| Background and PurposeCataract is the leading cause of blindness in the world.Surgical reconstruction is the only effective method available today.With the convergence of cataract surgery and refractive surgery,more and more ophthalmologists have recognized the clinical efficacy of Toric intraocular lens implantation in cataract patients with regular astigmatism.Toric intraocular lens is an integrated hydrophobic acrylate material with excellent biocompatibility and stability.In this study,the anterior segment parameters of Toric intraocular lens implantation at 6 months,12 months and 18months after surgery were compared with those before surgery.The traditional slit lamp method and corneal analyzer method were used to measure the deviation between the postoperative Toric intraocular lens axis and the target axis.To evaluate the stability of bag rotation after Toric IOL implantation.In addition,the difference between predicted surgical induced astigmatism and actual surgical induced astigmatism was analyzed by comparing the residual astigmatism before and after surgery.Then guide the clinician to adjust the incision position,the incision size and to improve the operation skill.At the same time,the parameters of anterior and posterior anterior segment of IOL eyes were compared with those of normal lens eyes before and after mydriasis.The above study evaluated the clinical efficacy of TECNIS Toric intraocular lens to correct the cataract combined with regular astigmatism,providing a reference for clinicians to standardize surgical operations.ObjectsFrom September 2016 to September 2017,119 patients(129 eyes)who underwent phacoemulsification cataract extraction and Toric intraocular lens implantation in the ophthalmology center of The First Affiliated Hospital of Zhengzhou University were selected as subjects.There were 56 male patients(62eyes)and 63 female patients(67 eyes)with an average age of(45.76±12.78)years.Inclusion criteria:1.Phacoemulsification cataract extraction and TECNIS Toric intraocular lens implantation were performed in the ophthalmology center of The First Affiliated Hospital of Zhengzhou University in patients with simple cataract complicated with regular astigmatism of the cornea,without intraoperative and postoperative complications.No new eye diseases or trauma occurred after operation.All operations were performed by the same senior physician.2.Complete preoperative examination data were retained without obvious abnormality,including current history,uncorrected visual acuity,best-spectacles corrected visual acuity,intraocular pressure,axial length,corneal endothelial cell count,Schirmer tear test,B-scan ultrasonography of eye,optical coherence tomography,corneal curvature,corneal astigmatism,Toric intraocular lens diopter,incision axis,intraocular lens preset axis,predicted residual astigmatism and predicted residual astigmatism axis,etc.3.The patient can insist on regular review at 6,12 and 18 months after surgery,and keep complete follow-up records and examination data.Exclusion criteria:1.Patients with ocular diseases such as congenital microphthalmus,congenital microcornea,high myopia,irregular astigmatism of cornea,keratoconus,etc.2.Severe postoperative complications such as uveitis,intraocular lens pupil clamps,intraocular lens dislocation,posterior cataract,secondary glaucoma,etc.Patients who cannot be regularly reviewed after surgery and lack complete examination data,surgical data and postoperative follow-up medical records.At the same time,21(42eyes)normal eye volunteers were recruited as the control group,including 12(24eyes)males and 9(18 eyes)females,aged 21-61 years old,with an average age of(39.33±12.34)years.The visual acuity of both eyes should be no less than 1.0,the refraction of the equivalent spherical should be no more than 0.5D,and the astigmatism should be no more than 0.5D.And no ocular and systemic diseases.MethodsThis study is a prospective study.119 patients(129 eyes)underwent intraocular lens implantation as experimental group and 21 normal eyes(42 eyes)as control group.Surgical method in the experimental group:axial position was marked by slit lamp.During the operation,the marked ring with scale was used to mark the surgical incision and the intraocular lens axis according to the marked horizontal position.we performed phacoemulsification,implanted intraocular lens and made its axial position consistent with pre-operation marking axial position.In the experimental group,visual acuity,intraocular pressure,subjective optometry and slit lamp examination were performed at 6,12 and 18 months after surgery,and iTrace visual function analyzer was performed in the dark room.At the last follow-up the parameters of anterior segment were measured by Pentacam three-dimensional anterior segment analysis system before and after mydriasis with compound topicamide eye drops.The axial position of Toric intraocular lens was measured by conventional slit lamp method and the anterior segment photography was performed after mydriasis.In the control group,visual acuity,intraocular pressure,subjective optometry and slit lamp examination were performed.The parameters of anterior segment were measured by Pentacam three-dimensional anterior segment analysis system before and after mydriasis with compound topicamide eye drops.All operations are performed by the same examiner.SPSS 20.0 statistical software was used for statistical analysis of the data in this study.The measurement data were expressed as(mean±standard deviation).P-P chart was used to test the normality of measurement data.Single factor repeated measurement analysis of variance was used in the comparison of each time point after operation in the experimental group compared with that before the operation.Paired t test was used for the last follow-up and preoperative comparison.Pearson correlation analysis was used to analyze the correlation between the traditional slit lamp measurement method and the iTrace aberration instrument measurement method.The comparison of anterior segment parameters before and