目的 比较白内障超声乳化术中透明角膜切口位置对角膜前表面波前像差和散光的影响.方法 前瞻性病例对照研究.选择2007年8月至2008年1月期间因年龄相关性白内障行透明角膜切口白内障超声乳化手术患者46例(62眼),根据透明角膜切口位置的选择分为两组:在最大角膜屈光度子午线方位做透明角膜切口的为试验组,24例(32眼);不论散光轴向在哪个方位均做上方11点方位透明角膜切口的为对照组,22例(30眼).在术前及术后1周、1个月、3个月行医学验光及角膜地形图检查,对视力、散光、像差等数据行重复设计的方差分析.结果 两组患者的最佳矫正视力在术后1周、1个月和3个月3个时间点的比较差异均无统计学意义(P＞0.05).试验组术后l周、1个月和3个月角膜散光量明显小于术前(P＜0.05).试验组术后1周5.0 mm及6.0 mm角膜分析直径的前表面球差与术前相比明显变小(P＜0.05);术后1个月,4.0 mm、5.0 mm及6.0 mm角膜分析直径的前表面总高阶像差、彗差及三叶草像差,5.0 mm及6.0 mm角膜分析直径的前表面球差与术后1周相比明显变大(P＜0.05);术后3个月,4.0 mm、5.0 mm及6.0 mm角膜分析直径的角膜前表面三叶草像差与术后1个月相比明显变小(P＜0.05).在4.0 mm、5.0 mm及6.0 mm角膜分析直径,试验组术后1个月角膜前表面彗差轴向、术后1个月及术后3个月三叶草像差轴向,对照组术后3个月彗差轴向、术后1个月及3个月三叶草像差轴向与术前相比,均明显向角膜切口方位旋转(P＜0.05).结论 按最大角膜屈光度子午线方位做透明角膜切口可以减少角膜散光.早期角膜前表面球差变小,3个月时,各项高阶像差均恢复至术前水平,但彗差和三叶草像差轴向向切口方向旋转.%Objective To compare the changes of wavefront aberrations of the corneal anterior surface between different clear corneal incision position (incision on the steepest corneal meridian and incision on the superior position) in phacoemulsification. Methods Forty-six patients (62 eyes) were selected and divided into control group (incision on the superior position, 32 eyes of 24 patients)and test group (incision on the steepest corneal meridian, 30 eyes of 22 patients) according to the position of incision. Examinations of the best corrected visual acuity (BCVA) and corneal topography were carried out before cataract surgery and 1 week, 1 month, 3 months after surgery. Results The differences of BCVA (logMAR) between the two groups before cataract surgery and 1 week, 1 month,3 months after surgery were not significant (P＞0.05). The corneal astigmatism in test group 1 week,1 month and 3 months postoperative were significantly smaller than those of preoperation (P＜0.05).the corneal spherical aberrations (diameter at 5.0 mm and 6.0 mm) in test group 1 week postoperative were significantly smaller than those of preoperations (P＜0.05), the corneal total higher-order wavefront aberrations (HOA) (diameter at 4.0 mm, 5.0 mm and 6.0 mm), coma(diameter at 4.0 mm, 5.0 mm and 6.0 mm), spherical aberrations (diameter at 5.0 mm and 6.0 mm) and trefoil (diameter at 4.0 mm,5.0 mm and 6.0 mm) in test group 1 month postoperative were significantly larger than those of 1 week postoperative (P＜0.05), the corneal trefoil (diameter at 4.0 mm, 5.0 mm and 6.0 mm) in test group 3 months postoperatively were significantly smaller than those of 1 month postoperative (P＜0.05).The axial direction of corneal coma and trefoil in test group and control group 1 month and 3 months postoperative turned to the incision direction obviously. Conclusion The study shows that eyes with incision on the steepest corneal meridian can reduce the corneal astigmatism, and the size and orientation of corneal higher-order wavefront aberrations.
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