小切口非超声乳化白内障手术后角膜曲率变化的分析

摘要

目的：测量小切口非超声乳化白内障手术后角膜曲率的变化,探讨手术源性角膜散光的特点。　　方法：分别测量小切口非超声乳化白内障手术患者99例116眼的术前、术后3 d；1,2 wk；1,3,6 mo；1,2,3 a的角膜水平曲率( horizontal corneal curvature, HCC)和垂直曲率值( vertical corneal curvature,VCC),求出HCC和VCC的术后相对于术前的差值。用统计软件对术后HCC差值和VCC差值进行统计分析。　　结果：术后3d,VCC减少2.01D,HCC增大1.62D,两者之间有显著差异( P<0.001)；术后3 mo内HCC和VCC差值均迅速减小,3mo时VCC差值-0.52D,HCC差值0.46D；3 mo后VCC和HCC差值均缓慢减少,6 mo时VCC差值-0.29D,HCC差值0.29D,两者之间无显著差异( P=0.801)；术后3a,VCC仍较术前小(-0.26D),HCC较术前大(0.25D)。术后各时间点的角膜曲率差值进行配对t检验：术后3d至术后6mo的时间内,VCC和HCC均明显减小(P<0.001),术后6mo 到3a 之间 VCC(P=0.284)和HCC(P =1.000)无明显改变。　　结论：小切口白内障手术术后短期角膜散光较大,手术方式需进一步改进以减少散光。%AIM: To investigate the changes of corneal curvature after non-phacoemulsification in small-incision cataract surgery with intraocular lens implantation and discuss the essence of iatrogenic astigmatism. METHODS: In this study, the horizontal corneal curvature(HCC) and vertical corneal curvature(VCC) of 99 patients (116 eyes) were documented before and after cataract surgery,with the postoperative follow-up of 3d;1, 2wk;1, 3, 6mo; 1, 2, 3a. The difference value of the HCC and the VCC between preoperation and postoperation were calculated and statistically analyzed. RESULTS: The VCC was deceased by 2. 01D, while the HCC was increased by 1. 62D on the 3d after surgery; the difference value of the HCC and VCC were both decreased acutely in the 3mo postoperationly ( the difference value of the VCC was - 0. 52D and HCC was 0. 46D ); the difference value of the HCC and VCC both were decreased mildly after 3mo of postoperation, There was no significant difference between the difference value of HCC (0.29D) and VCC (-0.29D) at 6mo (P=0.801); VCC was still smaller than that of preoperation (-0. 26D), and HCC was larger than that of preoperation (0. 25D) at the 3a. Paired t test was performed in these curvature differences, which both decreased apparently from 3d to 6mo after surgery (P<0. 001), while they stayed still from 6mo to 3a postoperatively ( VCC: P = 0. 284; HCC:P =1.000). CONCLUSION: It remains astigmatism for a short time after small-incision cataract surgery and the treatment requires improvement so as to minimize the astigmatism as much as possible.