Ma Li-Wei, Xuan Dwight, Li Xiao-Yan, Zhang Jin-Song
Department of Ophthalmology, the 4th Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Provincial Key Laboratory of Lens Research of Liaoning, Shenyang 110005, Liaoning Province, China.
Int J Ophthalmol. 2011;4(5):502-7. doi: 10.3980/j.issn.2222-3959.2011.05.09. Epub 2011 Oct 18.
To study the impact of scleral flap position, under which the posterior chamber intraocular lenses (PC-IOL) were sulcus-fixed by trans-scleral suture, on cornea astigmatism.
Twenty-six aphakic or cataract eyes were comprised in this prospective noncomparative case series study. Eleven eyes had traumatic cataract removed without sufficient capsular support, 3 had blunt trauma with subluxated traumatic cataract, 8 had undergone vitreoretinal surgery and 4 had congenital cataract removed. The average age was 54 years (range 21-74 years), with 17 men and 7 women. The foldable PC-IOL was fixed in sulcus by trans-scleral suture. The incision for IOL implantation was made 1mm posterior to limbus along the steepest meridian of cornea, while scleral flaps to bury the knots of trans-scleral suture were made along the flattest meridian. All the surgeries were performed by a single doctor (Ma L), and the follow up was at least 13 months (range 13-28 months). The preoperative, 3 months and 1 year postoperative corneal curvature along the steepest and flattest cornea meridian and overall cornea astigmatism were compared.
The curvature along the steepest meridian changed from 44.25±2.22D preoperatively to 44.08±2.16D at 3 months postoperatively, and 43.65±5.23D at 1 year postoperatively (P>0.05); the curvature along the flattest meridian changed from 41.24±2.21D preoperatively to 43.15±3.94D at 3 months postoperatively, and 42.85±5.17D at 1 year postoperatively (P<0.05); and the surgery induced astigmatism (SIA) on cornea was calculated by vector analysis, which was 2.42±2.13D at 3 months postoperatively, and 2.18±3.42D at 1 year postoperatively, the difference was statistically significant (P<0.05).
The scleral flap made along the flattest meridian, under which the posterior chamber intraocular lenses (PCIOL) were sulcus-fixed by trans-scleral suture, can steepen the cornea in varying degrees, thus reducing preexisting corneal astigmatism.
研究经巩膜缝线将后房型人工晶状体（PC-IOL）沟内固定时巩膜瓣位置对角膜散光的影响。
本前瞻性非对照病例系列研究纳入26只无晶状体或白内障眼。11只眼因外伤性白内障摘除且无足够的囊膜支撑，3只眼因钝挫伤合并外伤性白内障半脱位，8只眼接受过玻璃体视网膜手术，4只眼因先天性白内障接受过手术。平均年龄54岁（范围21 - 74岁），男性17例，女性7例。可折叠PC-IOL经巩膜缝线固定于睫状沟。人工晶状体植入切口沿角膜最陡子午线在角膜缘后1mm处制作，而用于埋藏巩膜缝线线结的巩膜瓣沿最平子午线制作。所有手术均由同一医生（马L）完成，随访至少13个月（范围13 - 28个月）。比较术前、术后3个月及1年沿角膜最陡和最平子午线的角膜曲率以及总的角膜散光情况。
沿最陡子午线的曲率术前为44.25±2.22D，术后3个月为44.08±2.16D，术后1年为43.65±5.23D（P>0.05）；沿最平子午线的曲率术前为41.24±2.21D，术后3个月为43.15±3.94D，术后1年为42.85±5.17D（P<0.05）；通过矢量分析计算角膜手术源性散光（SIA），术后3个月为2.42±2.13D，术后1年为2.18±3.42D，差异有统计学意义（P<0.05）。
沿最平子午线制作巩膜瓣，在此巩膜瓣下经巩膜缝线将后房型人工晶状体（PCIOL）沟内固定，可不同程度地使角膜变陡，从而降低术前角膜散光。
