Clinical Observation Of 2.4mm Clear Corneal Incision Combined With Toric Intraocular Lens Implantation

Objective:To evaluate the clinical efficacy of 2.4-mm clear corneal incision combined with Toric IOL implantation in the treatment of cataract with corneal astigmatism.Methods:The clinical data of 47 eyes of 36 patients with cataract and corneal astigmatism≥0.75D who underwent 2.4mm clear corneal incision combined with TECNIS^? Toric IOL implantation in our hospital from September 2021 to November 2022 were retrospectively analyzed.Preoperative data of the patients were collected:Gender,age,eye side,anterior chamber depth,axial length,intraocular pressure,Schirmer test,spherical power,corneal curvature,total and corneal astigmatism,predicted residual astigmatism,uncorrected visual acuity（UCVA）,corrected visual acuity（BCVA）,total and corneal higher-order aberrations,IOL astigmatism axis,objective visual quality,subjective visual quality,etc.Follow-up was conducted at 1w,1m and 3m after operation and the following data were collected:Postoperative UCVA,BCVA,total ocular and corneal astigmatism,IOL rotation axis,total ocular and corneal higher-order aberrations,and objective visual quality related parameters were measured by OPD-Scan III visual quality analyzer.Subjective visual quality and satisfaction were evaluated by questionnaire.SPSS 25.0 software was used for statistical analysis.Results:1.The UCVA and BCVA at 1w,1m and 3m after surgery were significantly higher than those before surgery（P<0.001）;UCVA and BCVA were significantly improved at 3 days after surgery compared with 1 week after surgery and at 1 month after surgery（P<0.01）;There was no significant difference in UCVA and BCVA between 3m and 1m after surgery（P>0.05）.2.Astigmatism:the postoperative total astigmatism was significantly lower than that before surgery（P<0.001）;Astigmatism at3 days postoperatively was significantly lower than that at 1 week postoperatively（t=4.72,P<0.001）.Astigmatism was significantly lower at 1 month after surgery than at 1 week after surgery（t=3.17,P<0.01）;There was no significant difference in astigmatism between patients at3m and 1m after surgery（t=1.36,P=0.18）,indicating that astigmatism tended to be stable at 1m after surgery.The corneal astigmatism at 1week after surgery was significantly higher than that before surgery（t=2.65,P<0.05）;There was no significant difference in corneal astigmatism at 1m and 3m after surgery（P>0.05）.The corneal astigmatism at 1m and 3m after surgery was significantly lower than that at 1w after surgery（P<0.05）.However,there was no significant difference in corneal astigmatism between 3m and 1m after surgery（t=1.36,P=0.18）,indicating that corneal astigmatism tended to be stable at 1m after surgery.There was no significant difference in postoperative total astigmatism（0.39±0.21）D compared with the expected residual astigmatism（0.32±0.20）D（t=1.54,P=0.128）.3.Stability of IOL rotation:the difference between IOL positioning and predicted axis was 2°（2°,3°）and 3°（2°,3°）at 1w and 3m after surgery,respectively,and the difference was not statistically significant（Z=1.88,P=0.06）,indicating that IOL rotation tended to be stable at 1w after surgery.4.Aberrations:the ocular higher-order aberrations,spherical aberration,coma aberration and trefoil aberration were significantly decreased 3 days after surgery（P<0.05）.There was no significant difference in corneal coma and trefoil at 3m after surgery compared with those before surgery（P>0.05）.5.Objective visual quality:OPD results showed that the spot area of PSF point spread function decreased significantly after surgery.The SR value of 3m after surgery（0.17±0.02）was significantly higher than that before surgery（0.05±0.04）,and the difference was statistically significant（t=15.818,P<0.001）.The MTF modulation transfer function curve was significantly increased,the ETDRS visual target and night simulated landscape map were clearer than before operation,and the IOL axial position was basically consistent with the preoperative planning.6.Subjective visual quality:the preoperative VF-14 score was 25（25,50）,and the postoperative 3m score was 75（75,100）.The differences were statistically significant（Z=7.44,P<0.001）.The subjective visual quality of patients after surgery was significantly better than that before surgery.7.Satisfaction:The patients were followed up for 3 months,and there was no need for secondary surgery to adjust the position of IOL.Thirty-four patients（94%）were satisfied or very satisfied after operation,and no patient was dissatisfied.Conclusions:1.2.4-mm clear corneal incision combined with Toric IOL implantation is safe,effective and predictable,which can significantly improve postoperative uncorrected and corrected distance vision and reduce preoperative corneal astigmatism,and the corneal incision can recover in the early postoperative period.2.2.4-mm clear corneal incision combined with Toric IOL implantation can effectively reduce higher-order aberrations of the whole eye and provide satisfactory subjective and objective visual quality for patients after surgery.3.2.4-mm clear corneal incision combined with Toric IOL implantation has good IOL rotation stability,high spectacle-independence rate,and good satisfaction,which improves the quality of life of patients after surgery.