对比白内障超声乳化术中两种角膜切口方向对角膜屈光的影响

摘要

目的 对比白内障超声乳化手术中颞侧和上方两种透明角膜切口对角膜屈光的影响.方法 白内障35例(42眼),随机分为颞侧透明角膜切口组(A组)和上方透明角膜切口组(B组),在手术前1d、手术后1d,1周、1个月和2个月行视力及角膜地形图测定.结果 术后1d,A组患者视力好于B组(P=0.043)；术后1周、1个月、2个月两组间视力差别无统计学意义.术前、术后1c,1周、1个月、2个月A组散光值分别为(0.543±0.264)D,(0.821 ±0.317)D,(0.732±0.320)D,(0.690 ±0.283)D,(0.657±0.233)D；B组分别为(0.568 ±0.243)D,(1.092±0.357)D,(0.987±0.257)D,(0.934 ±0.312)D,(0.866 ±0.371)D.白内障术后各阶段A组散光值均小于B组(P＜0.05),术后1d两组散光值均最大,随后逐渐缩小,术后1周以后,A组散光与术前相比差别无统计学意义,B组散光高于术前(P＜0.01).颞侧透明角膜切口组术后以顺规散光为主,上方角膜切口组以逆规散光为主.结论 白内障超声乳化术中颞侧透明角膜切口术后早期视力恢复好,且角膜散光改变小于上方切口.%Objective To compare the effect of different corneal incisions on corneal refraction after phacoemulsification and foldable intraocular lens implantation.Methods 42 eyes of 35 patients with cataract were divided into two groups randomly:group A,received temporal clear corneal incision(18 eyes of 18 cases),group B,received superior(11:00) clear corneal incision (24 eyes of 17 cases).Patients were examined preoperatively and 1 day,1 week,1 month and 3 months postoperatively by using slit-lamp microscope and corneal topography,and visual acuity also was examined.Results The visual acuity in group A was better than that in group B at 1 day postoperatively.But at 1 week,1 month,2 months postoperatively,the difference of visual acuity between two groups was not statistically significant.At 1 day preoperatively and at 1 day,1 week,1 month,2 months postoperatively,the mean astigmatism were (0.543 ± 0.264) D,(0.821 ±0.317)D,(0.732±0.320)D,(0.690±0.283)D,(0.657 ±0.233)D and (0.51 ±0.27)D in group A respectively.And at the same time points,the mean astigmatism in group B were (0.568 ± 0.243)D,(1.092 ± 0.357) D,(0.987 ± 0.257) D,(0.934 ± 0.312) D and (0.866 ± 0.371) D respectively.The mean astigmatism in group A was lower than in group B,and the difference was statistically significant (P ＜0.05).The superior incision group showed against-the-rule astigmatic changes,whereas with-the-rule astigmatism was seen in the temporal incision group.Conclusion The visual acuity in the temporal incision group was better than that in superior incision group at 1 day postoperatively.And the mean astigmatism changes in group A was lower than in group B.