高度近视白内障合并角膜散光患者植入Toric人工晶状体效果评估

摘要

目的 观察术前伴有规则角膜散光的高度近视合并白内障患者行超声乳化白内障吸除术联合Toric人工晶状体(IOL)植入术后的临床效果及囊袋内旋转稳定性.方法 前瞻性研究.收集32例(47眼)角膜散光均大于1D的高度近视白内障患者(眼轴长度＞25 mm).术前通过生物测量及软件计算确定IOL型号及放置轴位,行超声乳化白内障吸除术,术中将IOL准确放置于目标位置.术后1 d、1周、1个月和3个月充分散瞳后裂隙灯照相,采用Adobe Photoshop软件行IOL轴位分析,记录各组术前、术后裸眼视力(UCVA)、最佳矫正视力(BCVA)、术前角膜散光、预计残留散光、术后实际散光、IOL旋转度数及其他并发症.采用单项有序资料列联表分析和配对t检验.结果 术后3个月,91％患者UCVA大于0.5,显著高于术前BCVA,差异有统计学意义(x2=80.67,P＜0.05).术前平均角膜散光为(2.11±0.83)D,预计残留散光为(0.31±0.26)D,术后3个月残留散光为(0.44±0.35)D,术前、术后散光比较差异有统计学意义(t=12.48,P＜0.05).预计残留散光与术后3个月实际散光度数比较差异无统计学意义(t=1.69,P＞0.05).术后3个月IOL旋转度数为(3.75±1.39)°,其中旋转度数＞5°的有3例(占 6％),无旋转度数超过10°的病例.结论 Toric IOL能有效地矫正高度近视白内障患者的角膜散光,预测性强,且植入后具有良好的旋转稳定性,患者术后获得更好的裸眼远视力.%Objective To assess the clinical outcomes and rotational stabilility of toric intraocular lenses (IOL) for the correction of preexisting corneal astigmatism in cataract patients with myopia.Methods Forty-seven eyes of 32 patients were enrolled in this prospective study.Preoperative corneal astigmatism was more than 1.0 diopter (D) for all eyes.All patients underwent similar phaeoemulsification combined with toric IOL implantation.Uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),preoperative corneal astigmatism,anticipated residual astigmatism,postoperative residual astigmatism and toric lens axis were measured.The postoperative IOL position was assessed at 1 day,1 week,1 month and 3 months using digital pictures under a slit lamp.Data were analyzed using chi-square test and paired t test.Results At 3 months following surgery,91％ of the eyes had 0.5 or better UCVA,much higher than preoperative BCVA (x2=80.67,P＜0.05).Mean preoperative corneal astigmatism was 2.11±0.83 D and postoperative refractive cylinder was 0.47±0.35 D,indicating a significant decrease in refractive cylinder after surgery (t=12.48,P＜0.05).The mean rotation of the toric IOLs was 3.75°±1.39° after 3 months postoperatively.Only 3 eyes had more than 5° of rotation after the operation and none eye had more than 10° of rotation.Conclusion Toric IOLs provide cataract patients with better UCVA,good rotational stability and predictability in the correction of corneal astigmatism.The combined procedure of phacoemulsification and posterior chamber toric IOL implantation is an effective option for the correction of preexisting corneal astigmatism in cataract patients with myopia.