Toric人工晶状体矫正中低度角膜规则散光的短期疗效
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摘要
目的评价Toric人工晶状体(intraocular lens,IOL)矫正中低度数角膜规则散光的有效性及其在囊袋内的旋转稳定性。设计回顾性病例系列。研究对象年龄相关性白内障合并中低度角膜规则散光患者59例(94眼)。方法 2017年4月至12月就诊的白内障患者59例(94眼),均行白内障超声乳化联合Toric IOL(型号:AT1BH～AT4BH)植入治疗,将IOL散光轴标记线(最小屈光力方向)与角膜散光最大屈光力方向重合,从而降低全眼残余散光。观察和比较术前及术后3个月的裸眼视力、角膜散光(角膜地形图)、术后全眼残余散光(电脑自动验光)、IOL轴位(裂隙灯检查)及其并发症的情况。主要指标裸眼视力、角膜散光、术后全眼残余散光、IOL轴位、并发症。结果术前及术后3个月角膜散光分别为(1.48±0.50)D和(1.43±0.47)D(Z=-0.49,P=0.62);术后3个月全眼残余散光(0.38±0.29 D)低于术前角膜散光(U=131.50,P<0.01);术后3个月裸眼视力(0.83±0.13)高于术前(0.20±0.11)(Z=-8.69,P<0.01)。术后3个月,术眼IOL轴位与预定轴位的偏差平均2.83°±2.08°,其中轴位偏差≤8°者94眼(100%),轴位偏差≤5°者83眼(88.3%),轴位偏差≤3°者64眼(68.1%)。所有患者在随访期间内均未出现并发症。AT1BH组、AT2BH组、AT3BH组、AT4BH组的患者术后3个月角膜散光均与术前无显著差异(P均>0.05),术后3个月全眼残余散光均低于术前角膜散光(P均<0.05),术后3个月裸眼视力均高于术前裸眼视力(P均<0.05),术后3个月IOL轴位旋转均≤8°。结论 Toric IOL能有效矫正合并角膜规则散光的白内障患者的角膜散光,提高裸眼远视力,并具有良好的旋转稳定性。
Objective To evaluate the efficacy of Toric intraocular lens(IOL) for correcting low and moderate corneal regular astigmatism and its rotation stability in the bag in the cataract patients. Design Retrospective case series. Participants 59 patients(94 eyes) with age-related cataract combined with low or moderate degree of corneal regular astigmatism who visited from April to December 2017. Methods 59 cataract patients(94 eyes) were treated with phacoemulsification combined with Toric IOL(AT1 BH～AT4 BH)implantation. The IOL astigmatism axis marking line(the direction of minimum refractive power) coincides with the direction of maxi-mum refractive power of the corneal astigmatism, thereby reducing residual astigmatism in the whole eye. The visual acuity, corneal astigmatism, total astigmatism, IOL axis, and complications before surgery and 3 months after the operation were observed and compared. Main Outcome Measures The visual acuity, corneal astigmatism, total astigmatism, IOL axis, and complications. Results The corneal astigmatism was(1.48 ±0.50) D pre-operation and(1.43±0.47) D at 3 months postoperatively(Z=-0.49, P=0.62). The residual astigmatism at 3 months after operation(0.38±0.29 D) was lower than the corneal astigmatism in preoperative(U=131.50, P<0.01). The visual acuity(0.83±0.13) after 3 months was higher than preoperative visual acuity(0.20±0.11)(Z=-8.69, P<0.01). At 3 months after the operation, the average deviation between the IOL axis and the predetermined axis was(2.83±2.08) degrees, 100%(94/94 eyes) of which the axial deviation was less than 8 degrees, 88.3%(83/94 eyes) was less than 5 degrees, and 68.1%(64/94 eyes) was less than 3 degrees. No complications occurred during the follow-up period. In group AT1 BH, AT2 BH, AT3 BH and AT4 BH, there was no signifi-cant difference in corneal astigmatism between pre-surgery and after 3 months(all P>0.05); the total residual astigmatism in 3 months after operation was lower than that of preoperative corneal astigmatism(all P<0.05); the uncorrected distance visual acuity in 3 months after operation was higher than that before operation(all P<0.05); and IOL axis of 3 months after operation was less than 8 degrees.Conclusion Toric IOL can effectively correct the low and moderate regular astigmatism of cornea, improve the uncorrected distance visual acuity, and have good rotation stability.
