不同切口矫正白内障超声乳化摘除术前角膜散光的疗效评价
发布时间：2019-06-08 18:24
【摘要】： 白内障是全球主要致盲眼病之一,在我国亦居致盲眼病的首位。迄今为止,手术是目前唯一有效的治疗方法。白内障超声乳化摘除联合折叠型人工晶状体植入术是当今最主流的手术方式,具有切口小、手术时间短及术后视力恢复好等优点。但随着白内障手术技术及设备的提高改进,白内障手术已不仅仅停留在简单的复明阶段,更佳的术后视觉效果已成为广大医生和患者的追求。研究表明,患者术前存在的角膜散光及手术源性散光是影响术后视力的重要因素。针对这一情况,在行白内障超声乳化摘除手术时,我们试图通过采取不同的手术切口,或同时联合不同的角膜散光矫正术,来矫正患者术前已存在的角膜散光,从而降低或消除术前角膜散光,力求取得更佳的术后视功能,最终达到提高患者视觉质量的目的。 目的: 对行超声乳化白内障摘除联合折叠型人工晶状体植入术的患者,根据术前角膜地形图检查显示的角膜散光状态,选择不同手术切口,评价其对术前角膜散光的矫正效果,达到提高视觉质量的目的。 方法: 收集2008年9月至2009年8月在我院行白内障超声乳化摘除联合折叠型人工晶状体植入术的年龄相关性白内障患者63例(77眼),术前及术后1周,1月,3月常规查角膜地形图,按术前角膜散光程度分为3组(A组、B组、C组),每组患者选择不同手术切口。 A组:17例(22眼):术前角膜散光≤1.0D,手术切口为11:00钟位3.0mm透明角膜切口,3:00钟位角膜缘内做辅助切口。 B组:29例(35眼):术前角膜散光1.0D～2.0D,分为2组(B1组、B_2组),B_1组:14例(18眼)手术切口为角膜最陡峭子午线上的透明角膜切口,辅助切口与主切口成120°夹角,B2组:15例(17眼)手术切口选择同A组。 C组:17例(20眼):术前角膜散光2.0D,分2组(C1组、C2组),C1组:9例(10眼)首先完成同A组的手术操作,术毕做垂直于角膜最陡峭子午线的成对“T”切口,C2组:8例(10眼)手术同A组。 术中均植入Rayner折叠型人工晶状体。观察患者术后1周,1月,3月的裸眼视力、角膜散光、手术源性角膜散光及散光轴向的变化情况,并进行统计学分析。 结果: 1、各组术后裸眼视力情况 各组病例裸眼视力术后较术前均有大幅度提高。B1组与B2组裸眼视力比较,术后1周差别无统计学意义(p0.05),1月、3月差别有统计学意义(p0.01),B1组优于B2组;C1组与C2组裸眼视力比较,术后1周差别无统计学意义(p0.05),1月、3月差别有统计学意义(p0.01),C1组优于C2组。 2、各组术后角膜散光情况 A组角膜散光术后1周、1月、3月与术前相比差别均无统计学意义(p0.05)。B1组患者的角膜散光术后1周、1月、3月较术前均减小,与术前比较差别有统计学意义(p0.05, p0.01, p0.01),B1组与B2组平均角膜散光3个时间点比较,术后1周差别无统计学意义(p0.05),术后1月、3月差别有统计学意义(p0.01),B1组角膜散光低于B2组。C1组患者的角膜散光术后1周、1月、3月较术前均减小,与术前比较差别有统计学意义(p0.01),术后1周、1月、3月C1组与C2组平均角膜散光比较,差别有统计学意义(p0.05, p0.01, p0.01),C1组角膜散光低于C2组。 3、各组术后手术源性散光的大小 各组术式均产生一定的手术源性散光,随时间推移手术源性散光逐渐减小,各组手术源性散光术后1周与1月比较,1月与3月比较差别均无统计学意义(p0.05)。B1组与B2组各时间点手术源性散光比较差别均无统计学意义(p0.05),C1组与C2组各时间点手术源性散光比较差别均无统计学意义(p0.05)。 4、各组术后散光轴向的改变 各组角膜散光轴术后1周向顺规散光改变,术后1月逐渐向逆规散光改变,但构成比比较,各组术后1周与1月,1月与3月差别均无统计学意义(p0.05)。B1组与B2组各时间点散光轴向构成比比较,差别无统计学意义(p0.05),C1组与C2组各时间点散光轴向构成比比较,差别无统计学意义(p0.05)。 结论: 1、术前角膜散光1D的白内障患者,行3mm透明角膜切口超声乳化术,角膜散光度数无明显变化。 2、术前角膜散光1.0D～2.0D的白内障患者,选择位于角膜最陡峭子午线上的透明角膜切口可以部分矫正术前散光。 3、术前角膜散光2.0D的白内障患者做垂直于角膜最陡峭子午线的成对“T”切口,能有效地矫正术前角膜散光。
[Abstract]:Cataract is one of the main causes of blindness in the world. So far, surgery is the only effective way to treat. Cataract phacoemulsification and foldable intraocular lens implantation is the most mainstream operation in the present day. It has the advantages of small incision, short operation time and good recovery of vision after operation. However, with the improvement of the technique of cataract surgery and the improvement of the equipment, the cataract surgery has not only stayed in a simple reming stage, and the better postoperative visual effect has become the pursuit of a large number of doctors and patients. The study shows that the pre-operative corneal astigmatism and surgical-derived astigmatism are important factors that affect the postoperative visual acuity. In response to this, we have attempted to correct pre-operative corneal astigmatism by taking different surgical incisions or, at the same time, in combination with different corneal astigmatism, to reduce or eliminate pre-operative corneal astigmatism, And the aim of improving the visual quality of the patient is finally achieved. Objective: To study the corneal astigmatism status of patients with cataract extraction combined with foldable intraocular lens implantation, and to select different surgical incisions according to the pre-operative corneal topography. the correction effect of the astigmatism is improved, visual quality Methods:63 cases (77 eyes) of age-related cataract with cataract phacoemulsification and foldable intraocular lens implantation in our hospital from September 2008 to August 2009 were collected. In the week, January and March, the corneal topography was examined and divided into 3 groups (group A, group B, C) according to the degree of astigmatism before operation. Group), different operative incisions were selected for each group. Group A:17 (22 eyes): pre-operative corneal astigmatism, 1.0 D, surgical incision of 11:00, and a clear angle of 3.0 mm Incision of the membrane,3:00, the secondary incision in the limbal. Group B:29 (35 eyes): the pre-operative corneal astigmatism was 1.0D-2.0D, divided into two groups (group B1, group B _ 2), and group B _ 1:14 (18-eye) surgical incision was the most steep meridian of the cornea. Clear corneal incision, the auxiliary incision is 120 掳 with the main incision Angle, B2 group:15 (17 eyes) surgical incision and group A. Group C:17 (20 eyes): pre-operative corneal astigmatism of 2.0D, partial group 2 (C1 group, C2 group), C1 group:9 (10 eyes) first completed the operation of the same group, and it was made to be perpendicular to the most steep meridian of the cornea. T " cut, C2 group:8 (10 The patients with the same group A were implanted with the Rayner's foldable intraocular lens. The visual acuity and the angle of the naked eyes at 1 week, January and March after the operation were observed. membrane astigmatism , surgical-derived