| BackgroundWith the progress of technology and cataract surgery technique,the types of intraocular lens available for surgery are becoming more and more abundant.During the clinlic therapy,there is a considerable number of cataract patients combined with a certain degree of corneal astigmatism.Large corneal astigmatism that is not corrected can lead to a series of visual unfitness symptoms after cataract surgery.In order to help these patients getting a good visual experience after surgery,the Toric intraocular lens(Toric IOL)came into being.Compared with ordinary IOL,Toric IOL can reduce or eliminate postoperative astigmatism by offsetting corneal refractive power in a specific direction.Due to the particularity of its function,Toric IOL needs to maintain a stable direction and position in the intraoperative eye,so as to play its role of astigmatism correcting successfully.The possible postoperative rotation of IOL axis is a problem that every surgeon needs to face.In recent years,many IOL manufacturers have designed their own brands of Toric IOL and adopted some unique designs to ensure the postoperative stability of Toric IOL.However,few studies have directly compared these Toric IOL to understand their differences and advantages.ObjectiveTo investigate the postoperative effects and stability of Acrysof Toric IOL and Tecnis Toric IOL.MethodsA prospective case-control study was conducted to collect patients who underwent phacoemulsification cataract extraction combined with Toric IOL implantation in the third department of ophthalmology,zhengdong district,the First Affiliated Hospital of Zhengzhou University from May 2018 to May 2019.Forty-one patients(53 eyes),18 males and 23 females,average age 58.96± 13.64,were divided into two groups.There was no significant difference in age and sex composition between the two groups.Group A included 21 patients(27 eyes),9 males(12 eyes)and 12 females(15 eyes),implanted with Acrysof Toric IOL(Alcon,USA);Group B included 20 patients(26 eyes),9 males(11 eyes)and 12 females(15 eyes),average age 58.27±16.87,implanted with Tecnis Toric IOL(Johnson&Johnson Vision,USA)during the same period.Patients were followed up in 2 weeks,1 month and 3 months after the operation to measure the postoperative uncorrected distance visual acuity,the best corrected distance visual acuity,residual astigmatism,and the actual axial position of Toric IOL after the operation.Using slit lamp to check the postoperative ocular condition.Three months after the operation,a questionnaire was given to investigate the visual experience and postoperative satisfaction of the patients.Chi-square test is used for qualitative data analysis(when the minimum theoretical frequency is<5,the corrected chi-square test is used and when the minimum theoretical frequency is<1,the Fisher’s exact probabilities is used).The independent sample t-test is used to test the normal distribution of quantitative data with uniform variances(using corrected t-test when there was heterogeneity of variance).Mann-Whitney U test is used for quantitative data of non normal distribution.The Bonferrroni method is used for the comparison among groups.Pearson correlation analysis is used for analyzing the correlation brtween quantitative data.ResultThe percentage of group A that UCDVA reached 0.3(logMAR)three months after surgery was 92.59%and the percentage of group B that UCDVA reached 0.3(logMAR)was 84.62%and there were no statistically significant difference between two groups(χ2=0.233,P=0.629).The percentage of group A that BCDVA reached 0.3(logMAR)three months after surgery was 96.30%and the percentage of group B that BCDVA reached 0.3(logMAR)was 88.46%and there were no statistically significant difference between two groups(χ2=0.313,P=0.576).The statistically difference of uncorrected distance visual acuity between group A and group B at 2 weeks and one month after surgery was significant(P<0.05).The difference of uncorrected distance visual acuity between group A and group B in three month after surgery was not statistically significant(P>0.05).There were no significant difference in BCDVA between two groups at one month and three months(P>0.05)when there were significant difference at two weeks(P<0.05).Pairwise comparison of UCDVA at each postoperative time point in group A showed no statistically significant difference(all P>0.05).Pairwise comparison of BCDVA at each postoperative time point in group A showed no statistically significant difference(all P>0.05).Pairwise comparison of UCDVA at each postoperative time point in group B showed statistically significant difference(all P<0.05).Pairwise comparison of BCDVA at each postoperative time point in group B showed no statistically significant difference(all P>0.05).There were significant statistical differences in UCDVA of the two groups at 2 weeks,1 month and 3 months after surgery compared with that of the two groups before surgery(P<0.01).The BCDVA of the two groups at each time point after operation was compared with that before the operation,and the difference was statistically significant(P<0.01).The residual astigmatism at each time point after operation was significantly different from that before operation(P<0.01).There was no statistically significant difference in the decrease of postoperative astigmatism between the two groups(P>0.05),and no statistically significant difference in the comparison of residual astigmatism between the two groups at each postoperative time point(P>0.05).There was no significant difference in IOL rotation degree between the two groups after 2 weeks,1 month and 3 months(all P>0.05).The ratio of IOL rotation degree<5°in group A 3 months after surgery was 81.84%,and the ratio of rotation degree<10°was 92.59%;The ratio of IOL rotation degree<5° in group B 3 months after surgery was 80.78%,and the ratio of rotation degree<10° was 92.31%.There was no significant difference in the percentage of postoperative rotation degree<5° between the two groups(χ2=0.004,P>0.05),and no significant difference in the percentage of postoperative rotation degree<10°either(χ2=0.002,P>0.05).The difference between the actual residual astigmatism 3 months after the operation and the predicted astigmatism before the operation was statistically significant(P<0.05).The correlation between preoperative intraocular pressure and postoperative rotation degree of Toric IOL in the two groups was not statistically significant(r=-0.096,P=0.733;r=-0.165,P=0.419).There was no significant correlation between axial length and postoperative rotation degree of Toric IOL in the two groups(r=-0.203,P=0.311;r=-0.204,P=0.318).The correlation between anterior chamber depth and postoperative rotation degree of Toric IOL in the two groups was not statistically significant(r=-0.009,P=0.964;r=0.009,P=0.965).There was no significant correlation between posterior corneal surface astigmatism and postoperative residual astigmatism in group A(r=0.137,P=0.514).There was no significant correlation between posterior corneal surface astigmatism and postoperative residual astigmatism in group B either(r=0.100,P=0.626).All the patients in the two groups were followed up for 3 months after the operation without any visual adverse phenomena such as glare,halo and night vision blur.The long distance spectacle independence rate after operation was 90.48%in group A and 80.00%in group B.The long distance spectacle independence rate between group A and group B was not statistically significant(χ2=0.257,P>0.05).The percentage of postoperative no trouble driving in group A was 90.00%and the percentage in group B was 87.50%.There was no significant difference between two groups in the percentage of no trouble driving(P>0.05).Postoperative overall satisfaction,the average score of group A was 4.67±0.55,the satisfaction rate was 95.24%.The average score of group B was 4.85±0.37,the satisfaction rate was 100.00%.The satisfaction rate between two groups had no statistically significant difference(P>0.05).There was no corneal edema,anterior chamber reaction,fundus disease,IOL dislocation or IOL opacification in both groups at 3 months.ConclusionAcrysof Toric IOL and Tecnis Toric IOL can effectively improve the postoperative visual acuity,reduce postoperative residual astigmatism and have the equally reliable postoperative stability.They can make the majority of patients do not rely on glasses for daily activities after surgery,and both have achieved good satisfaction.The postoperative rotational stability of Toric IOL has no correlation with preoperative intraocular pressure,axial length,anterior chamber depth. |
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