Objective To evaluate the efficacy of Toric intraocular lens(IOL) for correcting low and moderate corneal regular astigmatism and its rotation stability in the bag in the cataract patients. Design Retrospective case series. Participants 59 patients(94 eyes) with age-related cataract combined with low or moderate degree of corneal regular astigmatism who visited from April to December 2017. Methods 59 cataract patients(94 eyes) were treated with phacoemulsification combined with Toric IOL(AT1 BH～AT4 BH)implantation. The IOL astigmatism axis marking line(the direction of minimum refractive power) coincides with the direction of maxi-mum refractive power of the corneal astigmatism, thereby reducing residual astigmatism in the whole eye. The visual acuity, corneal astigmatism, total astigmatism, IOL axis, and complications before surgery and 3 months after the operation were observed and compared. Main Outcome Measures The visual acuity, corneal astigmatism, total astigmatism, IOL axis, and complications. Results The corneal astigmatism was(1.48 ±0.50) D pre-operation and(1.43±0.47) D at 3 months postoperatively(Z=-0.49, P=0.62). The residual astigmatism at 3 months after operation(0.38±0.29 D) was lower than the corneal astigmatism in preoperative(U=131.50, P<0.01). The visual acuity(0.83±0.13) after 3 months was higher than preoperative visual acuity(0.20±0.11)(Z=-8.69, P<0.01). At 3 months after the operation, the average deviation between the IOL axis and the predetermined axis was(2.83±2.08) degrees, 100%(94/94 eyes) of which the axial deviation was less than 8 degrees, 88.3%(83/94 eyes) was less than 5 degrees, and 68.1%(64/94 eyes) was less than 3 degrees. No complications occurred during the follow-up period. In group AT1 BH, AT2 BH, AT3 BH and AT4 BH, there was no signifi-cant difference in corneal astigmatism between pre-surgery and after 3 months(all P>0.05); the total residual astigmatism in 3 months after operation was lower than that of preoperative corneal astigmatism(all P<0.05); the uncorrected distance visual acuity in 3 months after operation was higher than that before operation(all P<0.05); and IOL axis of 3 months after operation was less than 8 degrees.Conclusion Toric IOL can effectively correct the low and moderate regular astigmatism of cornea, improve the uncorrected distance visual acuity, and have good rotation stability.
引文
[1]中华医学会眼科学分会白内障与人工晶状体学组.我国散光矫正型人工晶状体临床应用专家共识(2017年).中华眼科杂志,2017, 53(1):7-10.
[2]宋旭东,郝燕生,鲍永珍,等. Toric人工晶状体植入术有效性和安全性的多中心研究.中华眼科杂志, 2018, 54(5):349-356.
[3]李莉,蓝倩倩,王璐.非球面散光型人工晶状体植入治疗合并角膜散光白内障患者的临床研究.中国临床新医学, 2016, 9(1):1-5.
[4]苏定旺,钟丘,岑志敏,等.白内障超声乳化术3.2mm透明角膜切口术源性散光的分析.国际眼科杂志, 2010, 10(1):58-60.
[5] Gy觟ngy觟ssy B, Jirak P, Sch觟nherr U. Long-term rotational stability and visual outcomes of a single-piece hydrophilic acrylic toric IOL:a 1.5-year follow-up. Int J Ophthalmol, 2017, 10(4):573-578.
[6] Visser N, Bauer NJ, Nuijts RM. Toric intraocular lenses:historical overview, patient selection, IOL calculation, surgical techniques,clinical outcomes, and complications. J Cataract Refract Surg, 2013,39(4):624-637.
[7] Linnola RJ, Werner L, Pandey SK, et al. Adhesion of fibronectin,vitronectin, laminin, and collagen type IV to intraocular lens materials in pseudophakic human autopsy eyes. Part 1:histological sections. J Cataract Refract Surg, 2000, 26(12):1792-1806.
[8] Lombardo M, Carbone G, Lombardo G, et al. Analysis of intraocular lens surface adhesiveness by atomic force microscopy. J Cataract Refract Surg, 2009, 35(7):1266-1272.
[9] Torquetti L. Toric intraocular lens rotation related to the capsulorhexis. J Cataract Refract Surg, 2015, 41(2):483-483.
