【摘要】 目的：研究白内障人群角膜散光分布规律。方法：分析980例（1010眼）白内障患者的角膜地形图。结果：(1)散光度数的大小与年龄呈正相关（r=0.092,P=0.003），随着年龄的增长，散光度数有增大的趋势；而散光度数的大小与性别及左右眼之间没有相关性(P>0.05)；(2)24.8%的白内障患者术前角膜散光<0.50D，而>1.00D的有41.8%；(3)随着年龄的增长，顺规散光所占比例越来越小(由41～50岁的66.7%减少为>90岁的22.2%)，而逆规散光所占比例越来越大（由20.0%～66.7%），而对于斜向散光，则没有很明确的趋势。结论：随着年龄增长，散光度数有增大的趋势；大约40%的白内障患者可能需要矫正散光；随着年龄增长，顺规散光逐渐向逆规散光漂移。
【关键词】 白内障；角膜散光；矫正
The distribution of corneal astigmatism in the patients with cataract
LiPing Wu, YaoHua Sheng, YuLan Wang, XiangYu Ye
Department of Ophthalmology, Xinhua Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai 200092, China
Abstract
AIM: To study the distribution of corneal astigmatism in the patients with cataract.
METHODS: A retrospective analysis was performed of 980 cataract patients (1010 eyes) without having been suffered injury or performed operation. The degree and the axis of astigmatism were analyzed using the corneal topography.
RESULTS: Significant correlations were found between the degree of corneal astigmatism and the age(r=0.092, P=0.003), the older they are, the bigger the degree of astigmatism is. There was no significant correlation between the gender and the degree of astigmatism(P>0.05),and there was no difference between the right eye and the left eye. 24.8% eyes of these patients have less than 0.50D of astigmatism, and exactly 41.8% are more than 1.00D. And the percentage of astigmatism with the rule decreased with the age(from the group of 41～50 years old with 66.7% to the older than 90 with 22.2%),but increased for astigmatism against the rule(from 20.0% to 66.7%) .And there was no trend for oblique astigmatism.
CONCLUSION: In the patients with cataract, the degree of astigmatism increased with the age and more than 40% eyes of them need correct their astigmatism. And the pattern of corneal astigmatism shifts from withtherule to againsttherule astigmatism.
KEYWORDS：cataract; corneal astigmatism; correct
0引言
屈光理念引导的现代白内障手术中，患者对术后视觉质量的要求不断增高。散光是影响术后眼球成像质量的一个重要原因。人眼的散光主要来源于角膜、晶状体以及两者之间的相对位置，由于角膜前表面约占眼睛总屈光力的3/4，白内障摘除后角膜散光成分愈加重要，并会明显影响术后视功能。但是目前国内对白内障人群中角膜散光的分布情况尚未研究清楚，本研究通过大样本观察上海杨浦区白内障患者术前的角膜地形图来分析白内障人群角膜散光的分布规律，从而为临床医师更好的了解白内障人群角膜散光分布情况提供依据，从而选择合理的矫正散光策略。
1对象和方法
1.1对象 选取200701/10于我院行白内障超声乳化和人工晶状体植入手术的住院患者，平均年龄12～94（平均72.3±10.7）岁，男347眼，女663眼；入选标准为：无角膜外伤或手术病史，无角膜瘢痕或其他角膜病变；泪膜分布均匀；无角膜接触镜配戴史；主要仪器设备：角膜地形图仪：humphery（model 900,zeiss公司）。
1.2方法 测量并统计患者术前角膜地形图数据，每眼均重复测量3次，选择最佳的图像进行分析和统计。本研究按Gimbel 方法[1]对散光状态进行分类。顺规散光(with the rule ,WTR) :45°< 散光轴位≤135°；逆规散光(against the rule ,ATR) :散光轴位≤30°或150°< 散光轴位≤180°；斜轴散光(Obilque) :30°< 散光轴位≤45°或135°< 散光轴位≤150°。
表1 各年龄组散光度数分布（略）
表2 各年龄组散光类型分布（略）
统计学分析：应用SPSS 11.5统计软件，相关性分析采用Spearman相关系数r,各年龄组散光度数分布采用交叉分析，各年龄组散光类型分布构成比采用R×C表的卡方检验。
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