corneal astigmatism and astigmatism Axial change and statistical analysis. Results:1. There was a significant increase in the visual acuity of the naked eyes in each group after the operation. The visual acuity of the naked eyes in the group B1 and the group B2 was not statistically significant (p0.05), the difference of the 1-month and the third month was statistically significant (p0.01), the B1 group was better than that of the B2 group, and the visual acuity of the naked eyes in the C1 group and the C2 group. Comparison,1-week difference after surgery No statistical significance (p0.05) There was no significant difference (p0.01) in the first month and the third month, and the C1 group was superior to that of the C2 group. The average corneal astigmatism in the B1 group and the B2 group was compared with the average corneal astigmatism for 1 week, the first week, the first month and the third month after the astigmatism, and the average corneal astigmatism in the B1 group and the B2 group was compared with the mean corneal astigmatism for 1 week. The difference was not significant (p0.05), the difference was statistically significant (p0.01) in the first month and the third month after the operation, and the corneal astigmatism in the B1 group was lower than that of the B2 group. In the C1 group, the corneal astigmatism was decreased 1 week,1 month and 3 months after the operation, and the difference was statistically significant (p0.01),1 week,1 month,3 months, and C. The comparison of average corneal astigmatism in group 2 and the difference between the two groups The mean corneal astigmatism in the C1 group was lower than that of the first group (p0.05, p0.01, p0.01). In group C2.3, the operation-induced astigmatism in each group had a certain operation-induced astigmatism, and the operation-induced astigmatism gradually decreased over time, and the operation-induced astigmatism was compared with one month after operation. There was no significant difference between January and March (p0.05). There is no statistical difference in the comparative difference of the operation-derived astigmatism. The difference of operation-derived astigmatism for each time point in group C1 and C2 was of no statistical significance (p0.05). P 0.05).4. The postoperative astigmatism in each group was changed by one week after the operation of the corneal astigmatism axis, and the incidence of astigmatism was gradually changed to the normal astigmatism in the first month after the operation, but there was no significant difference between 1 week and January, January and March after the operation (p0.05). The B1 and B2 groups At each time of the group The axial composition ratio of the point-to-point astigmatism was not statistically significant (p0.05), and the astigmatism axial composition of the time points in the C1 and C2 groups was not statistically significant (p0.05). The difference was not significant (p0.05). Conclusion:1. The cataract with 1 D of the pre-operative corneal astigmatism is a 3-mm clear angle. There was no apparent change in the degree of corneal astigmatism. The corneal astigmatism was 1.0D ~ 2.0D in the patients with cataract, and the choice of corneal astigmatism was on the most steep meridian of the cornea.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.66
本文编号：2495481
[Abstract]:Cataract is one of the main causes of blindness in the world. So far, surgery is the only effective way to treat. Cataract phacoemulsification and foldable intraocular lens implantation is the most mainstream operation in the present day. It has the advantages of small incision, short operation time and good recovery of vision after operation. However, with the improvement of the technique of cataract surgery and the improvement of the equipment, the cataract surgery has not only stayed in a simple reming stage, and the better postoperative visual effect has become the pursuit of a large number of doctors and patients. The study shows that the pre-operative corneal astigmatism and surgical-derived astigmatism are important factors that affect the postoperative visual acuity. In response to this, we have attempted to correct pre-operative corneal astigmatism by taking different surgical incisions or, at the same time, in combination with different corneal astigmatism, to reduce or eliminate pre-operative corneal astigmatism, And the aim of improving the visual quality of the patient is finally achieved. Objective: To study the corneal astigmatism status of patients with cataract extraction combined with foldable intraocular lens implantation, and to select different surgical incisions according to the pre-operative corneal topography. the correction effect of the astigmatism is improved, visual quality Methods:63 cases (77 eyes) of age-related cataract