白内障术中飞秒激光弧形角膜切开术矫正角膜散光的疗效

目的：研究白内障术中飞秒激光弧形角膜切开术（FSAK）矫正术前角膜散光的临床疗效。方法：回顾性病例对照研究。连续纳入北京爱尔英智眼科医院2017年3月至2021年12月术前规则角膜散光为0.75~2.00 D且接受飞秒激光辅助白内障手术的患者89例（89眼）。所有患者按照术前角膜散光轴位分为顺规散光组（90°±30°）、逆规散光组（180°±30°）及斜轴散光组（45°±15°、135°±15°）。飞秒激光辅助白内障手术及弧形角膜切开术使用Lensx平台。观察患者总体和顺规、逆规散光组术前及术后3个月角膜散光的变化及分布情况。使用配对样本t检验或Wilcoxon符号秩检验比较总体及各亚组术前、术后的散光差异;使用独立样本t检验或Mann-Whitney U检验比较顺规散光组及逆规散光组的差异;散光变化的分析采用Alpins矢量分析法。结果：纳入的89例（89眼）患者中,顺规散光组38例,逆规散光组44例,斜轴散光组7例。所有患者角膜水平径为（11.48±0.57）mm,垂直径为（10.66±0.60）mm。患者总体术后裸眼远视力、最佳矫正远视力相比术前有显著改善（Z=8.01、-7.49,P<0.001）。总体术前角膜散光为（1.28±0.33）D,术后3个月残余散光（0.67±0.37）D,散光矫正量为（0.61±0.33）D。顺规及逆规散光组角膜散光矫正量分别为（0.48±0.27）D、（0.74±0.34）D。总体及顺规、逆规散光组术后平坦轴角膜曲率均有明显升高,而陡峭轴角膜曲率则出现明显下降。矢量分析法显示总体散光矫正指数为0.63±0.30,平坦指数为0.58±0.30,成功指数为0.51±0.25,误差角为-1.83°±12.59°。逆规散光组矫正效果最佳,矫正指数为0.81±0.25,平坦指数为0.75±0.26,成功指数为0.40±0.24;顺规散光组次之,矫正指数为0.42±0.21,平坦指数为0.39±0.21,成功指数为0.63±0.21。结论：白内障术中FSAK矫正术前角膜散光具有良好的有效性和安全性,相同的弧形切口设计方式在逆规散光中取得了更好的疗效,角膜直径可能是产生影响的重要因素。

Clinical Observation on Correction of Corneal Astigmatism by Femtosceond Laser-AssistedArcuate Keratotomy during Cataract Surgery

Objective: To research the clinical effect of femtosceond laser-assisted arcuate keratotomy (FSAK) in the correction of preoperative corneal astigmatism during cataract surgery. Methods:This was a retrospective case control study. Eight-nine patients (89 eyes) with preoperative regular corneal astigmatism of 0.75 -2.00 D who underwent femtosecond laser-assisted cataract surgery from March 2017 to December 2021 in Beijing Aier-Intech Eye Hospital were continuously collected. Femtosecond laser assisted cataract surgery and arcuate keratotomy were performed on Lensx platform. All patients were divided into 3 subgroups according to the axis of preoperative astigmatism, with the rule astigmatism group (90°±30°),against the rule astigmatism group (180°±30°) and the oblique astigmatism group (45°±15° and 135°±15°). Femtosecond laser-assisted cataract surgery and arcuate incisions were performed on Lensx platform.Observe the changes and distribution of corneal astigmatism before and 3 months after surgery in the general and subgroups of with the rule and against the rule subgroups. Paired samples t-test or Wilcoxon signed-rank test were used to compare the preoperative and postoperative astigmatism differences between the whole and each subgroup. Independent samples t-test or Mann-Whitney U test were used to compare the differences between the with-the-rule and the against-the-rule astigmatism groups, astigmatism change analysis usingAlpins vector analysis method.Results: Eighty-nine patients (89 eyes) were included,there were 38 cases in with the rule group, 44 cases in against the rule group and 7 cases in oblique group. The corneal horizontal diameter was 11.48±0.57 mm and the vertical diameter was 10.66±0.60 mm.The post-operative uncorrected distance visual acuity and corrected distance visual acuity of the patients weresignifcantlyimprovedcomparedwithpre-operative.Totalmeancornealastigmatismbeforeoperation was1.28±0.33D,and the residual corneal astigmatism was 0.67±0.37 D at 3 months after operation, the correction magnitudle of astigmatism is 0.61±0.33 D. In with the rule and against the rule groups, the net changes of corneal astigmatism were 0.48±0.27 D, 0.74±0.34 D, respectively. The postoperative fat keratometric of the patients in the overall and with the rule, against the rule groups increased signifcantly, while the steep keratometric decreased significantly. Alpins vector analysis shows that the overall astigmatism correction index is 0.63±0.30, the fatting index is 0.58±0.30, the index of success is 0.51±0.25,and the angle of error is -1.83°±12.59°. Among two subgroups, the against the rule group has the best correction effect (correction index is 0.81±0.25, fatting index is 0.75±0.26, index of success is 0.40±0.24), the with the rule group takes the second place (correction index is 0.42±0.21, fatting index is 0.39±0.21, index of success is 0.63±0.21).Conclusions: FSAK during cataract surgery is effective and safe in the treatment of corneal astigmatism, the same arcuate incision design achieved better curative effect in the against the rule astigmatism group, and corneal diameter maybe an important factor affecting the amount of astigmatism correction.