飞秒激光辅助白内障手术与传统白内障手术联合Toric人工晶状体植入术治疗长眼轴白内障患者的临床疗效比较

目的　比较飞秒激光辅助白内障手术与传统白内障手术联合Toric人工晶状体植入术治疗长眼轴白内障患者的临床疗效。方法　选取在我院行白内障手术眼轴长度大于24 mm的白内障患者49例49眼，按患者主观意愿选择术式；飞秒组患者20例20眼，均行飞秒激光辅助白内障手术；传统组患者29例29眼，均行传统白内障手术。两组患者术中眼内均植入 Toric人工晶状体。每例患眼均行IOL-Master、OPD-SCAN Ⅲ视觉质量分析仪检测，获得患者散光度、最佳矫正视力（best corrected visual acuity，BCVA）、角膜规则指数、表面不对称指数、不规则散光指数、角膜球差及像差与斯特列尔比值。角膜规则指数、表面不对称指数、不规则散光指数、角膜球差及眼高阶像差与斯特列尔比值相关情况采用Spearman相关分析。结果　术后3个月，两组患者BCVA均较术前显著提高，差异均有统计学意义（均为P<0.05）；飞秒组患者BCVA为0.09±0.09，传统组为0.13±0.10，两组相比差异无统计学意义（P>0.05）。术前飞秒组患者散光度为（1.84±0.57）D，传统组为（2.17±0.83）D，两组比较差异无统计学意义（P>0.05）。术后3个月，飞秒组患者总残余散光度为（0.50±0.50）D，传统组为（0.55±0.37）D，两组间比较差异无统计学意义（P>0.05）。术后3个月，飞秒组患者斯特列尔比值为0.18±0.15，传统组为0.15±0.12，两组比较差异无统计学意义（P>0.05）。术后3个月，飞秒组患者斯特列尔比值与角膜规则指数、表面不对称指数、不规则散光指数、角膜球差之间均无相关性（均为P>0.05）；传统组亦均无相关性(均为P>0.05）。飞秒组患者斯特列尔比值与全眼人工晶状体倾斜棱镜、3-8阶所有项高阶像差总和、高阶球面像差呈负相关（均为P<0.05）。传统组患者斯特列尔比值与角膜0-8阶所有项高阶像差总和、人工晶状体倾斜棱镜，眼内人工晶状体倾斜棱镜、3-8阶所有项高阶像差总和、高阶彗差、高阶球面像差，全眼人工晶状体倾斜棱镜、3-8阶所有项高阶像差总和、高阶彗差、高阶球面像差均呈负相关（均为P<0.05）。结论　飞秒激光辅助白内障手术与传统白内障手术联合Toric人工晶状体植入术均能显著提高长眼轴白内障患者术后视力。

Comparative analysis of clinical efficacy between femtosecond laser-assisted cataract surgery and traditional cataract surgery combined with Toric IOL implantation in treatment of long-axis cataract

Objective To compare the clinical effects between femtosecond laser-assisted cataract surgery and traditional cataract surgery combined with Toric intraocular lens(IOL)implantation in treatment of patients with long-axis cataract.Methods Totally 49 eyes of 49 cataract patients with axial length longer than 24 mm received cataract surgery in our hospital were selected,and divided into two groups according to the surgical methods on patient’s subjective willingness:Femtosecond group(20 eyes in 20 patients)received femtosecond laser-assisted cataract surgery;traditional group(29 eyes in 29 patients)received traditional cataract surgery.All patients received Toric IOL implantation during surgery.IOL-Master and OPD-SCAN III visual quality analyzer were used for examination of affected eyes,to collect astigmatism,best corrected visual acuity(BCVA;converted to logMAR),corneal regularity index,surface asymmetry index,irregular astigmatism index,corneal spherical aberration and higher-order aberration and Strehl ratio.Spearman correlation analysis was used to analyze the relation of corneal regularity index,surface asymmetry index,irregular astigmatism index,corneal spherical aberration and higher-order aberration with Strehl ratio.Results Three months after surgery,BCVA was higher than that before surgery in both two groups(both P<0.05).BCVA were 0.09±0.09 in femtosecond group and 0.13±0.10 in traditional group,and no significant difference was observed between the two groups(P>0.05).Before surgery,the astigmatism were(1.84±0.57)D in femtosecond group and(2.17±0.83)D in traditional group,and there was no significant difference between the two groups(P>0.05).Three months after surgery,the total residual astigmatism were(0.50±0.50)D in femtosecond group and(0.55±0.37)D in traditional group,and there was no significant difference between the two groups(P>0.05).Three months after surgery,the Strehl ratios were 0.18±0.15 in femtosecond group and 0.15±0.12 in traditional group,and there was no significant difference between the two groups(P>0.05).Three months after surgery,there was no correlation of Strehl ratio with corneal regularity index,surface asymmetry index,irregular astigmatism index or corneal spherical aberration in the femtosecond group(all P>0.05)or in the traditional group(all P>0.05).Strehl ratio had negative correlation with the full ocular artificial lens oblique prism,total high-order aberrations at 3-8 orders and high-order spherical aberration in femtosecond group(all P<0.05).For patients in traditional group,Strehl ratio had negative correlation with total high-order aberrations at 3-8 orders,artificial lens oblique prism,IOL oblique prism,high-order coma,high-order spherical aberration(all P<0.05).Conclusion Femtosecond laser-assisted cataract surgery and traditional cataract surgery combined with Toric IOL implantation can significantly improve postoperative visual acuity in patients with long-axis cataract.