| ［摘要］ 目的 本研究着重就白内障超声乳化术中,同时行角膜边缘切开松解术来矫正术前即存在的较大角膜散光（>1.0 D）的效果做一初步分析。方法 联合手术组在角膜散光最大轴向上用带刻度的金刚刀加做长6 mm、宽1.5 mm角膜缘内1 mm成对松解切口,深度分别为角膜中心厚度的40%（1.0~2.0 D）、60%（~3.0 D）、80%（>3.0 D）。结果 (1)联合手术组术后最佳矫正视力0.02～0.1者2眼,0.1～0.3者4眼,0.3～0.5者16眼,0.5～1.0者31眼。（2）联合手术组术前散光与术后1周、1个月,3个月角膜散光均值经方差分析,各组总体P<0.01,差异有非常显著性。各组组间两两比较,除术后1个月、3个月间P>0.05,差异无显著性外,其余各组间P<0.01。（3）术后3个月联合手术组角膜散光轴向有9眼出现90°±30°偏离。结论 该法可以有效矫正老年性白内障患者术前即将存在的散光,其中对1.0~2.0 D范围散光矫正效果好。术后视力明显提高。
［关键词］ 角膜散光；角膜缘松解术；白内障；手术
Application of astigmatism keratotomy correcting Preexisting astigmatism in cataract surgery
REN Xiaojun,CAI Jinhong,WU Xiubao.Ophthalmology Center of Xiamen,Xiamen 361001,China
［Abstract］ Objective To evaluate effects of the astigmatism keratotomy correcting preexisting astigmatism (>1.0 D)in cataract surgery.Methods A retrospective analysis was performed of 67 cataract patients (100 eyes) without having been suffered injury or performed operation.54 eyes with more than 1.0D astigmatism accepted AK(astigmatism keratotomy) combined with phacoemulsification. 46 eyes with less than 1.0D astigmatism accepted cataract phacoemulsification only. AK with limbus, one 6 mm length incision and a length of 1.5 mm of the diameter was performed on all subjects. A depth of 40% of the central thickness was performed in （1.0~2.0）D ,60% in （2.0~3.0）D ,80% in over 3.0D.The changes in corneal shape and the degrees of astigmatism were analyzed using corneal topography. The parameters also included uncorrected vision,mean radius of corneal curvature, axial misalignment, noncontacted intraocular pressure. The followingup time is 1 week,2 months,3 months in postoperation.Results Uncorrected vision of 47 eyes was over 0.3 after surgery in “combined” group. Analysis of variance showed that the preoperative astigmatism were significantly correlated with the surgical effects in one month and three months of postoperation(P<0.05).Conclusion AK with phacoemulsification is effective and safe in reducing the preexisting astigmatism, especially to (1.0～2.0)D group.
［Key words］ astigmatism keratotomy;cornea;cataract;surgery
白内障是我国目前致盲率第一眼病,目前约占46.1%,随社会人口的不断增加和人口老龄化,患病人数还将不断增加,是一个庞大群体。随人们生活水平的提高,对视力的要求也越来越高,在影响白内障术后视力的诸多因素中（角膜散光,人工晶体的度数、位置,屈光介质,眼底病及术者的手术技巧等）,角膜散光作为原因之一,因其发生率高,越来越引起国内外学者的关注。许多术前即存在较大散光的白内障患者在行白内障摘除及人工晶体植入术后仍需配镜,以解决其视物模糊、视疲劳、旋光等症状,给生活、学习、工作造成诸多不便,降低了生活质量。
角膜散光的矫正分为眼镜矫正和手术矫正。手术矫正已有一百多年历史,适用于配镜无法矫正或无法忍受配镜及接触镜矫正的较大散光。角膜散光的手术矫正方法有多种［1］,如角膜楔状切除术、松弛切开术、角膜表层镜片术、角膜的T形切开、角膜内缝线法、斜方形角膜切开、角膜边缘的热烧灼法、角膜环形切开法、骨胶原物质植入法。本文着重研究白内障超声乳化术中,同时行角膜边缘切开松解术来矫正术前即存在的较大角膜散光（>1.0 D）的手术方式、术后效果,并发症及眼压与散光矫正量的相关性做一初步分析,以求确立一种安全、有效的手术矫正方法,提高白内障患者术后的视功能和生活质量。
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