CAJ | 학술논문

背景白内障超声乳化术中切口的不同会引起不同的角膜手术源性散光已经被众多研究所证实,影响因素包括切口的长度、位置和形态等,但关于2.2 mm、3.0mm角膜缘切口白内障超声乳化手术引起的手术源性散光,尤其是引起的角膜后表面散光变化的研究国内外鲜有报道. 目的对比经2.2 mm、3.0mm角膜缘切口的白内障超声乳化摘出联合人工晶状体(IOL)植入术后引起的角膜前表面、角膜后表面手术源性散光( SIA)值、总的SIA值及其变化.方法将白内障患者47例71眼分成2.2mm切口组和3.0 mm切口组2个组,分别在角膜曲率最大子午线轴位做2.2 mm、3.0 mm角膜缘切口,行白内障超声乳化摘出联合IOL植入术.术前及术后1d、1周、1个月、3个月应用Pentacam系统测量角膜前表面、角膜后表面曲率及中央角膜厚度.根据角膜前表面平坦轴和陡轴方向的曲率半径及角膜前表面所在的空气和角膜本身的屈光指数计算角膜前表面散光值,以同样的方法计算角膜后表面的散光值,根据所得的角膜前表面、角膜后表面散光值,应用矢量法得出角膜总散光.使用Jaffe/Clayman分析法分别计算2个组患者不同时间点角膜前表面、角膜后表面SIA值和总SIA值,比较术后上述各时间点2个组间及2个组内SIA值的差别.结果术后1d、1周、1个月及3个月2.2mm切口组白内障超声乳化摘出联合IOL植入术后平均角膜前表面、角膜后表面SIA值及总SIA值均低于3.0mm切口组,不同时间点组间的总体比较差异无统计学意义(前表面:P=0.290；后表面:P=0.740；总SIA:P=0.434).2个组术后3个月平均角膜前表面、角膜后表面散光值均明显低于术后1d和术后1周的散光值,差异均有统计学意义(2.2 mm切口组:P=0.020、0.036；3.0 mm切口组:P=0.006、0.023).术后1d时2.2mm切口组和3.0mm切口组术后角膜后表面散光值分别为(0.70±0.43)D和(0.75±0.54)D,而术后1周、1个月和3个月散光值均逐渐减少,与术后1d比较差异均有统计学意义(2.2mm切口组:均P=0.001；3.0 mm切口组:P=O.028、0.044、0.032).2个组术后1周、1个月、3个月的角膜总SIA值均明显低于术后1d值,差异均有统计学意义(2.2mm切口组:P=0.015、0.002、0.002；3.0mm切口组:P=O.049、0.007、0.016).结论 2.2mm和3.0 mm角膜缘切口超声乳化白内障摘出联合IOL植入术相比,前者SIA值相对较小但差异无统计学意义.对两组各个时间点的比较发现,角膜总的SIA值和后表面SIA值变化趋势基本一致,但与角膜前表面SIA值变化趋势不完全一致. 揹景白內障超聲乳化術中切口的不同會引起不同的角膜手術源性散光已經被衆多研究所證實,影響因素包括切口的長度、位置和形態等,但關于2.2 mm、3.0mm角膜緣切口白內障超聲乳化手術引起的手術源性散光,尤其是引起的角膜後錶麵散光變化的研究國內外鮮有報道. 目的對比經2.2 mm、3.0mm角膜緣切口的白內障超聲乳化摘齣聯閤人工晶狀體(IOL)植入術後引起的角膜前錶麵、角膜後錶麵手術源性散光( SIA)值、總的SIA值及其變化.方法將白內障患者47例71眼分成2.2mm切口組和3.0 mm切口組2箇組,分彆在角膜麯率最大子午線軸位做2.2 mm、3.0 mm角膜緣切口,行白內障超聲乳化摘齣聯閤IOL植入術.術前及術後1d、1週、1箇月、3箇月應用Pentacam繫統測量角膜前錶麵、角膜後錶麵麯率及中央角膜厚度.根據角膜前錶麵平坦軸和陡軸方嚮的麯率半徑及角膜前錶麵所在的空氣和角膜本身的屈光指數計算角膜前錶麵散光值,以同樣的方法計算角膜後錶麵的散光值,根據所得的角膜前錶麵、角膜後錶麵散光值,應用矢量法得齣角膜總散光.使用Jaffe/Clayman分析法分彆計算2箇組患者不同時間點角膜前錶麵、角膜後錶麵SIA值和總SIA值,比較術後上述各時間點2箇組間及2箇組內SIA值的差彆.