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复位手术矫正Toric人工晶状体错位的发生率和预后

Oshika, T., Inamura, M., Inoue, Y., et al.

期刊名称:Ophthalmology

卷期:2018年第125卷第1期

姚颖 沈阳兴齐眼药股份有限公司医学经理

白内障病人手术前后的角膜散光一直是困绕医生及病人的一大难题,它直接影响了白内障术后的视觉效果,由此也被越来越多的医生所重视,并设计出多种方法对角膜散光加以矫正,而目前国际最流行的是用散光人工晶体矫正术前角膜的散光,并取得了良好的临床效果。

Toric人工晶体只适应于角膜规则性散光。手术前做眼的生物测量,做角膜曲率和地形图检查,精确判定眼的散光大小和方向,眼的最大屈光力的轴即为散光轴,术中与人工晶体标记的轴相重合。

后房型散光人工晶体最常见的问题是术后人工晶体轴的偏位,即在囊袋内的稳定性,它是影响其推广的最大障碍。文献报道,散光人工晶体的轴位在预定的位置,则角膜的散光度能完全矫正,偏离10°则只能矫正预计散光度的2/3,偏离30°则完全不起作用,超过30°反而增加原有的散光度数。如果ToricIOL的轴向偏位超过30°,则会出现复视、眩光和视力降低等症状,这部分病人不得不再手术调整位置或取出人工晶体,是病人投诉的主要原因。造成ToricIOL术后位置偏移的因素很多,首先是人工晶体本身设计的缺陷,二是手术的因素.三是术前标记的准确性.此外,植入散光人工晶体的术后效果还与术前角膜散光度数和方向的精确测定有关,术前要做角膜曲率和地形图的双重检查,切记不要只凭电脑验光的数据做出判断,因为术前无论是主观或客观验光所得出的散光数值是角膜和晶状体散光的总和,在行白内障手术后,晶状体的因素已解除,所以我们术前预计矫正的只是角膜的散光。术前检查越精确,术后效果越好。

植入散光人工晶体矫正术前角膜的散光,无论是对医生还是对病人都有着很强的诱惑性,但目前它还有诸多不足之处,价格也比较昂贵,一旦术后发生人工晶体的移位,不但影响了效果,同时也为纠纷提供了机会,所以眼科医生要本着为病人着想的态度,认真慎重的来开展这项技术,相信通过生产厂家和眼科医生的共同努力,很快能使之成为一项成熟的矫正角膜散光的手术,进一步完善白内障手术所发挥的屈光矫正作用。


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摘要

摘要:目的:旨在分析丙烯酸折叠式Toric人工晶状体(IOLs)错位的复位手术发生率和再次手术时机。 设计:回顾性,多中心病例系列。研究对象:8个手术点接受超声乳化术和Toric人工晶状体植入的患者。主要观察指标:复位手术的发生率,时机及预后。结果:植入Toric人工晶状体的6431只眼中,42例患者的42只眼(0.653%)在人工晶状体植入后平均9.9±7.5天(范围0-30天)进行复位手术。术后7.6±5.0周测量显示,复位手术显着减少错位从32.9°±15.7°至8.8°±9.7°(P <0.001)。屈光度从2.4±1.1屈光度(D)明显降低到1.1±0.8 DP <0.001)。白内障手术至复位手术的间隔时间与残余角度错位程度呈明显负相关(r = -0.439P <0.001)。白内障手术后6天内进行复位手术时,剩余错位为13.1°±13.5°,7天或更长时间后复位IOL的残留错位为6.3°±5.9°(P <0.001)。白内障手术后24小时内治疗的2只眼中,IOL重新旋转明显,需要额外的手术治疗。结论:复位Toric人工晶体占0.63%。复位手术时机与手术预后之间存在关联。这些数据表明,复位手术应在IOL植入后1周进行。

PURPOSE:To analyze the incidence and appropriate timing of repositioning surgery to correct misalignment of acrylic foldable toric intraocular lenses (IOLs).DESIGN:Retrospective, multicenter case series.PARTICIPANTS:Patients who had undergone phacoemulsification and implantation of toric IOL at 8 surgical sites.METHODS:Patient charts were reviewed to collect data on repositioning surgery of toric IOLs.MAIN OUTCOME MEASURES:Incidence, timing, and outcomes of repositioning surgery.RESULTS:Among 6431 eyes implanted with toric IOLs, 42 eyes (0.653%) of 42 patients underwent repositioning surgery at an average of 9.9±7.5 days (range, 0-30 days) after IOL implantation. The repositioning surgery significantly reduced misalignment from 32.9°±15.7° to 8.8°±9.7° (P < 0.001), which was measured at 7.6±5.0 weeks postoperatively. Refractive cylinder was significantly reduced from 2.4±1.1 diopters (D) to 1.1±0.8 D (P < 0.001). There was a significant negative correlation between the interval from cataract surgery to repositioning procedure and the degree of residual misalignment (r = -0.439, P < 0.001). The residual misalignment was 13.1°±13.5° when the repositioning surgery was performed within 6 days after cataract surgery, whereas the residual misalignment was 6.3°±5.9° when the IOL was repositioned 7 days or later (P < 0.001). In 2 eyes that were treated within 24 hours after cataract surgery, the IOL re-rotated significantly, and additional surgical intervention was required.CONCLUSIONS:Toric IOLs were repositioned in 0.653% of cases. A relationship was found between the timing of repositioning surgery and surgical outcome. These data suggest that repositioning surgery should be performed 1 week after IOL implantation.


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