目的: 比较右上方透明角膜切口联合散光矫正型人工晶体(toric intraocular lens,Toric IOL)植入与陡峭轴切口联合非球面人工晶体植入术后残余散光及视觉质量的影响。方法: 纳入2020年1月1日至2021年1月1日在包头医学院第一附属医院眼科门诊就诊,拟行白内障超声乳化吸除术联合IOL植入术的老年性白内障合并低度数角膜散光(散光度为1.0～1.5 D)患者60例(60眼),按不同手术方式分为右上方透明角膜切口联合Toric IOL植入组(试验组)和陡峭轴切口联合非球面IOL植入组(对照组),每组30例(30眼),术后随访3个月。观察患者裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)、残余散光(residual astigmatism,RA)、对比敏感度(contrast sensitivity,CS)和主观视觉质量。结果: 术后均随访3个月。试验组术眼UCVA明显优于对照组(P＜0.05);试验组和对照组术后BCVA比较,差异均无统计学意义(P＞0.05);试验组和对照组的散光度数均较术前明显降低(P＜0.05),且试验组残余散光度数较对照组明显减少(P＜0.05);试验组CS在暗光眩光环境下各空间频率(3、6、12、18 cpd)优于对照组(P＜0.05);两组CS在明光、明光眩光、暗光环境下各空间频率(3、6、12、18 cpd)对比,差异均无统计学意义(P＞0.05);试验组中有眩光视觉干扰症状的患者人数少于对照组(P＞0.05)。结论: 两种手术均可有效提高患者的视力及降低术后散光度数,但右上方角膜切口联合Toric IOL植入术可获得更佳的裸眼视力及对比敏感度、更低的残余散光度数和更高的视觉质量,是目前白内障合并低度数角膜散光患者较为有效的治疗方法。

Objective: To compare the effects of the upper right clear corneal incision combined with astigmatism corrected toric intraocular lens (intraocular lens, IOL) implantation and corneal steep axis incision combined with aspherical intraocular lens implantation on residual astigmatism and visual quality. Methods: From January 1, 2020 to January 1, 2021, 60 patients (60 eyes) with senile cataract and low-level corneal astigmatism (astigmatism degree, 1.0 to 1.5 D) who were scheduled to undergo phacoemulsification and intraocular lens implantation enrolled in the Ophthalmic Clinic of the First Affiliated Hospital of Baotou Medical College. According to different surgical methods, they were divided into the upper right clear corneal incision combined with astigmatism corrected toric IOL implantation group (Experimental group) and the corneal steep axis incision combined with aspherical intraocular lens implantation group (Control group), with 30 cases (30 eyes) in each group. All patients were followed up for 3 months. The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), residual astigmatism (RA), contrast sensitivity (CS) and subjective visual quality were observed and analyzed. Results: 3 months after operation, the UCVA of the experimental group was significantly better than that of the control group, and the difference was statistically significant (P＜0.05). There was no significant difference in terms of postoperative BCVA between the experimental group and the control group (P＞0.05). The astigmatism of the experimental group and the control group was significantly lower than that before operation, and the differences were statistically significant 3 months after operation (P＜0.05), and the residual astigmatism of the experimental group was significantly lower than that of the control group (P＜0.05). (3)The CS under different spatial frequencies (3, 6, 12, 18 cpd) of the experimental group in the low light and glare environment were better than that in the control group, and the differences were statistically significant (P＜ 0.05), there was no significant difference on CS under different spatial frequencies (3, 6, 12, 18 cpd) of in the light, glare, and dark environment between the two groups (P＞0.05). The number of patients with glare visual disturbance symptoms in the experimental group was less than that in the control group 3 months after operation, but the difference between the two groups was not statistically significant (P＞0.05). Conclusion: Both the two kinds of surgery could effectively improve the visual acuity and reduce the postoperative astigmatism, but the upper right clear corneal incision combined with astigmatism corrected toric IOL implantation could obtain better uncorrected visual acuity and contrast sensitivity, lower residual astigmatism and higher visual quality, which is an effective treatment for cataract patients with low corneal astigmatism.