結果術後1d、1週、1箇月及3箇月2.2mm切口組白內障超聲乳化摘齣聯閤IOL植入術後平均角膜前錶麵、角膜後錶麵SIA值及總SIA值均低于3.0mm切口組,不同時間點組間的總體比較差異無統計學意義(前錶麵:P=0.290；後錶麵:P=0.740；總SIA:P=0.434).2箇組術後3箇月平均角膜前錶麵、角膜後錶麵散光值均明顯低于術後1d和術後1週的散光值,差異均有統計學意義(2.2 mm切口組:P=0.020、0.036；3.0 mm切口組:P=0.006、0.023).術後1d時2.2mm切口組和3.0mm切口組術後角膜後錶麵散光值分彆為(0.70±0.43)D和(0.75±0.54)D,而術後1週、1箇月和3箇月散光值均逐漸減少,與術後1d比較差異均有統計學意義(2.2mm切口組:均P=0.001；3.0 mm切口組:P=O.028、0.044、0.032).2箇組術後1週、1箇月、3箇月的角膜總SIA值均明顯低于術後1d值,差異均有統計學意義(2.2mm切口組:P=0.015、0.002、0.002；3.0mm切口組:P=O.049、0.007、0.016).結論 2.2mm和3.0 mm角膜緣切口超聲乳化白內障摘齣聯閤IOL植入術相比,前者SIA值相對較小但差異無統計學意義.對兩組各箇時間點的比較髮現,角膜總的SIA值和後錶麵SIA值變化趨勢基本一緻,但與角膜前錶麵SIA值變化趨勢不完全一緻.
배경 백내장초성유화술중절구적불동회인기불동적각막수술원성산광이경피음다연구소증실,영향인소포괄절구적장도、위치화형태등,단관우2.2 mm、3.0mm각막연절구백내장초성유화수술인기적수술원성산광,우기시인기적각막후표면산광변화적연구국내외선유보도. 목적 대비경2.2 mm、3.0mm각막연절구적백내장초성유화적출연합인공정상체(IOL)식입술후인기적각막전표면、각막후표면수술원성산광( SIA)치、총적SIA치급기변화.방법 장백내장환자47례71안분성2.2mm절구조화3.0 mm절구조2개조,분별재각막곡솔최대자오선축위주2.2 mm、3.0 mm각막연절구,행백내장초성유화적출연합IOL식입술.술전급술후1d、1주、1개월、3개월응용Pentacam계통측량각막전표면、각막후표면곡솔급중앙각막후도.근거각막전표면평탄축화두축방향적곡솔반경급각막전표면소재적공기화각막본신적굴광지수계산각막전표면산광치,이동양적방법계산각막후표면적산광치,근거소득적각막전표면、각막후표면산광치,응용시량법득출각막총산광.사용Jaffe/Clayman분석법분별계산2개조환자불동시간점각막전표면、각막후표면SIA치화총SIA치,비교술후상술각시간점2개조간급2개조내SIA치적차별.결과 술후1d、1주、1개월급3개월2.2mm절구조백내장초성유화적출연합IOL식입술후평균각막전표면、각막후표면SIA치급총SIA치균저우3.0mm절구조,불동시간점조간적총체비교차이무통계학의의(전표면:P=0.290；후표면:P=0.740；총SIA:P=0.434).2개조술후3개월평균각막전표면、각막후표면산광치균명현저우술후1d화술후1주적산광치,차이균유통계학의의(2.2 mm절구조:P=0.020、0.036；3.0 mm절구조:P=0.006、0.023).술후1d시2.2mm절구조화3.0mm절구조술후각막후표면산광치분별위(0.70±0.43)D화(0.75±0.54)D,이술후1주、1개월화3개월산광치균축점감소,여술후1d비교차이균유통계학의의(2.2mm절구조:균P=0.001；3.0 mm절구조:P=O.028、0.044、0.032).2개조술후1주、1개월、3개월적각막총SIA치균명현저우술후1d치,차이균유통계학의의(2.2mm절구조:P=0.015、0.002、0.002；3.0mm절구조:P=O.049、0.007、0.016).결론 2.2mm화3.0 mm각막연절구초성유화백내장적출연합IOL식입술상비,전자SIA치상대교소단차이무통계학의의.대량조각개시간점적비교발현,각막총적SIA치화후표면SIA치변화추세기본일치,단여각막전표면SIA치변화추세불완전일치.
