摘要
目的:评价合并角膜散光的白内障患者植入平板襻Toric人工晶状体(IOL)后的散光矫正效果和稳定性。方法:前瞻性临床研究。连续性纳入2022年11月至2023年6月在常州市第三人民医院眼科就诊并接受白内障超声乳化术联合平板襻Toric IOL植入术、术前角膜散光≥0.75 D的白内障患者72例(72眼)。记录患者术后1 d、1周、1个月、3个月的裸眼视力(UCVA)和最佳矫正视力(BCVA)、残余散光(RAS),并与术前进行比较,同时记录术后1周、1个月、3个月的Toric IOL旋转度数,分析IOL旋转度数与RAS、眼内压(IOP)、眼轴长度(AL)、前房深度(ACD)、白到白(WTW)距离的相关性。于术后3个月行患者满意度调查。采用配对样本t检验评估术前和术后数据之间的差异,采用重复测量方差分析方法评估患者术后各时间点IOL旋转度数、RAS和视力的变化,采用Pearson相关分析方法评估连续变量之间的关系。结果:排除2例失访患者,共计有效纳入患者70例(70眼),其中男33例(33眼),女37例(37眼),年龄为(72.7±8.7)岁,术前散光为(1.51±0.55)D。术后UCVA、BCVA及RAS与术前相比,差异均有统计学意义(均P<0.05)。术后1周、1个月、3个月的Toric IOL旋转度数分别为(4.22±2.75)°、(3.68±2.73)°、(3.58±2.26)°。术后1个月与1周的IOL旋转度数差异有统计学意义(F=2.43,P=0.029),而术后1个月与3个月的IOL旋转度数差异无统计学意义(P>0.05)。术后1周、1个月、3个月IOL旋转度数与RAS呈正相关(r=0.38,P=0.004;r=0.43,P=0.001;r=0.40,P=0.021),与IOP、AL、ACD、WTW距离之间无相关性(均P>0.05)。术后视远脱镜率达94%,97%的患者对术后效果非常满意或满意。术中及术后未发生危及视觉的严重并发症,随访过程中未发现有患者需要进行IOL调位。结论:平板襻Toric IOL能有效矫正散光并改善合并角膜散光的白内障患者的视力,在术后早期便能展现出良好的旋转稳定性能。
Objective:To evaluate the efficacy and stability of plate-haptic toric intraocular lenses(IOLs)in patients with cataract and corneal astigmatism.Methods:This was a prospective clinical study.A total of 72 cataract patients(72 eyes)with preoperative corneal astigmatism of≥0.75 D who underwent phacoemulsification combined with plate-haptic toric IOL implantation at Changzhou Third People's Hospital from November 2022 to June 2023 were continuously enrolled in this study.Postoperative uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),and residual astigmatism(RAS)were observed at 1 day,1 week,1 month,and 3 months after surgery.The results were compared with preoperative data.The degree of IOL rotation was observed at 1 week,1 month,and 3 months postoperatively.The correlations between IOL rotation and RAS,intraocular pressure(IOP),axial length(AL),anterior chamber depth(ACD),and white-to-white(WTW)distance were analyzed.Patient satisfaction was evaluated 3 months postoperatively.Paired sample t-test was used to assess differences between preoperative and postoperative data,repeated measures analysis of variance was employed to assess changes in IOL rotation,RAS,and visual acuity at various postoperative time points,and Pearson correlation analysis was conducted to assess the relationships between continuous variables.Results:Two patients lost to follow-up were excluded.Ultimately,a total of 70 patients(70 eyes)were included,with 33 males(33 eyes)and 37 females(37 eyes).The mean age was 72.7±8.7 years and the mean preoperative astigmatism was 1.51±0.55 D.Postoperative UCVA,BCVA,and RAS were statistically different from the preoperative data(all P<0.05).The mean degrees of toric IOL rotation at 1 week,1 month,and 3 month postoperatively were 4.22±2.75°,3.68±2.73°,and 3.58±2.26°,respectively.The difference between postoperative 1 month and 1 week IOL rotation was statistically significant(F=2.43,P=0.029),whereas the difference between postoperative 1 month and 3 months IOL rotation was not(P>0.05).IOL rotation was positively correlated with RAS at 1 week,1 month and 3 months after surgery(r=0.38,P=0.004;r=0.43,P=0.001;r=0.40,P=0.021).No significant correlations were found between toric IOL rotation and IOP,AL,ACD,or WTW distance(all P>0.05).The postoperative spectacle independence rate for distance vision was 94%.Patient satisfaction was reported as high or very high by 97%of patients.No eye-threatening complications were observed intraoperatively or postoperatively,and no patients required IOL repositioning during follow-up.Conclusion:Plate-haptic toric IOL can effectively correct astigmatism and improve visual acuity in cataract patients with corneal astigmatism,demonstrating good rotational stability in the early postoperative period.
作者
高昕
周栋
孙倬
邹茜
江一
朱婕
刘志南
邓国华
Xin Gao;Dong Zhou;Zhuo Sun;Xi Zou;Yi Jiang;Jie Zhu;Zhinan Liu;Guohua Deng(Changzhou School of Clinical Medicine,Nanjing Medical University,Changzhou 213000,China;Department of Ophthalmology,Changzhou Third People's Hospital,Changzhou 213000,China)
出处
《中华眼视光学与视觉科学杂志》
CSCD
北大核心
2024年第11期853-860,共8页
Chinese Journal Of Optometry Ophthalmology And Visual Science
基金
南京医科大学常州医学中心科研创新项目(CMCB202225)