after mydriasis between the experimental group and the control group was performed by independent sample t test,and the comparison within the group was performed by paired sample t test.The difference was statistically significant(P<0.05).ResultsAt 6 months after operation in the experimental group the uncorrected visual acuity was(0.07±0.07),and the best corrected visual acuity was(0.02±0.04).At 12months after operation the uncorrected visual acuity was(0.08±0.09),and the best corrected visual acuity was(0.03±0.05).And at 18 months after operation the uncorrected visual acuity was(0.09±0.09),and the best corrected visual acuity was(0.03±0.05).All the above results were statistically significant compared with those before surgery(all at P<0.001).At 18 months after operation,the corneal curvature K1 was(42.99±1.23)D,the axial position of K1 was(93.23±52.75),the corneal curvature K2 was(44.80±1.24)D,and the corneal astigmatism was(1.82±0.56)D(iTrace aberration instrument measurement).The differences were all statistically significant compared with those before operation(all at P<0.05).At each postoperative follow-up time point the correlation analysis of preoperative preset axial position and postoperative axial position measured by traditional slit lamp showed a positive correlation(all at P<0.001).Correlation analysis of preoperative preset axial position and postoperative axial position measured by iTrace aberration instrument showed a positive correlation(all at P<0.001).The IOL deviation at each postoperative follow-up time point measured by traditional slit lamp was(3.26±2.12)°,(3.24±1.9)°and(3.74±2.2)°respectively.And the IOL deviation at each postoperative follow-up time point measured by iTrace aberration instrument was(3.3±2.11)°,(3.42±2.09)°and(3.04±2.2)°respectively.And the correlation analysis of the deviation between the axial position measured by the two methods and the preoperative preset axial position also showed a positive correlation(all at P<0.001).The actual surgical induced astigmatism at each postoperative follow-up time point were(0.54±0.16)D,(0.55±0.16)D and(0.54±0.16)D,which were significantly different from that of preoperative preset surgical induced astigmatism(all at P<0.05).The postoperative residual astigmatism at each postoperative follow-up time point were(0.40±0.29)D,(0.39±0.28)D and(0.39±0.29)D,which were significantly different from the preoperative residual astigmatism(0.11±0.11)D(all at P<0.001).The actual surgical induced astigmatism after operation was(0.54±0.16)D,which was significantly different from that of preoperative preset surgical induced astigmatism(t=3.096,P=0.002).However,there was no significant difference in actual surgical astigmatism and actual residual astigmatism between 6months and 18 months after operation(P>0.05).At 18 months after operation the pupil diameter of the experimental group after mydriasis was(6.21±0.53)mm,which was larger than that before mydriasis(2.70±0.38)mm,and the difference was statistically significant(t=-68.146,P<0.001).The volume of anterior chamber after mydriasis was(152.53±26.16)mm~3,which was larger than that before mydriasis(141.48±18.75)mm~3,and the difference was statistically significant(t=-6.431,P<0.001).The thickness of corneal apex before and after mydriasis was(557.72±31.92)μm and(570.01±33.03)μm respectively.The thickness of the thinnest cornea was(548.52±32.09)μm and(556.77±32.12)μm respectively,the difference was statistically significant(P<0.001).The pupil diameter of the control group was(6.02±0.29)mm after the dilation of the eyes with compound topicamine,which was larger than that before the dilation(2.67±0.43)mm,and the difference was statistically significant(t=-57.786,P<0.001).The volume of anterior chamber after mydriasis was(156.02±18.53)mm~3,which was larger than that before mydriasis(134.95±14.21)mm~3,and the difference was statistically significant(t=-9.962,P<0.001).The thickness of corneal apex before and after dilation was(537.31±15.85)μm and(544.00±15.36)μm respectively.The thickness of the thinnest cornea was(521.81±15.05)μm and(529.62±13.51)μm respectively,and the difference was statistically significant(P<0.001).The anterior chamber volume of intraocular lens eyes in the experimental group was(141.48±18.75)mm~3,which was larger than that in the control group(134.95±14.21)mm~3,and the difference was statistically significant(t=2.070,P=0.040).The corneal astigmatism of intraocular lens eyes was(1.82±0.56)D,while that of normal eyes was(0.35±0.10)D,and the difference was statistically significant(t=28.477,P<0.001).The anterior chamber volume(164.36±31.28)mm~3 of intraocular lens eyes in the experimental group after pupil dilation was larger than that of normal eyes(146.02±18.53)mm~3,and the difference was statistically significant(t=8.523,P<0.001).The corneal astigmatism of intraocular lens eyes was(1.81±0.58)D,while that of normal eyes was(0.34±0.10)D,and the difference was statistically significant(t=-7.493,P<0.001).Conclusion1.Phacoemulsification and TECNIS Toric intraocular lens implantation are effective methods for the treatment of cataracts with regular astigmatism of the cornea,which can effectively reduce the residual astigmatism and provide satisfactory visual quality for patients.2.The traditional slit lamp measurement method and iTrace aberrometer measurement method are both accurate and reliable to evaluate the axial position of Toric intraocular lens.TECNIS Toric intraocular lens with one sheet hydrophobic acrylate has good biocompatibility and rotational stability.3.Anterior chamber volume and corneal thickness increase after dilation of intraocular lens and normal eyes.Therefore,anterior segment parameters should be measured under small pupil after cataract surgery to reduce errors.After phacoemulsification combined with TECNIS Toric intraocular lens implantation,the parameters of the anterior segment did not change except that the volume of the anterior chamber increased compared with that of the normal eye. |
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