飞秒激光撕囊复曲面人工晶状体植入的临床观察

目的　观察飞秒激光辅助超声乳化白内障吸出术联合Toric 人工晶状体（toric intraocular lens，Toric IOL）植入矫正散光的效果以及IOL的旋转稳定性与居中性。方法　本文为前瞻性非随机对照研究。收集确诊为年龄相关性白内障并伴有角膜规则散光>1.0 D的患者68例（82眼），其中41眼采用飞秒激光辅助超声乳化白内障吸出术联合Toric IOL植入术（观察组），另41眼采用传统超声乳化术联合Toric IOL植入术（对照组）。观察并比较术前和术后6个月患者的裸眼视力、残余散光的度数；采取重复测量分析比较两组术后1个月、3个月、6个月IOL轴位旋转的度数及IOL在囊袋内水平、垂直偏移的距离和垂直偏转的度数。结果　观察组术前裸眼视力（logMAR）为1.03±0.32，术前角膜散光为（2.09±0.73）D，术后最佳矫正视力为0.13±0.11，术后6个月残余散光度数为（0.33±0.27）D；对照组术前裸眼视力为0.92±0.40，术前角膜散光为（1.69±0.64）D，术后最佳矫正视力为0.13±0.09，术后6个月残余散光度数为（0.26±0.22）D；与术前相比，两组患者术后视力均明显提高，散光明显降低，差异均有统计学意义（均为P<0.001）；两组比较，术后1个月、3个月、6个月IOL轴位旋转的度数差异均无统计学意义（均为P>0.05），但IOL水平偏移距离与垂直偏移距离差异均有统计学意义（均为P<0.05）；两组术后1个月、3个月、6个月的IOL倾斜度差异均有统计学意义（均为P<0.05）。结论　飞秒激光辅助Toric IOL植入术与超声乳化白内障吸出术联合Toric IOL植入术后均有良好的旋转稳定性和可预测性。

Clinical observation of femtosecond laser capsulorhexis with toric intraocular lens implantation

Objective　To evaluate the clinical effect of femtosecond laser assisted cataract surgery with Toric IOL implantation on correcting astigmatism and IOL rotating stability.Methods　A prospective，nonrandomized，controlled study was conducted in 68 patients （82 eyes） diagnosed as age-related cataract with more than 1.0 diopter （D） regular astigmatism，including 41 eyes undergoing Toric IOL implantation with femtosecond laser assisted cataract surgery，and the other eyes receiving Toric IOL with phacoemulsification.And observation was performed for the uncorrected visual acuity （UCVA） before operation and 6 months after operation，preoperative corneal astigmatism，anticipated and postoperative residual astigmatism 6 months after operation.Then，comparison was performed for the degree of Toric lens axis rotation，as well as the horizontal and vertical movement of the IOL and the degree of vertical deflection in the capsule at 1，3，and 6 months after operation.Results　In the observation group，preoperative UCVA （logMAR），preoperative corneal astigmatism，postoperative BCVA and the residual astigmatism at 6 months after operation was 1.03±0.32，（2.09±0.73）D，0.13±0.11 and （0.33±0.27）D，respectively，while the corresponding data in the control group was 0.92±0.40，（1.69±0.64）D，0.13±0.09，（0.26±0.22）D；the postoperative visual acuity in both groups was significantly improved，and residual astigmatism was significantly decreased at 6 months after operation （all P<0.001）.There was no significant difference in Toric lens axis after femtosecond laser assisted surgery and phacoemulsification at 1 month，3 months，6 months after operation （all P＞0.05），but the differences in the IOL movement in horizontal and vertical direction were statistically significant at the different time-points （all P<0.05），and there was significant differences in the degree of vertical deflection （all P<0.05）.Conclusion　Both femtosecond laser assisted cataract surgery and phacoemulsification combined with Toric IOL can achieve a better stability and predictability.