【摘要】 目的：探讨透明角膜切口白内障超声乳化吸除联合折叠人工晶状体植入术后角膜散光的变化情况。方法：收集年龄相关性白内障患者58例79眼，全部实施透明角膜小切口超声乳化吸除联合折叠人工晶状体植入术。观察术前，术后3d;1wk;1mo视力及角膜散光情况。结果：术后1mo视力提高明显且趋于稳定。平均角膜散光度，术后1mo较1wk明显减少，二者比较差异有显著性。结论：3.2mm透明角膜切口白内障超声乳化吸除联合折叠人工晶状体植入术，术后角膜散光小，视力恢复快，稳定时间短，是理想的白内障手术切口方法
【关键词】 透明角膜切口;超声乳化;折叠人工晶状体;角膜散光
linical observation of corneal astigmatism after phacoemulsification and foldable intraocular lens implantation by clear corneal incisionXiuLing Ye, ZhongChen ZhangDepartment of Ophthalmology, Aerospace Center Hospital of Beijing, Beijing 100049,ChinaAbstractAIM: To explore the change of corneal astigmatism after phacoemulsification associated with fold artiphakia lens embedded with hyaline corneal incision.METHODS: Seventynine eyes of 58 cases were enrolled. All cases underwent similar phacoemulsification combined with fold artiphakia lens implantation.The changes of corneal astigmatism before and 3 days,1 week,1 month after operation were compared as well as visual acuity.RESULTS: One month after operation,visual acuity elevated and became stabilization. Average corneal astigmatism were decreased obviously 1 month compared with 1 week after operation. There was significant difference.CONCLUSION: Phacoemulsification combined with fold artiphakia lens implantation with 3.2mm hyaline corneal incision may be a safe and effective method to treat cataract for smaller corneal astigmatism, quicker visual recovery and shortter stable time.
KEYWORDS: hyaline corneal incision; phacoemalsification; fold artiphakia lens; corneal astigmatism0引言
近年来，随着白内障超声乳化吸除术的广泛发展，手术切口引起的角膜散光越来越引起人们的重视。有研究认为白内障摘出及人工晶状体植入术的切口和缝合对角膜屈光力的影响，是造成术后角膜散光的主要原因[1]。切口越大，术后散光越大[2]。5mm切口白内障超声乳化吸除术后可产生较明显的散光，而3.2mm透明角膜切口白内障超声乳化吸除联合折叠人工晶状体因其切口小、手术便捷且术后散光小、恢复快，得到众多眼科医生的青睐。我院自2005年始开展此技术，现对我院200712/200812住院手术的白内障患者58例79眼就术后角膜散光情况进行了临床观察，报告如下。
1对象和方法
1.1对象
收集200712/200812在我院行透明角膜切口白内障超声乳化吸除联合折叠人工晶状体植入术患者58例79眼，其中男19例28眼，女39例51眼，合并高血压病34例，合并糖尿病22例。合并重度高血压或糖尿病视网膜病变6例8眼。年龄47～87(平均70.6)岁。根据LOCSⅡ标准[3]对白内障晶状体核混浊程度分级：Ⅱ级核20眼，Ⅲ级核29眼，Ⅳ级核30眼。所有手术均由同一手术医生完成。术前测裸眼视力及矫正视力、光定位、色觉、裂隙灯及眼底检查。以TOPCON自动验光仪测量角膜曲率和屈光度，以天津SUOER型眼A/B超测量眼轴，计算人工晶状体度数。均植入日本KS3Ai折叠人工晶状体，展开后光学直径6.0mm，袢长12.5mm。
1.2方法
术前1h滴用复方托吡卡胺滴眼液充分散大瞳孔，术前15min点爱尔卡因眼液(每5min 1次共3次)表面麻醉。以日本产3.2mm MANI穿刺刀自上方角膜缘垂直穿刺，在角膜基质内向视轴方向移行约2.0mm穿刺入前房，以MANI 15°穿刺刀在角膜缘9∶00位作穿刺口，前房内注入黏弹剂，连续环形撕囊，直径5.0～5.5mm，水分离晶状体核，使用美国眼力健White Star超声乳化仪，采用囊袋内劈核技术超声乳化吸除晶状体核，并吸除残留皮质，前房内注入黏弹剂，扩大角膜切口至3.2mm，植入折叠式人工晶状体于囊袋内，吸除前房及囊袋内黏弹剂，以平针头自角膜穿刺口注入BSS液形成前房使切口自然闭合，确认无渗漏。术后3d;1wk;1mo进行裸眼视力及矫正视力、裂隙灯检查，测量角膜曲率，记录角膜最陡径线及垂直径线上的屈光度。
统计学分析：数据经SPSS 11.0统计处理。
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