基于全角膜散光规划Toric人工晶状体植入手术的临床效果

摘要

目的:比较基于全角膜散光和基于角膜前表面散光规划Toric人工晶状体(IOL)植入手术的柱镜度数和轴位治疗年龄相关性白内障合并角膜散光的临床效果.方法:回顾性病例对照研究.选择2015年1月至2016年12月于宁波市眼科医院行白内障超声乳化吸除联合Toric IOL植入的年龄相关性白内障合并角膜散光患者141例(171眼),其中观察组75例(90眼),对照组66例(81眼).观察组采用中央3 mm直径区域的全角膜散光进行手术规划,对照组采用中央3 mm直径区域的前表面角膜散光进行手术规划.检查术后3个月的裸眼远视力(UCDVA)、残余散光、IOL旋转度,视力采用LogMAR视力记录.根据角膜前表面散光与全角膜散光柱镜相差是否≥0.50 D或轴位相差是否≥10°,进一步将2组患者分为散光偏差亚组与散光无偏差亚组.视力、等效球镜度、眼轴长度、角膜散光、残余散光等以(-x)±s进行描述,组间两两比较采用成组t检验.结果:术后3个月,对照组和观察组的平均UCDVA分别为0.10±0.13和0.06±0.12,差异无统计学意义(t=1.35,P=0.18);残余散光分别为(0.63±0.29)D和(0.52±0.22)D,差异有统计学意义(t=2.07,P=0.04);IOL轴位偏离分别为5.6°±3.6°和5.8°±3.8°,差异无统计学意义(t=0.66,P=0.51).术后3个月,观察组的散光偏差亚组的UCDVA优于对照组的散光偏差亚组(t=2.54,P=0.02),残余散光低于对照组的散光偏差亚组(t=3.40,P ＜ 0.001);观察组的散光无偏差亚组与对照组的散光无偏差亚组间UCDVA、残余散光、IOL轴位偏差差异均无统计学意义.结论:根据全角膜散光规划Toric IOL植入的柱镜度数和轴位治疗年龄相关性白内障合并角膜散光患者,其术后临床效果优于只考虑角膜前表面散光计算者.%ABSTRACT Objective: We compared the clinical outcomes of toric intraocular lens (IOL) implantation for treating age-related cataracts associated with either total corneal astigmatism or anterior corneal astigmatism. Methods:In this retrospective clinical control study, 141 patients with age-related cataracts and corneal astigmatism were recruited and divided into an observation group (75 patients, 90 eyes) and a control group (66 patients, 81 eyes). The observation group was established based on a total corneal astigmatism of 3 mm in diameter, and the control group was established based on an anterior corneal astigmatism of 3 mm in diameter. The uncorrected distance vision acuity (UCDVA), residual astigmatism (RA), and IOL rotation three months after the surgery were recorded. The visual acuity was measured as the logarithm of the minimum angle of resolution (LogMAR). An astigmatism-biased subgroup and an astigmatism-unbiased subgroup were established within the observation and control groups according to whether the difference of the cylindrical lens was larger than 0.5 diopter (D) or the difference of the axial view was larger than 10° between the total and anterior corneal astigmatism. The means ± standard deviations (( x-) ± s ) of vision acuity, spherical equivalent, axial length, corneal astigmatism, and RA were determined. Comparisons between groups were based on the independent samples t-tests. Results: Three months after the surgery, the UCDVA values of the control and observation groups were 0.10 ± 0.13 and 0.06 ± 0.12 (LogMAR), respectively. The mean IOL rotations were 5.6° ± 3.6° and 5.8° ± 3.8°, respectively. There were no significant differences between the groups (UCDVA: t=1.35, P=0.18; IOL rotations: t=0.66, P=0.51). The mean RA values for the control and observation groups were 0.63 ± 0.29 D and 0.52±0.22 D, respectively (t=2.07, P=0.04). The mean UCDVA of the astigmatism-biased subgroup was significantly better, and the mean RA was significantly lower than the corresponding values in the control group (UCDVA: t=2.54, P=0.02; RA: t=3.40, P＜0.001). The mean UCDVA, RA, and IOL rotations in the astigmatism-unbiased subgroup and the control group were not significantly different. Conclusions: The clinical outcomes of toric IOL implantation for treating age-related cataracts are better for patients with total corneal astigmatism than those with anterior corneal astigmatism.