CAJ | 학술논문

目的观察术前具有1.00～1.50 D角膜散光的年龄相关性白内障患者行超声乳化联合多焦点人工品状体植入术,采用角膜K值引导的透明角膜双切口方法矫正角膜散光的效果及术后视觉质量,并评价该手术方法的可行性、安全性.方法临床病例对比研究.选取2010年3月至2012年3月在乐山市人民医院眼科就诊的年龄相关性白内障角膜散光≤1.50 D患者共48例(96只眼).依据术前光学相干生物测量仪(IOL-Master)检测角膜散光的结果,将角膜散光在1.00～1.50 D的患者采用最陡散光轴行透明角膜双切口白内障超声乳化联合多焦点人工晶状体植入术,作为观察组41只眼.角膜散光＜ 1.00 D的患者采用最陡散光轴行透明角膜单切口白内障超声乳化联合多焦点人工晶状体植入术,作为对照组55只眼.术后3个月观察角膜散光度变化情况,裸眼远、中、近视力及最佳矫正远、近视力,对比敏感度和问卷调查.结果术后3个月进行两组比较,患者术后角膜散光较术前皆明显降低,差异有统计学意义(P＜0.05)；术后3个月角膜残余散光度数比较差异无统计学意义(P＞0.05)；裸眼和矫正远视力、近视力及中距离视力方面差异无统计学意义(P＞0.05)；术后3个月对比敏感度均位于正常范围内,在低频区和高频区二者的差异无统计学意义(P＞0.05),仅在中频区(6 c/d)差异有统计学意义(P＜0.05),观察组低于对照组；术后3个月脱镜率、夜间视力模糊、眩光和光晕无统计学差异(P＞0.05).结论白内障超声乳化联合多焦点人工晶状体植入术中,采用角膜K值引导的透明角膜双切口矫正1.00～1.50 D角膜散光能获得与多焦点人工晶状体传统适应证范围内患者相同的全程视力和视觉质量,该方法可拓展多焦点人工品状体的适应证范围.
목적 관찰술전구유1.00～1.50 D각막산광적년령상관성백내장환자행초성유화연합다초점인공품상체식입술,채용각막K치인도적투명각막쌍절구방법교정각막산광적효과급술후시각질량,병평개해수술방법적가행성、안전성.방법 림상병례대비연구.선취2010년3월지2012년3월재악산시인민의원안과취진적년령상관성백내장각막산광≤1.50 D환자공48례(96지안).의거술전광학상간생물측량의(IOL-Master)검측각막산광적결과,장각막산광재1.00～1.50 D적환자채용최두산광축행투명각막쌍절구백내장초성유화연합다초점인공정상체식입술,작위관찰조41지안.각막산광＜ 1.00 D적환자채용최두산광축행투명각막단절구백내장초성유화연합다초점인공정상체식입술,작위대조조55지안.술후3개월관찰각막산광도변화정황,라안원、중、근시력급최가교정원、근시력,대비민감도화문권조사.결과 술후3개월진행량조비교,환자술후각막산광교술전개명현강저,차이유통계학의의(P＜0.05)；술후3개월각막잔여산광도수비교차이무통계학의의(P＞0.05)；라안화교정원시력、근시력급중거리시력방면차이무통계학의의(P＞0.05)；술후3개월대비민감도균위우정상범위내,재저빈구화고빈구이자적차이무통계학의의(P＞0.05),부재중빈구(6 c/d)차이유통계학의의(P＜0.05),관찰조저우대조조；술후3개월탈경솔、야간시력모호、현광화광훈무통계학차이(P＞0.05).결론 백내장초성유화연합다초점인공정상체식입술중,채용각막K치인도적투명각막쌍절구교정1.00～1.50 D각막산광능획득여다초점인공정상체전통괄응증범위내환자상동적전정시력화시각질량,해방법가탁전다초점인공품상체적괄응증범위.
Objective To observe the effect of phacoemulsification with paired clear corneal incision guided by K values on the correction of preoperative corneal astigmatism and the visual function after implantation of multifocal intraocular lens,and evaluate the feasibility and security of this surgical method.Methods Forty-eight patients (96 eyes) with age-related cataract and corneal astigmatism≤l.50D were enrolled in this study.According to the preoperative comeal astigmatism measured by IOL-Master,they were divided into two groups; 30 patients (41 eyes) whose preoperative corneal astigmatism was 1.00D to 1.50D,as observation group,37 patients (55 eyes) whose astigmatism less than 1.0D were included in control group.The observation group received the clear comeal incision on the steepest meridian axis guided by K values during phacoemulsification and implanted IQ ReSTOR +3D multifocal intraocular lens,an additional symmetric clear corneal incision was made on the opposite side.And the control group only received the clear corneal incision on the steepest meridian axis guided by K values during phacoemulsification and implanted IQ ReSTOR + 3D multifocal intraocular lens.Three months after surgery,corneal astigmatism change,naked and corrected visual acuity in near-,intermediate-and far-distance,contrast sensitivity and patient questionnaires were observed.Results The mean preexisting astigmatism in the two groups significantly reduced postoperatively (after 3 months).Between the two groups,there were significant statistical differences (P ＜0.05),but there were no significant statistical difference in postoperative residual astigmatism (P ＞0.05).No significant statistical difference existed in uncorrected and corrected visual acuity in near-,intermediate-and far-distance (P ＞0.05).The postoperative contrast sensitivity in the two groups were normal,there was no significant difference in low frequencies and high frequencies (P ＞0.05),only there was statistical difference in medium frequency (P ＜0.05),the observation group lower than those of the control group.There was no statistically significant difference in the off-near glass rate,night blurred vision,glare and halos in two groups.Conclusions The cataract patients with high astigmatism who receive phacoemulsification with paired clear corneal incision guided by K values and implantation of multifocal intraocular lens can obtain good results,such as visual acuity in near-,intermediate-and far-distance,and quality of vision.This surgical method can develop clinical application range of the multifocal intraocular lens.