Background The different incisions in phacoemulsification,including the length,location and shape etc.,can cause surgery-induced astigmatism ( SIA ).But the SIA caused by 2.2 mm,3.0 mm corneal limbal incision after phacoemulsification,especially the change of posterior corneal surface astigmatism is still rarely reported. Objective This study was to investigate the anterior,posterior and total corneal SIA and compare their differences between phacoemulsification and foldable intraocular lens (IOL) implantation with 2.2 mm and 3.0 mm corneal limbal incisions. Methods Seventy-one eyes of 47 cases were randomly divided into two groups with matched age,visual acuity and astigmatism degree.Phacoemulsification and IOL implantation with 2.2 mm incision at the steepest corneal meridian was performed on the patients of 2.2 mm incision group,and the same surgery was adopted with 3.0 mm incision as 3.0 mm incision group.Corneal curvature radius and central corneal thickness were measured by Pentacam at 1 day before surgery and 1 week,1 month and 3 months after surgery respectively.The anterior and posterior corneal surface SIAs were calculated according to the flat axis and steep axis of corneal curvature and the air and the cornea refractive index.Based on the anterior and posterior surface SIAs,the total corneal SIA was then calculated using the vector analysis method.Jaffe/Clayman vector method was used to calculate the anterior and posterior and total corneal SIAs in the different time points,and the differences were compared between the two groups.Oral informed consent was obtained from each subject prior to the trial. Results The mean anterior and posterior surface corneal SIAs appeared to be lower in 2.2 mm incision group compared with 3.0 mm incision group at postoperative 1 day,1 week,1 month and 3 months but were not significantly different among groups at various time points ( anterior SIA:P =0.290 ; posterior SIA:P =0.740 ; total SIA:0.434 ).The mean anterior corneal surface SIAs were significantly lower at the postoperative 3 months than those at postoperative 1 day,1 week in both groups(2.2 mm incision group:P=0.020,0.036;3.0 mm incision group:P=0.006,0.023 ).The posterior corneal surface SIAs were (0.70±0.43 ) D and (0.75 ±0.54 ) D at 1 day in 2.2 mm incision group and 3.0 mm inscision group,respectively,and significantly decreased posterior corneal surface SIAs were found in postoperative 1 week,1 month and 3 months compared with 1 day in both groups ( 2.2 mm incision group:all P =0.001 ; 3.0 mm incision group:P=0.028,0.044,0.032).The total corneal surface SIA showed significant differences between 1 day and 1 week,1 month,3 months after surgery ( 2.2 mm incision group:P =0.015,0.002,0.002 ; 3.0 mm incision group:P =0.049,0.007,0.016 ). Conclusions There are no significant differences in the anterior,posterior and total corneal surface SIAs between 2.2 mm and 3.0 mm incisions after phacoemulsification with IOL implantation.The SIA is gradually reduced with the prolongation of postoperative time.