with cataract phacoemulsification and foldable intraocular lens implantation in our hospital from September 2008 to August 2009 were collected. In the week, January and March, the corneal topography was examined and divided into 3 groups (group A, group B, C) according to the degree of astigmatism before operation. Group), different operative incisions were selected for each group. Group A:17 (22 eyes): pre-operative corneal astigmatism, 1.0 D, surgical incision of 11:00, and a clear angle of 3.0 mm Incision of the membrane,3:00, the secondary incision in the limbal. Group B:29 (35 eyes): the pre-operative corneal astigmatism was 1.0D-2.0D, divided into two groups (group B1, group B _ 2), and group B _ 1:14 (18-eye) surgical incision was the most steep meridian of the cornea. Clear corneal incision, the auxiliary incision is 120 掳 with the main incision Angle, B2 group:15 (17 eyes) surgical incision and group A. Group C:17 (20 eyes): pre-operative corneal astigmatism of 2.0D, partial group 2 (C1 group, C2 group), C1 group:9 (10 eyes) first completed the operation of the same group, and it was made to be perpendicular to the most steep meridian of the cornea. T " cut, C2 group:8 (10 The patients with the same group A were implanted with the Rayner's foldable intraocular lens. The visual acuity and the angle of the naked eyes at 1 week, January and March after the operation were observed. membrane astigmatism , surgical-derived corneal astigmatism and astigmatism Axial change and statistical analysis. Results:1. There was a significant increase in the visual acuity of the naked eyes in each group after the operation. The visual acuity of the naked eyes in the group B1 and the group B2 was not statistically significant (p0.05), the difference of the 1-month and the third month was statistically significant (p0.01), the B1 group was better than that of the B2 group, and the visual acuity of the naked eyes in the C1 group and the C2 group. Comparison,1-week difference after surgery No statistical significance (p0.05) There was no significant difference (p0.01) in the first month and the third month, and the C1 group was superior to that of the C2 group. The average corneal astigmatism in the B1 group and the B2 group was compared with the average corneal astigmatism for 1 week, the first week, the first month and the third month after the astigmatism, and the average corneal astigmatism in the B1 group and the B2 group was compared with the mean corneal astigmatism for 1 week. The difference was not significant (p0.05), the difference was statistically significant (p0.01) in the first month and the third month after the operation, and the corneal astigmatism in the B1 group was lower than that of the B2 group. In the C1 group, the corneal astigmatism was decreased 1 week,1 month and 3 months after the operation, and the difference was statistically significant (p0.01),1 week,1 month,3 months, and C. The comparison of average corneal astigmatism in group 2 and the difference between the two groups The mean corneal astigmatism in the C1 group was lower than that of the first group (p0.05, p0.01, p0.01). In group C2.3, the operation-induced astigmatism in each group had a certain operation-induced astigmatism, and the operation-induced astigmatism gradually decreased over time, and the operation-induced astigmatism was compared with one month after operation. There was no significant difference between January and March (p0.05). There is no statistical difference in the comparative difference of the operation-derived astigmatism. The difference of operation-derived astigmatism for each time point in group C1 and C2 was of no statistical significance (p0.05). P 0.05).4. The postoperative astigmatism in each group was changed by one week after the operation of the corneal astigmatism axis, and the incidence of astigmatism was gradually changed to the normal astigmatism in the first month after the operation, but there was no significant difference between 1 week and January, January and March after the operation (p0.05). The B1 and B2 groups At each time of the group The axial composition ratio of the point-to-point astigmatism was not statistically significant (p0.05), and the astigmatism axial composition of the time points in the C1 and C2 groups was not statistically significant (p0.05). The difference was not significant (p0.05). Conclusion:1. The cataract with 1 D of the pre-operative corneal astigmatism is a 3-mm clear angle. There was no apparent change in the degree of corneal astigmatism. The corneal astigmatism was 1.0D ~ 2.0D in the patients with cataract, and the choice of corneal astigmatism was on the most steep meridian of the cornea.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.66
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