摘要
目的分析角膜后表面散光(PA)在年龄相关性白内障合并高度角膜散光人群中的分布规律,评估模拟角膜曲率计散光(KA)和总角膜散光(TCA)对散光型人工晶状体(Toric IOL)计算的影响。方法采用系列病例观察研究设计,纳入2016年8月至2017年4月在南通大学附属医院眼科就诊的KA>0.75D的年龄相关性白内障患者181例200眼。所有患者术前均行Petacam检查,记录KA、PA、TCA和角膜前表面散光(AA),统计PA散光度数和轴位的分布。根据AA轴向分为顺规散光组、逆规散光组和斜轴散光组,采用Pearson线性相关分析检测各组PA与AA间各矢量分解值以及KA与TCA间各矢量分解值的相关性,采用配对t检验法分析KA与TCA间各矢量分解值差异性。分析KA、TCA分别计算所得Toric IOL型号和轴向的差异。结果所有散光患者PA矢量平均值为-0.32D×93.1°,其中PA>0.5D者22眼,占11%,PA为逆规散光者163眼,占81.5%。所有散光患者中PA与AA间矢量分解值KP(0)和KP(45)均呈弱相关(r=0.480,P<0.001;r4=0.251,P45<0.001)。顺规散光组,KA和TCA的矢量平均值分别为1.44D×89.6°和1.32D×89.5°,KA>TCA者53眼,占69.7%;逆规散光组KA和TCA的矢量平均值分别为1.30D×153.4°和1.71D×154.4°,KA<TCA者82眼,占87.3%;斜轴散光组KA和TCA的矢量平均值分别为1.13D×122.0°和1.24D×124.2°,KA<TCA者20眼,占66.7%。各不同散光类型组患者KA与TCA的KP(0)比较,差异均有统计学意义(均P≤0.001)。分别用KA和TCA计算Toric IOL的型号及放置的轴位,其中两种方式计算Toric IOL型号不一致者占42.5%,计算轴位不一致者占88.2%。结论在高度角膜散光患者中,PA多为逆规散光,忽略PA将会使部分患者Toric IOL型号的选择和轴位放置产生偏差,对于无法测量PA或TCA的患者,应适当调整ToricIOL型号。
Objective To analysis the distribution of posterior corneal astigmatism(PA)and evaluate the influence of keratometric astigmatism(KA)and total corneal astigmatism(TCA)on the calculation of Toric intraocular lens(Toric IOL)in patients with age-related cataract(ARC)and high corneal astigmatism.Methods An observational study design was adopted.Pentacam was used to measure 200 eyes of 181 patients with ARC and KA>0.75 D in Affiliated Hospital of Nantong University from August 2016 to April 2017.KA,PA,TCA and anterior corneal astigmatism(AA)were recorded.The astigmatism magnitude and axis of PA was studied.The subjects were divided into astigmatism with the rule group,astigmatism against the rule group and oblique astigmatism group according to the axis of AA.The correlations of decomposition values between PA and AA or KA and TCA in each group were analyzed by Pearson linear correlation analysis.The difference of decomposition values between KA and TCA in each group was compared by paired sample t test.The type and axis of Toric IOL were calculated by online formula according to KA and TCA.This study followed the Declaration of Helsinki and written informed consent was obtained from each patient prior to any medical examination.Results The mean astigmatic magnitudes of PA was-0.32 D×93.1°.PA exceeded 0.5 D in 22 eyes(11%).The steepest posterior corneal meridian was vertically aligned in 163 eyes(81.5%).The decomposition value KP(0)and KP(45)of PA were positively correlated with those of AA(r=0.480,P<0.001;r=0.251,P<0.001).The mean astigmatic magnitudes of KA and TCA were 1.44 D×89.6°and 1.32 D×89.5°in astigmatism with the rule group,1.39 D×153.4°and 1.71 D×154.4°in astigmatism against the rule group and 1.13 D×122.0°and 1.24 D×124.2°in oblique astigmatism group.53 eyes(69.7%)had KA higher than TCA in astigmatism with the rule group.82 eyes(87.3%)had KA lower than TCA in astigmatism against the rule group;20 eyes(66.7%)had KA lower than TCA in oblique astigmatism group.There were significant differences in KP(0)between KA and TCA in different astigmatism groups(all at P<0.001).The calculated Toric IOL type were inconsistent in 85 eyes(42.5%)and the calculated axis were inconsistent in 176 eyes(88.2%).Conclusions In patients with high corneal astigmatism,the astigmatism type of PA is mostly astigmatism against the rule.Ignoring the PA can lead to deviation of Toric IOL type selection and axis placement in some patients.For patients who cannot measure PA or TCA,the type of Toric IOL should be adjusted appropriately.
作者
李盼盼
吴坚
薛莹
周婧
张聿剑
管怀进
Li Panpan;Wu Jian;Xue Ying;Zhou Jing;Zhang Yujian;Guan Huaijin(Department of Ophthalmology,Second Affiliated Hospital of Nantong University,Nantong 226001,China;Eye Institute,Affiliated Hospital of Nantong University,Nantong 226001,China)
出处
《中华实验眼科杂志》
CAS
CSCD
北大核心
2019年第6期460-466,共7页
Chinese Journal Of Experimental Ophthalmology
基金
江苏省科技计划项目基金项目(BE2016699)
南通市前沿与关键技术社会民生创新计划基金项目(MS22015072)
"十三五"科教强卫工程南通市青年医学重点人才基金项目(025)
南通市卫健委青年基金项目(WKZL201815).
