【摘要】 目的 探讨小切口超声乳化白内障吸除联合后房型人工晶状体植入手术后角膜散光情况及手术性散光度的变化。方法 对38例（38只眼)白内障患者行上方巩膜倒眉状小切口超声乳化白内障吸除联合人工晶状体植入手术。分别于术前，术后1 d、1个月及3个月使用角膜地形图仪及自动屈光仪进行角膜散光情况检测。结果 平均角膜散光度术后1 d、1个月及3个月分别为（1.10±0.71）、（1.08±0.66）及（0.87±0.55） d；术后3个月与术前比较差异无显著性(P＞0.05)。平均手术性散光度术后1 d、1个月及3个月分别为（1.37±1.03）、（1.24±0.93）及（1.04±0.75） d；术后3个月与术后1 d比较差异有显著性（P＜0.05)。结论 上方巩膜倒眉状无缝线小切口对术后角膜散光影响小；将手术性散光的度数及轴位变化进行矢量分析，可综合评价手术致角膜屈光状态的改变；角膜地形图可准确反映角膜曲率变化，对评价白内障手术后角膜散光变化具有重要的临床意义。
Analysis of postoperative astigmatism after phacoemulsification with intraocular lens implantation
ZHANG Qi, SHENG yaohua, LI Zengqi.
(Department of 0phthalmology, Xing Hua Hospital, Shanghai Second Medical university, Shanghai 200092, China)
【Abstract】 Objective To study the corneal astigmatism and the changes of surgically induced astigmatism after phacoemulsification with intraocular lens (IOL) implantation. Methods Thirty-eight eyes of 38 patients treated with phacoemulsification through a superior inversed frown shaped scleral incision were examined by corneal topography and auto-ref-keratometer preoperatively, one day, one month and three months postoperatively. ResultsThe postoperative corneal astigmatism at one day, one month and three months were(1.10 ±0.71), (1.08±0.66) and (0.87±0.55) D respectively. There was no statistic significance between the postoperative astigmatism at three months and at preoperative one day (P＞0.05). The mean surgically-induced astigmatism at postoperative one day, one month and three months were (1.37±1.03), (1.24±0.93) and (1.04±0.75)D respectively. There was significant difference between the astigmatism at three months and at one day postoperatively (P＜0.05). conclusions The superior inversed frown shaped scleral small incision with no suture has little effect on corneal astigmatism. Vector analysis can systemically evaluate surgically induced astigmatism. The results of corneal topography are more reliable to reflect changes in corneal curvature than that of auto-ref-keratometer, and corneal topography has more important clinical value in evaluating surgically induced astigmatism.
【Key words】 Phacoemulsification; Astigmatism； Surgically induced astigmatism
角膜散光是白内障手术后影响视力恢复的重要原因之一，尤其近年来随着超声乳化手术的广泛开展，因手术引起的角膜散光对手术效果的影响日益受到临床医生的重视。我们采用上方巩膜倒眉状无缝线小切口(弦长5.5 mm)行超声乳化白内障吸除联合后房型人工晶状体植入手术，并对手术前、后术眼散光情况进行分析。
资料和方法
一、研究对象
收集1998年9～12月在我院以上方巩膜倒眉状无缝线小切口行超声乳化白内障吸除联合后房型人工晶状体植入手术患者38例(38只眼),其中男18例（18只眼），女20例（20只眼）；年龄40～82岁，平均67岁。术前视力眼前手动至0.2。
二、手术方法
按白内障摘除手术常规进行术前准备及麻醉［1］。做以上方穹窿部为基底的球结膜瓣，手术区电凝止血，于巩膜12点钟方位做倒眉状切口，弦长5.5 mm，深达1/2巩膜厚度，顶点距角膜缘1.5 mm，两端距角膜缘3 mm,用巩膜板层分离刀在巩膜内做隧道至透明角膜内1 mm，用3.2 mm穿刺刀进入前房，15°前房穿刺刀于角膜缘3及11点钟方位做边孔以备术中使用。前房内注入粘弹性物质，行直径6 mm的连续环形撕囊，水分离，超声乳化晶状体核，采用灌注系统自动吸出残留皮质。5.5 mm穿刺刀扩大切口，将人工晶状体植于囊袋内。吸出前房内粘弹性物质，边孔注水维持前房深度。切口无需缝合自动闭合，烫合球结膜瓣。手术由专人完成。术中及术后无并发症发生。
三、检查方法及仪器
术前、术后1 d及术后1、3个月由专人重复测量术眼的角膜地形图(采用美国Zeiss公司产HumphreyModel900角膜地形图仪)和角膜曲率(采用日本Canon公司产RK-3型自动屈光仪)，选择最佳图像进行分析。
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