白内障摘除术复合性角膜切口矫正术前散光的研究

发布时间：2018-05-19 11:50

本文选题：角膜切口 + 白内障　；参考：《山东大学》2012年硕士论文

【摘要】：[背景及目的]白内障是世界范围内主要的致盲眼病。目前白内障超声乳化吸除联合人工晶状体植入术已成为治疗白内障的主流术式。随着白内障手术技术的日臻完善和患者对术后视觉质量要求的不断提高,现代白内障手术已步入屈光手术的时代。角膜散光是影响白内障患者术后视力恢复和舒适度的一个重要原因,因此尽可能减小白内障术后的角膜散光一直是眼科医生不懈追求的目标。正常情况下角膜处在张力平衡状态,维持着固定形态,具有屈光稳定性；如果角膜出现切口,就会打破这种张力平衡状态,改变角膜的屈光格局,形成新的屈光分布。因此存在通过手术切口来矫正角膜散光的可能性。据文献报道,在角膜最大曲率子午线轴位做角膜松解切口,可以有效的减轻角膜散光。本研究的目的在于探讨白内障超声乳化吸除术中在角膜最大曲率子午线轴位做透明角膜主切口及辅助切口对于矫正白内障患者术前角膜散光的有效性。 [方法]本研究为前瞻性研究。病例均为来自山东大学附属济南市中心医院,术前角膜散光值大于1.5D的年龄相关性白内障患者,共44例(47眼)。术前将患者随机分为2组,实验组(复合性角膜切口组——透明角膜主切口和辅助切口位于角膜最大曲率子午线轴位,主切口与辅助切口方位呈180°)26眼；对照组(右上方透明角膜切口组,主切口位于11：00,辅助口位于3：00,角膜最大曲率子午线为随机轴位)21眼。术前排除患有其它眼科疾病以及影响角膜散光和视力的疾病。所有患者均在3.2mm切口下行白内障超声乳化吸除术联合折叠式人工晶状体植入术。通过记录并比较术前、术后1周、1个月和术后3个月两组角膜平均散光度、裸眼视力、最佳矫正视力,研究两种切口对角膜散光的影响；同时实验组与采用单纯陡峭轴角膜切口矫正散光的文献报道进行比较。 [结果]两组患者术后视力均较术前有明显提高,术后1周和术后3个月,实验组裸眼视力好于对照组裸眼视力,差异有统计学意义(P0.05)；术后3个月两组矫正视力对比差异无统计学意义(P0.05)。实验组术后1周、1个月、3个月的平均角膜散光度分别为1.24±0.66D、1.58±0.71D、1.54±0.71D。对照组术后1周、1个月、3个月的平均角膜散光度分别为3.32±1.89D、2.65±1.08D、2.59±1.02D。术后1周、1个月、3个月实验组角膜散光度均小于对照组,差异有统计学意义(P0.05)。对照组术后1周、1个月、3个月角膜散光度大于术前,差异有统计学意义(P0.05),术后1周与术后1个月、3个月角膜散光度相比,差异有统计学意义(P0.05),术后1个月与3个月角膜散光度相比,差异无统计学意义(P0.05)。实验组术后1周、1个月、3个月角膜散光度小于术前,差异有统计学意义(P0.05),术后1周与术后1个月、3个月角膜散光度相比,差异有统计学意义(P0.05),术后1个月与3个月角膜散光度相比,差异无统计学意义(P0.05)。与国内学者行单纯陡峭轴角膜切口手术的研究相比,复合性角膜切口在角膜散光度的矫正量上更为有效。 [结论]在白内障超声乳化摘除术中,于角膜最大曲率子午线轴位上做透明角膜主切口和辅助切口(主切口与辅助切口方位呈180°),可以更加有效的矫正术前散光。随着术后1周到术后3个月时切口逐渐愈合、水肿消退、组织恢复,角膜屈光状态逐渐达到稳定状态,角膜散光度有一定的回退。精致的3.2mm透明角膜切口可提前(术后1月)进入屈光稳定状态。
[Abstract]:With the improvement of cataract surgery and the improvement of postoperative visual quality , modern cataract surgery has entered the age of refractive surgery . As the cataract surgery technique is perfected and the patient ' s requirements for postoperative visual quality have been improved , modern cataract surgery has entered the era of refractive surgery .
The purpose of this study is to study the effect of the primary incision and the auxiliary incision on the corneal astigmatism before the operation of the maximum curvature meridian axis of the cornea for the correction of the corneal astigmatism in the patients with cataract .

Methods Twenty - four patients ( 47 eyes ) were randomly divided into two groups : experimental group ( compound cornea incision group _ transparent cornea main incision and auxiliary incision in the axial position of maximal curvature meridian of cornea ) , and 26 eyes ( 180 掳 ) in main incision and auxiliary incision .
In the control group ( right upper clear corneal incision group , the main incision was located at 11 : 00 , the auxiliary port was located at 3 : 00 , the maximum curvature meridian of the cornea was the random axial position ) 21 eyes . All patients underwent phacoemulsification and foldable intraocular lens implantation at 3.2mm incision . All patients had corneal mean astigmatism after 1 week , 1 month and 3 months after operation . The effects of two incisions on corneal astigmatism were studied .
At the same time , the experimental group is compared with the literature report that uses simple steep - axis corneal incision to correct astigmatism .

The visual acuity of the experimental group was better than that in the control group after 1 week and 3 months after operation ( P0.05 ) .
There was no significant difference in corneal astigmatism after 1 week , 1 month and 3 months after operation ( P0.05 ) .

Conclusion : In phacoemulsification for cataract , the main incision and auxiliary incision ( 180 掳 of main incision and auxiliary incision ) were made on the axial position of the maximal radius of curvature of cornea .
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

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