摘要：
目的 系统比较散光矫正型人工晶状体(Toric IOL)与角膜切口术式矫正白内障患者低中度角膜散光的效果及安全性.方法 Meta分析.于2018年4至6月通过外文数据库MEDLINE、EMBASE、EBSCO、ScienceDirect、Trip Database、Ovid,以及中文数据库中国知网、万方数据库检索同行评议文献.纳入标准为比较白内障摘除术中植入Toric IOL与角膜切口术式矫正低中度散光的随机对照试验.应用Review Manager 5.3软件,以平均差(MD)、风险比(RR)分别衡量计量及计数资料的效应量,设置95％置信区间(95％CI),使用随机效应模型对术后最小分辨角对数(LogMAR)未矫正视力(UCVA)、残余散光及并发症数据进行合并.结果 12篇文献被纳入,其中包含330只眼植入Toric IOL,336只眼植入非Toric IOL联合角膜切口术式.Meta分析结果示Toric IOL植入术后LogMAR UCVA优于角膜切口术式,差异有统计学意义(MD:-0.05;95％CI:-0.08～-0.02;P<0.01).Toric IOL植入术后残余散光度数低于角膜切口术式,差异有统计学意义(MD:-0.33 D;95％CI:-0.48～-0.18 D;P<0.01).两种散光矫正方法术后并发症的发生风险差异无统计学意义(RR:0.45;95％CI:0.07～2.95;P=0.40).结论 白内障摘除术中Toric IOL植入比角膜切口术式能更有效地矫正低中度散光,且更好地恢复术后视力.两种散光矫正方法在术后并发症的发生风险上相似.%Objective To systematically compare the effects of Toric intraocular lens (IOL) implantation and corneal incisional procedures on the correction of astigmatism during cataract surgery . Methods A peer-reviewed literature search was implemented in MEDLINE, EMBASE, EBSCO, ScienceDirect, Trip Database, Ovid, and the Chinese databases including CNKI and Wanfang Data. The inclusion criteria were randomized controlled trials (RCTs) that compared the Toric IOL implantation and the corneal incisional procedures to correct low and moderate astigmatism during cataract surgery. The mean difference (MD) and the relative risk were respectively used to describe the effect sizes of continuous data and nominal data with a confidence interval (CI) of 95％. The random effects model was applied to pool the data including postoperative uncorrected visual acuity, residual astigmatism and surgical complications by Review Manager 5.3. Results A total of 12 RCTs were included in this study, including 330 eyes implanted with Toric IOLs and 336 eyes with non-Toric IOLs combined with corneal incisional procedures to correct astigmatism. According to the types of corneal incisions, the included RCTs were divided into three groups: limbal relaxing incision group, opposite clear corneal incision group, and astigmatic keratotomy group. Meta-analysis showed that postoperative logarithm of the minimum angle of resolution uncorrected visual acuity was significantly better in eyes implanted with Toric IOLs than those with corneal incisional procedures (MD, -0.05; 95％ CI, -0.08 to -0.02; P<0.01), and the residual astigmatism was significantly lower in eyes implanted with Toric IOLs (MD,-0.33 D;95％CI,-0.48 to-0.18 D;P<0.01). There was no significant difference in the risk of surgical complications between the Toric IOL implantation and the corneal incision correction for astigmatism (relative risk, 0.45;95％CI, 0.07 to 2.95;P=0.40). Conclusions The current evidence suggests that Toric IOL implantation is more effective in correcting astigmatism than corneal incisional procedures during cataract surgery and shows better postoperative visual acuity. However, they are similar in the risk of postoperative complications.
