【摘要】 目的 对轴性近视散光白内障患者使用囊袋张力环联合散光IOL（Toric IOL）植入及单纯Toric IOL植入的临床效果进行量化对比。方法 回顾性对照研究。2012年1月至2013年1月在大庆市油田接受白内障超声乳化吸出联合Toric IOL植入术的轴性近视散光患者，入选术眼术前角膜散光≥1.5 D，眼轴长度＞25.5 mm，角膜地形图结果显示均为规则散光。联合组Toric IOL+CTR植入，共20例（20眼）；单纯组Toric IOL植入，共13例（13眼）。术前使用IOLMaster、主觉验光等分别测得术前角膜散光、全眼散光、UCVA、BCVA等，根据Alcon提供的在线计算器计算术眼所需Toric IOL球镜度数、晶状体型号及轴位、预计残留散光，术后6个月，使用主觉验光、裂隙灯显微镜测得术眼UCVA、BCVA、残余散光、Toric IOL轴位。采用t检验、秩和检验、χ2检验对数据进行分析。结果 术后6个月，联合组Toric IOL均位于囊袋内，仅有2例发生轻微旋转，大约是2°～3°，余均未发生旋转。单纯组Toric IOL虽位于囊袋内，但IOL轴位均发生旋转，5眼旋转＜10°，7眼＜20°，1眼＜30°。联合组术后6个月残余散光（-0.40±0.15）D与预计残留散光（-0.36±0.11）D比较，差异无统计学意义（t=-1.647，P＞0.05）。单纯组术后6个月残余散光（-1.07±0.37）D高于预计残留散光（-0.40±0.12）D，差异有统计学意义（t=-8.490，P＜0.01）。术后6个月，联合组UCVA（4.6±0.1）高于单纯组UCVA（4.5±0.1），差异有统计学意义（t=2.443，P＜0.05）。结论 CTR植入可以有效提高轴性近视散光白内障患者术后Toric IOL囊袋内旋转稳定性，达到预期矫正角膜散光的目的，患者视力明显提高。
【关键词】 近视； 散光； 人工晶状体，散光； 囊袋张力环
DOI：10.3760/cma.j.issn.1674-845X.2014.03.013
作者单位：163001 黑龙江省大庆市油田眼科
通信作者：刘洋，Email：ly1333@163.com
Use of a capsular tension ring combined with toric intraocular lens implantation for patients with axial myopia after cataract surgery Liu Ge， Liu Yang， Fang Jun. Department of Ophthalmology， Oil Field General Hospital of Daqing， Daqing 163001， China
Corresponding author：Liu Yang，Email：ly1333@163.com
【Abstract】 Objective To compare quantitatively the clinical effects on patients with axial myopic astigmatism after cataract surgery using either a capsular tension ring combined with toric intraocular lens （IOL） implantation or simple toric IOL implantation. Methods This was a retrospective analysis. Patients with axial myopia who agreed to undergo modern cataract phacoemulsification combined with toric IOL implantation were selected from 2012 January to 2013 January. The selected patients had preoperative corneal astigmatism of ≥1.5 D， an axial length of ＞25.5 mm， and rule astigmatism as measured by corneal topography. The combined group received a toric IOL+CTR implantation （20 cases） and the simple group received toric IOL implantation only （13 cases）. IOLMaster and Alcon provided online calculations and subjective refraction preoperatively. Subjective refraction and a slit lamp microscope were used to measure uncorrected distant visual acuity， best corrected visual acuity， residual astigmatism， and the toric IOL axis 6 months postoperatively. A t test， rank sum test and χ2 test were used to analyze the data. Results At 6 months postoperatively in the combined group， the toric IOL was located in the capsular sac. Only 2 patients had a slight rotation of about 2° d， and others had no rotation. In the simple group， the toric IOL was located in the sac， but the IOL had an axial rotation： 5 eyes rotation ＜10°， 7 eyes ＜20°， 1 eye ＜30°. The combined group had a residual astigmatism of -0.40±0.15 D at 6 months postoperatively， the predicted residual astigmatism was -0.36±0.11 D. There was no significant difference between actual residual astigmatism and predicted astigmatism （t=-1.647， P>0.05）. The simple group had a residual astigmatism of -1.07±0.37 D at 6 months postoperatively， the predicted residual astigmatism was -0.40±0.12 D. The difference was statistically significant （t=-8.490， P<0.01）. At postoperative 6 months， UCVA for the combined and simple groups was 4.6±0.1 and 4.5±0.1， respectively. The difference was statistically significant （t=2.443， P<0.05）. Conclusion In patients with axial myopic astigmatism， CTR can effectively increase the rotation stability of a toric IOL， achieving the desired goal of correcting corneal astigmatism. There was an obvious improvement in visual acuity.
【Key words】 Myopia； Astigmatism； Intraocular lenses，toric； Capsular tension ring
