不同术式白内障术后屈光状态变化规律及稳定性研究

目的：研究不同术式白内障术后患者的屈光状态变化规律,分析白内障术后患者屈光稳定性,为白内障患者术后视觉质量获得提供参考。
　　方法：回顾性研究。选取2014-01/2015-12常州市第一人民医院行白内障摘除联合人工晶状体植入术的患者126例150眼作为研究对象,按照手术方式不同分为3组,第1组行上方3 mm透明角膜切口42例50眼；第2组行颞侧3 mm透明角膜切口52例60眼,第3组行3 mm上方角巩膜隧道切口32例40眼。分别测量患者不同时间点的裸眼远视力、最佳矫正远视力、球镜度数及散光度数,对比分析术后患者的屈光状态变化规律及屈光稳定性。
　　结果：裸眼远视力组内比较,术前与术后各时间点均差异具有统计学意义(P<0.01),术后早期(术后1、3d)与术后1、3mo差异具有统计学意义(P<0.05),三组患者术后裸眼远视力较术前均提高明显,且均在术后1 mo趋于稳定；最佳矫正远视力组内比较,术前与术后各时间点均差异具有统计学意义(P<0.01),术后1wk与术后1、3d差异具有统计学意义(P<0.05),术后1wk与术后1、3mo差异无统计学意义(P>0.05),三组患者最佳矫正远视力术后较术前均提高明显,且均在术后1 wk趋于稳定；球镜度数组内比较,术后1、3d差异无统计学意义(P>0.05),出现远视漂移,术后1wk与术后1、3d比较差异具有统计学意义( P<0.05),术后1wk与术后1、3mo比较差异无统计学意义(P>0.05),三组患者球镜度数在术后1wk趋于稳定；散光度数组内比较,术后较术前角膜散光度数均增加,术后1d,各组术后角膜散光达到最大,随后逐渐减小；术后1wk与术后1、3d比较差异具有统计学意义(P<0.05),术后1wk与术后1、3mo差异无统计学意义(P>0.05),三组患者术后较术前散光度数均增加明显,且均在术后1 wk趋于稳定。
　　结论：白内障手术中3 mm左右上方透明角膜切口、颞侧透明角膜切口及上方巩膜隧道切口不同术式术后视力恢复均良好,均可作治疗白内障的常规手术术式；白内障术后早期屈光状态呈轻度远视状态,且在术后1 wk左右稳定,结合临床可指导配镜。

Retrospective study on the changes of refractive state and stability after cataract surgery

AIM: To compare and contrast different operation after cataract patients with refractive change rules. To analyze the patients with refractive stability after cataract surgery, and to provide a reference for cataract patients with clinical surgery after visual quality.

METHODS: Retrospective study. A total of 126 cases(150 eyes)were selected from Jan. 2014 to Dec. 2015 in Changzhou First People''s Hospital of cataract extraction combined with foldable intraocular lens implantation for cataract patients as the research samples. According to the different operation for three groups, the first group of 42 patients(50 eyes)underwent above 3 mm clear corneal incision; 52 cases in group 2(60 eyes)underwent temporal side 3 mm clear corneal incision. The third group, 32 cases(40 eyes)underwent 3 corner above the scleral tunnel incision. All the cases were measured at different time point in patients with naked eyes far visual acuity, best corrected visual acuity, spherical degree, the degree of astigmatism and astigmatic axial, comparative analysis of after cataract surgery in patients with refractive change regularity and stability of refraction.

RESULTS: The uncorrected distance visual comparison within the group, and each time point after preoperative differences were significant(P<0.01), and the early postoperative period after 1, 3mo significantly different(P<0.05). Three groups of patients after surgery compared with preoperative uncorrected distance visual acuity improved significantly, and were stable after 1mo. Compare the best corrected distance vision within the group, and each time point after preoperative differences were significant(P<0.01), postoperative 1wk and after 1, 3d significantly different(P<0.05), after 1wk and after 1, 3mo was not significantly different(P>0.05), three groups of patients were compared with the preoperative best corrected distance visual acuity were increased significantly, and were in stable after 1wk; relatively spherical degree within the array, after 1d and 3d was not significantly different(P>0.05), hyperopia drift, after 1wk and 1, 3d was significantly different(P<0.05), after 1wk and 1, 3mo was not significantly different(P>0.05). Three groups of patients'' spherical degrees after 1wk were stabilized. Comparative degree of astigmatism within the array, postoperative compared with preoperative corneal astigmatism were increased 1d after surgery. Corneal astigmatism in each group reached the maximum, and then decreases 1wk and 1d after surgery, compared with postoperative 3d was significantly different(P<0.05). After 1wk and 1, 3mo was not significantly different(P>0.05). Three groups of patients were compared with preoperative astigmatism were significantly increased, and in operation after 1wk were stabilized; astigmatic axis were three groups in the preoperative astigmatism against the rule, the first and third group after 1d, three Tianshun rule astigmatism proportional were increased, and then decreased. Group 2 the-rule astigmatism proportion, after 1wk, 1 and 3mo, the first and third group gradually reduced the proportion of cis regulatory astigmatism, and compared with preoperative increased, increasing the-rule astigmatism group 2 ratio, and increased compared with preoperative.

CONCLUSION: Above 3 mm the transparent corneal incision, temporal clear corneal incision and above the scleral tunnel incision different surgical postoperative visual acuity are good. It can be used as a routine surgical procedure in treatment of cataract; phacoemulsification in cataract patients with former majority against the rule astigmatism. After cataract surgery, early refractive state is a state of mild hyperopia and stabilized about 1wk, combined with clinical guide glasses.