）。术后1、3、6、12个月手术源性散光分别为＋1．94D、＋2．26D、＋2．29D、＋2．25D，轴向分别为171。、170。、181。、175。。顺规组术后各时间点术源性散光分别为（＋1．97±1．84）D、（＋2．25±1．75）D、（＋2．27±1．76）D、（＋2．24＋1．75）D；逆规组术后各时间点术源性散光分别为（＋1．75±1．88）D、（＋2．35±1．74）D、（＋2．38±1．76）D、（＋2．34±1．74）D，术后各时间点两组间术源性散光值比较差异均无统计学意义（t=0．54、-0．29、-0．27、-0．29，P=0．59、0．78、0．79、0．78）。结论ArtisanIOL矫正高度近视是有效的，术中采用上方5．5mm巩膜隧道切口时，术后1年可在眼球175°子午线方向产生＋2．25D的手术源性散光。

Surgical-induced astigmatism via a 5.5mm superior scleral tunnel incision for implantation of an Artisan phakic intraocular lens

Background Surgical induced astigmatism induced by a 5.5mm of superior scleral tunnel incision is a key cause of influencing vision outcome in the high myopic eyes after implantation of Artisan phakic intraocular lens(IOL).Objective This study was to evaluate the surgical induced astigmatism through a 5.5mm superior scleral tunnel incision during the implantation of Artisan phakic IOL.Methods This was a case observational study.The clinical data of 202 eyes of 111 patients with Artisan IOL implantation for high myopia from October 2004 through October 2008 was collected.The patients were followed-up for 12 months.The uncorrected visual acuity(UCVA),best spectacle-corrected visual acuity(BCVA),spherical equivalent(SE),cylinder equivalent(CE) and cylinder axis were examined before surgery and postoperative 1,3,6,12 months.The patients were divided into with rule group and against rule group according to the cylinder axis.Surgery-induced astigmatism value was calculated using Holladay vector analysis formula.This clinical trial was approved by the Ethics Committee of Guangdong General Hospital.Written informed consent was obtained from each patient prior to the surgery.Results The UCVA of 195 eyes(94.1%) was 0.5 or better in postoperative 12 months,and that of 172 eyes(85.1%) showed the improvement of BCVA during the follow-up duration.The mean CE values were reduced in 1,3,6,12 months after surgery in comparison with before surgery(t=-4.30,P=0.00;t=-2.27,P=0.01;t=-2.04,P=0.04;t=-2.79,P=0.01).Vector analysis of total surgically induced astigmatism revealed that the mean incision-induced astigmatism value was +1.94D,+2.26D,+2.29D,+2.25D at 171°,170°,181°,175° in 1,3,6,12 months after surgery.The surgery-induced astigmatism was(+1.97±1.84)D,(+2.25±1.75)D,(+2.27±1.76)D,(+2.24±1.75)D in with rule group at postoperative 1,3,6,12 months respectively;while those in against rule group was(+1.75±1.88)D,(+2.35±1.74)D,(+2.38±1.76)D,(+2.34±1.74)D respectively.No significant differences were found between the two groups(t=0.54,-0.29,-0.27,-0.29;P=0.59,0.78,0.79,0.78).Conclusion Implantation of Artisan IOL is an effective approach for correction of high myopia.A 5.5mm superior scleral tunnel incision in operation induces a +2.25D astigmatism at 175° meridian.