[10] Garzón N, Poyales F, de Zárate BO, et al. Evaluation of rotation and visual outcomes after implantation of monofocal and multifocal Toric intraocular lenses. J Refract Surg, 2015, 31(2):90-98.
[11] Koshy JJ, Nishi Y, Hirnschall N, et al. Rotational stability of a single-piece Toric acrylic intraocular lens. J Cataract Refract Surg, 2010, 36(10):1665-1670.
[12] Shah GD, Praveen MR, Vasavada AR, et al. Rotational stability of a toric intraocular lens:influence of axial length and alignment in the capsular bag. J Cataract Refract Surg, 2013, 38(1):54-59.
[13] Chang DF. Early rotational stability of the longer Staar toric intraocular lens:fifty consecutive cases. J Cataract Refract Surg,2003, 29(5):935-940.
[14] Miyake T, Kamiya K, Amano R, et al. Long-term clinical outcomes of toric intraocular lens implantation in cataract cases with preexisting astigmatism. J Cataract Refract Surg, 2014, 40(10):1654-1660.
[15] Zhu X, He W, Zhang K, et al. Factors influencing 1-year rotational stability of AcrySof Toric intraocular lenses. Br J Ophthalmol,2016, 100(2):263-268.
[2]宋旭东,郝燕生,鲍永珍,等. Toric人工晶状体植入术有效性和安全性的多中心研究.中华眼科杂志, 2018, 54(5):349-356.
[3]李莉,蓝倩倩,王璐.非球面散光型人工晶状体植入治疗合并角膜散光白内障患者的临床研究.中国临床新医学, 2016, 9(1):1-5.
[4]苏定旺,钟丘,岑志敏,等.白内障超声乳化术3.2mm透明角膜切口术源性散光的分析.国际眼科杂志, 2010, 10(1):58-60.
[5] Gy觟ngy觟ssy B, Jirak P, Sch觟nherr U. Long-term rotational stability and visual outcomes of a single-piece hydrophilic acrylic toric IOL:a 1.5-year follow-up. Int J Ophthalmol, 2017, 10(4):573-578.
[6] Visser N, Bauer NJ, Nuijts RM. Toric intraocular lenses:historical overview, patient selection, IOL calculation, surgical techniques,clinical outcomes, and complications. J Cataract Refract Surg, 2013,39(4):624-637.
[7] Linnola RJ, Werner L, Pandey SK, et al. Adhesion of fibronectin,vitronectin, laminin, and collagen type IV to intraocular lens materials in pseudophakic human autopsy eyes. Part 1:histological sections. J Cataract Refract Surg, 2000, 26(12):1792-1806.
[8] Lombardo M, Carbone G, Lombardo G, et al. Analysis of intraocular lens surface adhesiveness by atomic force microscopy. J Cataract Refract Surg, 2009, 35(7):1266-1272.
[9] Torquetti L. Toric intraocular lens rotation related to the capsulorhexis. J Cataract Refract Surg, 2015, 41(2):483-483.
[10] Garzón N, Poyales F, de Zárate BO, et al. Evaluation of rotation and visual outcomes after implantation of monofocal and multifocal Toric intraocular lenses. J Refract Surg, 2015, 31(2):90-98.
[11] Koshy JJ, Nishi Y, Hirnschall N, et al. Rotational stability of a single-piece Toric acrylic intraocular lens. J Cataract Refract Surg, 2010, 36(10):1665-1670.
[12] Shah GD, Praveen MR, Vasavada AR, et al. Rotational stability of a toric intraocular lens:influence of axial length and alignment in the capsular bag. J Cataract Refract Surg, 2013, 38(1):54-59.
[13] Chang DF. Early rotational stability of the longer Staar toric intraocular lens:fifty consecutive cases. J Cataract Refract Surg,2003, 29(5):935-940.
[14] Miyake T, Kamiya K, Amano R, et al. Long-term clinical outcomes of toric intraocular lens implantation in cataract cases with preexisting astigmatism. J Cataract Refract Surg, 2014, 40(10):1654-1660.
[15] Zhu X, He W, Zhang K, et al. Factors influencing 1-year rotational stability of AcrySof Toric intraocular lenses. Br J Ophthalmol,2016, 100(2):263-268.