作者：赵婷，王平 作者单位：443001）中国湖北省宜昌市，三峡大学医学院；（443001）中国湖北省宜昌市，三峡大学仁和医院眼科
【摘要】 目的：观察评价AcrySof Toric人工晶状体( IOL)矫正角膜散光的效果及在囊袋内的稳定性。
【关键词】 白内障； toric人工晶状体；散光
Clinical report and experience summary of AcrySof Toric intraocular lens Ting Zhao, Ping Wang China Three Gorges University, Yichang 443001, Hubei Province, China;Department of Ophthalmology, Renhe hospital of China Three Gorges University, Yichang 443001, Hubei Province，China Abstract AIM: To evaluate the clinical effect and the rotational stability of AcrySof Toric intraocular lens (IOL).
METHODS : The type and aimaxis of IOL was calculated using calculator software. The site of incision and aimaxis of IOL was marked before operation. Phacoemulsification was performed and an AcrySof Toric IOL was implanted and rotated into astigmatic axis. Patients were followed up for 13 months. The uncorrected distance visual acuity(UCDVA),best corrected distance visual acuity(BCDVA), uncorrected near visual acuity(UCNVA), best corrected near visual acuity(BCNVA), corneal astigmatism, and toric lens axis were measured. RESULTS: Case 1 after the implantation, UCDVA was 0.3, BCDVA was 0.6，UCNVA was 0.66, BCNVA was 0.66.The corneal astigmatisms were 1.25D and 1.75D. Case 2 UCDVA，BCDVA, UCNVA and BCNVA were＞0.6. The corneal astigmatisms were 0.75D and 1.00D. The rotation of IOLs were within 2 degrees of right eye and left eye.
CONCLUSION: Implantation of AcrySof Toric IOL for correction corneal astigmatism is effective. This IOL showed good rotational stability in the capsular bag.
KEYWORDS: cataract; toric intraocular lens; astigmatism
方法：收集白内障并伴有角膜规则散光的患者，通过生物测量及软件计算人工晶状体型号及放置轴向，采用白内障超声乳化术植入AcrySof Toric IOL，并放置IOL于目标位置。术后随访1～3mo。观察裸眼远视力(UCDVA)、矫正远视力(BCDVA)，裸眼近视力（UCNVA）及矫正近视力（BCNVA）、角膜散光、IOL旋转度，并进行分析。
结果：病例1术后3mo双眼UCDVA 0.3，BCDVA 0.6，UCNVA及BCNVA均为0.66。角膜散光右眼1.25D,左眼1.75D。病例2术后1mo双眼UCDVA，BCDVA，UCNVA，BCNVA均＞0.6。角膜散光右眼0.75D，左眼1.00D。IOL旋转均＜2°。
结论：AcrySof Toric IOL能有效地矫正角膜散光，具有良好的囊袋内稳定性。
0引言 随着生活水平的提高和手术技术的进步，人们对视觉质量的要求也越来越高，白内障手术已从单纯的复明手术进入到了屈光性白内障手术时代。白内障患者中有很多伴有角膜散光，AcrySof Toric IOL（Alcon, Inc.）就是针对角膜散光>0.75D的白内障患者设计的新型屈光型人工晶状体。我们通过对200810/200905在我院植入该散光型人工晶状体的2例4眼患者进行总结分析，评价该人工晶状体的临床效果及囊袋内稳定性。
1对象和方法 1.1对象 病例1，患者卢某，女，56岁。术前检查：右眼裸眼远视力0.02，矫正远视力0.3；左眼裸眼远视力FC/40cm，矫正远视力0.08。外观检查正常，双眼角膜透明，前房清、深，瞳孔圆，虹膜纹理清，双眼晶状体周边皮质点状混浊，眼底正常。电脑检影：右眼10.00DS/3.75DC×12°；左眼10.25DS/2.25DC×180°。角膜曲率右眼K1 44.75 ,ax100°K2 46.50,ax10°；左眼K1 44.75,ax90°K246.50,ax180°。病例2，患者马某，女，40岁。术前检查：右眼裸眼远视力0.05，矫正远视力0.2；左眼裸眼远视力0.02，矫正远视力0.02。外观检查正常，双眼角膜透明，前房清、深，瞳孔圆，虹膜纹理清，双眼晶状体后囊下混浊，眼底正常。电脑检影：右眼4.75DS/2.75DC×178°；左眼4.50DS/2.50DC×6°。角膜曲率右眼K1 45.75,ax160°K2 47.75,ax70°；左眼K1 45.75,ax17°K2 48.50,ax107°。
1.2方法 手术由同一白内障专科医生完成。用手动角膜曲率计及角膜地形图测量角膜曲率，眼部A超确定所需晶状体的球镜度数。将数据输入AcrySof Toric在线计算器确定人工晶状体型号(卢某：右眼SA60T5,左眼SN60T4；马某：右眼SN60T5,左眼SN60T5)和轴位。术前充分散瞳,患者直立坐于裂隙灯前在角膜上标记90°，180°两点。表面麻醉后，患者取仰卧位，用C环在角膜上标记人工晶状体轴位；依术前设计的切口位置，作3.2mm透明角膜切口；前房注入黏弹剂；行直径约5.5mm连续、圆形、居中的环形撕囊(CCCC);BSS液行水分离及水分层；在囊袋内进行超声乳化摘除白内障，并行后囊膜抛光；在前房及囊袋内注入黏弹剂后，用推注器将人工晶状体植入到囊袋内后调整到预置轴位的前20°；彻底冲洗置换眼内的黏弹剂；最终调正人工晶状体轴位，将人工晶状体标记点与预置轴位相重合；用定位钩将人工晶状体轻轻向下按压，使其与后囊膜紧密贴合。术后1，3，7d；1mo检查双眼裸眼远视力、矫正远视力、裸眼近视力、矫正近视力、全眼屈光状态、手动角膜曲率、角膜地形图及术后人工晶状体轴位等。
表1 卢某的视力变化比较（略）
表2 马某的视力变化比较（略）
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