Kristianslund Olav, Østern Atle Einar, Drolsum Liv
Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Invest Ophthalmol Vis Sci. 2017 Sep 1;58(11):4747-4753. doi: 10.1167/iovs.17-22723.
To compare surgically induced astigmatism (SIA) and refractive outcomes between two operation methods for late in-the-bag IOL dislocation.
In this prospective, randomized, parallel-group clinical trial, 104 patients (eyes) were assigned to IOL repositioning by scleral suturing 1.5- to 2-mm posterior to limbus (n = 54) or IOL exchange with a retropupillar iris-claw IOL using a 5.5-mm scleral pocket incision (n = 50). The SIA was determined by vector analysis through conversion of corneal cylinders to Cartesian coordinates, and is presented as magnitude in diopters @ direction in degrees (D @ °). Follow-up was 6 months.
The SIA was 0.24 D @ 8° for IOL repositioning and 0.65 D @ 171° for IOL exchange, which was a nonsignificant group difference (X coordinate: P = 0.08; Y coordinate: P = 0.16). Mean SIA magnitude was 0.60 ± 0.50 D and 1.12 ± 0.85 D, respectively (P < 0.001). Mean postoperative spherical equivalent was -1.6 ± 1.6 D after IOL repositioning and -0.5 ± 1.0 D after IOL exchange (P < 0.001). For IOL repositioning, this represented a mean myopic shift of -0.7 ± 1.1 D compared with before the IOL dislocation (P < 0.001). For IOL exchange, it was within ±1 D of target refraction in 83% of the patients.
Surgically induced astigmatism was modest in both operation groups, albeit with a tendency of being more pronounced for IOL exchange. Repositioning surgery led to a myopic shift, whereas exchange surgery provided good refractive predictability.
比较两种治疗晚期囊袋内人工晶状体脱位手术方法的手术诱导散光（SIA）和屈光结果。
在这项前瞻性、随机、平行组临床试验中，104例患者（眼）被分配接受在角膜缘后1.5至2毫米处巩膜缝合进行人工晶状体复位（n = 54）或使用5.5毫米巩膜隧道切口用瞳孔后虹膜爪型人工晶状体进行人工晶状体置换（n = 50）。通过将角膜柱镜转换为笛卡尔坐标进行矢量分析来确定SIA，并以屈光度@方向度数（D @ °）表示大小。随访6个月。
人工晶状体复位组的SIA为0.24 D @ 8°，人工晶状体置换组为0.65 D @ 171°，组间差异无统计学意义（X坐标：P = 0.08；Y坐标：P = 0.16）。平均SIA大小分别为0.60±0.50 D和1.12±0.85 D（P < 0.001）。人工晶状体复位术后平均等效球镜度为-1.6±1.6 D，人工晶状体置换术后为-0.5±1.0 D（P < 0.001）。对于人工晶状体复位，与人工晶状体脱位前相比，这代表平均近视偏移-0.7±1.1 D（P < 0.001）。对于人工晶状体置换，83%的患者其屈光在目标屈光度±1 D范围内。
两个手术组的手术诱导散光均较小，尽管人工晶状体置换组有更明显的趋势。复位手术导致近视偏移，而置换手术提供了良好的屈光可预测性。
