目的 比较在白内障超声乳化联合人工晶状体植入术中不同大小的透明角膜切口引起的术源性散光(surgically induced astigmatism,SIA)差异.方法 收集本科室行白内障超声乳化联合人工晶状体植入术的97例97眼患者资料,53眼为2.8mm透明角膜切口(2.8 mm手术组),44眼为2.2 mm透明角膜切口(2.2 mm手术组).根据术前、术后4周的角膜曲率采用平均数法及质心法(centroid)计算SIA的大小及方向.比较两组手术切口引起的SIA大小差别及切口的稳定性.结果 术后4周,2.8 mm手术组centroid SIA为(0.234±0.423) D@105°,均数SIA为(0.552±0.349)D,其中右眼centroid SIA为(0.174±0.464) D@104°,均数SIA为(0.582±0.392) D;左眼centroid SIA为(0.272±0.382) D@106°,均数SIA为(0.545±0.300)D.术后4周,2.2 mm手术组centroid SIA为(0.108 ±0.417) D@98°,均数SIA为(0.506±0.362)D,其中右眼centroid SIA为(0.145 ±0.404)D@81°,均数SIA为(0.518±0.332) D;左眼centroid SIA为(0.127±0.418) D@120°,均数SIA为(0.516±0.418)D.两组间centroid SIA与均数SIA,及两组间左眼之间、右眼之间、双眼之间centroid SIA与均数SIA的比较差异均无统计学意义(均为P ＞0.05).SIA大于0.5D者合计47例(占48.5％),2.8mm手术组有28例(占52.8％),其中右眼12例(占22.6％)、左眼16例(占20.5％);2.2 mm手术组有19例(占43.2％),其中右眼10例(占22.7％)、左眼9例(占20.5％);两组之间SIA大于0.5D的比例及左右眼之间SIA大于0.5D的比例差异均无统计学意义(均为P＞0.05).结论 2.2mm与2.8mm透明角膜切口造成的SIA无明显区别,SIA轴位与切口位置关系密切,多为切口垂直方向,但2.2mm切口较2.8mm切口更为稳定.%Objective To evaluate the surgically induced astigmatism (SIA)caused by coaxial phacoemuisification and intraocular lens (IOL) implantation with different clear corneal incision.Methods Clinical data of 97 patients 97 eyes underwent phacoemulsification and IOL implantation with 2.2 mm (2.2 mm group,44 eyes) or 2.8mm (2.8 mm group,53 eyes) clear corneal incisions were retrospectively reviewed.The corneal curvature were measured before and four weeks after the surgery.Then SIA were calculated,followed by analysis of the differences in mean SIA and centroid SIA between the 2.2 mm and 2.8 mm groups.Results At 4 weeks after surgery,the centroid and mean SIA of the 2.8 mm group was (0.234 ± 0.423) D@105° and (0.552 ±0.349) D,respectively;the corresponding data was (0.174 ± 0.464) D@104° and (0.582 ±0.392) D in the right eyes,and (0.272 ±0.382)D@106° and (0.545 ±0.300) D in the left eyes,respectively.At 4 weeks after surgery,the centroid and mean SIA of the 2.2 mm group was (0.108 ±0.417)D@98°and (0.506 ±0.362) D,respectively;the corresponding data was (0.145 ±0.404)D@81° and (0.5182 ±0.332)D in the right eyes,and (0.127 ± 0.418) D@120° and (0.516 ± 0.418) D in the left eyes,respectively.There was no significant difference in centroid SIA and mean SIA,centroid SIA and mean SIA of the right and left eyes,as well as both eyes between the two groups (all P＞0.05);Atotal of 47 patients (48.5％) had SIA greater than 0.5 D,and 28 patients (52.8％) were in the 2.8 mm groups,including 12 patients (22.6％) in the right eyes and 16 patients (20.5％) in the left eyes;as well as 19 patients (43.2％) in the 2.2 mm group,including 10 patients (22.7％) in the right eyes and 9 patients (20.5％) in the left eyes.There was no significant difference in the proportion of SIA greater than 0.5 D and the proportion of SIA between the left and right eyes greater than 0.5 D between the two groups (all P ＞ 0.05).Conclusion The mean SIA and centroid SIA are not statistically different in the 2.2 mm group than in the 2.8 mm group,but SIA were more stable in the 2.2 mm group than in the 2.8 mm group.The axis of the SIA were closely related to the position of the incisions,which were the vertical direction of the incisions.
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