背景 白内障超声乳化摘出术联合角膜缘松解切开术(LRI)矫正白内障术前散光是有效的,但由于其改变了角膜形态,对角膜高阶像差的影响尚不清楚. 目的 观察LRI在白内障超声乳化手术中对角膜散光的矫正效果及其对角膜高阶像差的影响.方法 采用前瞻性自身对照系列病例观察研究方法,选取2014年8月至2015年4月在天津医科大学眼科医院诊治的白内障患者35例35眼,患者术前散光均≥1.0D.术眼均行LRI联合白内障超声乳化摘出联合IOL植入术,记录患眼术前及术后1d、1周、1个月、3个月裸眼视力(UCVA)和BCVA,进行显然验光,用Pentacam眼前节分析系统测量角膜前表面3 mm范围内的最大和最小屈光度、散光度及角膜高阶像差.验光结果及角膜前表面散光变化均采用矢量分析法,比较患眼术前及术后各时间点UCVA、BCVA、角膜散光值和角膜高阶像差的变化. 结果 患眼术后1d、1周、1个月和3个月UCVA分别为0.34±0.22、0.38±0.25、0.43±0.27和0.42±0.28,均明显高于术前的0.08±0.09;术后各时间点的BCVA分别为0.54±0.27、0.64±0.29、0.67±0.29和0.71±0.32,较术前的0.22±0.51明显提高,差异均有统计学意义(F=54.457,P=0.000;F=62.653,P=0.000).患眼术后柱镜度数及角膜散光均较术前明显减少,差异均有统计学意义(F=31.061,P=0.000;F=113.043,P=0.000).4 mm瞳孔直径下,术后各时间点角膜总高阶像差的均方根值(RMS)较术前明显增加,总体比较差异有统计学意义(F=11.189,P=0.000);6 mm瞳孔直径下,患眼垂直彗差、次级彗差、三叶草像差均较术前明显增加,差异均有统计学意义(均P＜0.05);而手术前后患眼水平彗差、初级球差的总体比较差异均无统计学意义(均P＞0.05).结论 LRI矫正白内障术后角膜散光是安全、有效和稳定的,术后会出现一定程度的角膜高阶像差增加,但未对患者视力产生影响.%Background phacoemulsification combined with limbal relaxing incision (LRI) is reported to be effective for the management of coexisting cataract astigmatism,but the influence of after phacoemulsification with LRI on corneal high-order aberration is still rarely reported.Objective This study was to evaluate the effect of cataract surgery with LRI for preoperative astigmatism or on corneal high-order aberration.Methods A selfcontrolled serial cases observational study was designed.A total of 35 cataractous eyes of 35 patients with astigmatism ≥ 1.0 D before cataract surgery were enrolled in Tianjin Medical University Eye Hospital from August 2014 to April 2015 under the informed consent of patients.LRIs were performed on the eyes during the phacoemulsification and IOL implantation.The uncorrected visual acuity (UCVA),BCVA and optometry were recorded before operation and 1 day,1 week,1 month,3 months after operation.Pentacam was employed to measure the maximal and minimal diopters,astigmatism and high-order aberrations within 3 mm of the anterior corneal surface at above-mentioned time points.All the results were compared among different time points.The optometry outcomes and the anterior corneal surface astigmatism change were analyzed using vector analysis method.Results The UCVA was 0.34 ±0.22,0.38 ± 0.25,0.43±0.27,0.42±0.28 in 1 day,1 week,1 month and 3 months after operation,which was significantly higher than 0.08 ±0.09 before operation;and the BCVA was 0.54 ± 0.27,0.64 ± 0.29,0.67 ± 0.29,0.71 ± 0.32 in 1 day,1 week,1 month and 3 months after operation,showing a significant increase in comparison with 0.22±0.51 before operation(F=54.457,P=0.000;F =62.653,P =0.000).The refractive cylindrical error and corneal astigmatism were significantly decreased after operation in comparison with before operation (F =31.061,P =0.000;F =113.043,P=0.000).High order aberrations (HOA) at postoperative 1 day,1 week,1 month,3 months were all higher than those in preoperation (F =11.189,P =0.000) under the 4 mm pupil diameter.Compared with preoperation,the vertical coma,secondary vertical coma and three leaf clover were significantly increased(all at P＜0.05),but the horizontal coma and primary spherical aberration were not significantly changed (all at P＞0.05) under the 6 mm pupil diameter.Conclusions Phacoemulsification combined with LRI can reduce the corneal astigmatism effectively and steadily,and the increase of corneal aberrations does not affect visual acuity.
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