From the Department of Ophthalmology, University of California, San Francisco, San Francisco, California (S.C. Schallhorn, J.M. Schallhorn); Optical Express, Glasgow, United Kingdom (S.C. Schallhorn, Hettinger, Pelouskova, Teenan, Venter, Hannan); Carl Zeiss Meditec, Inc., Dublin, California (S.C. Schallhorn); F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California (J.M. Schallhorn).
J Cataract Refract Surg. 2021 Aug 1;47(8):991-998. doi: 10.1097/j.jcrs.0000000000000560.
To evaluate the effect of residual astigmatism on postoperative visual acuity and satisfaction after intraocular lens (IOL) surgery.
Private practice, United Kingdom.
Retrospective case series.
Postoperative data of patients who had previously undergone refractive lens exchange or cataract surgery were used in a multivariate regression model to assess the effect of residual astigmatism on 3 months postoperative monocular uncorrected distance visual acuity (UDVA) and patient satisfaction. The analysis was based on residual refraction in the dominant eye of each patient. Odds ratios were calculated to demonstrate the effect of increasing residual astigmatism on UDVA and satisfaction with separate calculations for monofocal and multifocal IOLs.
Three months postoperative outcomes of 17 152 dominant eyes were used in multivariate regression analysis. Compared with eyes with 0.00 diopter (D) residual astigmatism, the odds of not achieving 20/20 vision in eyes with 0.25 to 0.50 D residual astigmatism increased by a factor of 1.7 and 1.9 (P < .0001) in monofocal and multifocal IOLs, respectively. For the residual astigmatism 0.75 to 1.00 D, the odds ratio for not achieving 20/20 vision compared with eyes with no astigmatism was 6.1 for monofocal and 6.5 for multifocal IOLs (P < .0001). The effect of residual astigmatism on satisfaction was more evident at the 0.75 to 1.00 D level, where the odds of not being satisfied with vision increased by a factor of 2.0 and 1.5 in patients with monofocal and multifocal IOLs, respectively (P < .0001). The orientation of astigmatism was not a significant predictor in multivariate analysis.
Multivariate analysis in a large population of patients demonstrated that low levels of residual astigmatism can degrade visual acuity. Corneal astigmatism of 0.50 D or greater should be included in surgical planning.
评估人工晶状体（IOL）手术后残余散光对术后视力和满意度的影响。
英国私人诊所。
回顾性病例系列。
使用多元回归模型评估患者的术后数据，这些患者之前曾接受过屈光性晶状体置换术或白内障手术，以评估残余散光对术后 3 个月单眼未矫正远距视力（UDVA）和患者满意度的影响。分析基于每位患者主导眼的残余屈光。计算比值比以显示残余散光对 UDVA 的影响，并分别计算单焦点和多焦点 IOL 的满意度。
多元回归分析中使用了 17152 只主导眼的术后 3 个月结果。与残余散光为 0.00 屈光度（D）的眼睛相比，残余散光为 0.25 至 0.50 D 的眼睛中，20/20 视力的可能性分别增加了 1.7 倍和 1.9 倍（P<0.0001）；在单焦点和多焦点 IOL 中分别增加了 1.7 倍和 1.9 倍（P<0.0001）。对于残余散光 0.75 至 1.00 D，与无散光的眼睛相比，20/20 视力的比值比为 6.1 对单焦点和 6.5 对多焦点 IOL（P<0.0001）。残余散光对满意度的影响在 0.75 至 1.00 D 水平更为明显，在单焦点和多焦点 IOL 中，对视力不满意的几率分别增加了 2.0 倍和 1.5 倍（P<0.0001）。散光方向在多元分析中不是一个显著的预测因素。
在大量患者的多元分析中，低水平的残余散光可降低视力。角膜散光 0.50 D 或以上应纳入手术计划。
