McAlinden Colm, Janicek David
Department of Ophthalmology, Singleton Hospital, Swansea Bay University Health Board, Port Talbot, UK.
Department of Ophthalmology, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK.
J Ophthalmol. 2021 Dec 18;2021:3286043. doi: 10.1155/2021/3286043. eCollection 2021.
This audit was conducted in a UK ophthalmology department and included 48 eyes of 42 patients. Surgery was performed during 2019 in patients with 2.50 diopters (D) or more corneal astigmatism. Anterior keratometry readings were used to determine the toric IOL power. Vector analysis using the Alpins method was used to assess changes in astigmatism pre to postoperatively.
There were 18 right and 26 left eyes included. In terms of gender, 61% of patients were female and 39% were male. The mean (±standard deviation (SD)) age was 70 (±11) years. The mean (±SD) axial length, 1, 2, and delta was 23.55 (±1.4) mm, 42.71 (±1.39) D, 45.78 (±1.60) D, and 3.01 (±0.89) D, respectively. Postoperatively, the median spherical, cylinder, and spherical equivalent refraction was 0.00 D, -1.00 D, and 0.00 D, respectively. Postoperatively, 41% of the eyes had ≤0.50 D of spectacle astigmatism and 80% had ≤1.00 D. No patient required a secondary procedure to reposition the IOL from rotation. In vector analysis with the use of polar diagrams, there was a tendency for overcorrection of with-the-rule astigmatism and undercorrection of against-the-rule astigmatism.
Significant reductions in astigmatism can be achieved with the use of toric IOLs in patients undergoing cataract surgery. Further improvements may be possible with surgeon-specific determination of their surgically induced astigmatism and flattening effect from the main corneal incision. Furthermore, the use of an optical biometer that directly measures the posterior corneal curvature and permits automatic toric IOL power determination with modern formulas avoiding the need for manual data entry may reduce the risk of human error and improve visual and refractive outcomes.
本审计在英国一家眼科进行，纳入了42例患者的48只眼。2019年对角膜散光2.50屈光度（D）及以上的患者进行了手术。使用前角膜曲率计读数来确定散光型人工晶状体的度数。采用Alpins方法进行矢量分析，以评估术前至术后散光的变化。
纳入18只右眼和26只左眼。在性别方面，61%的患者为女性，39%为男性。平均（±标准差（SD））年龄为70（±11）岁。平均（±SD）眼轴长度、角膜前表面散光度数、角膜后表面散光度数和散光差值分别为23.55（±1.4）mm、42.71（±1.39）D、45.78（±1.60）D和3.01（±0.89）D。术后，球镜、柱镜和等效球镜屈光度的中位数分别为0.00 D、-1.00 D和0.00 D。术后，41%的眼睛残余散光≤0.50 D，80%的眼睛残余散光≤1.00 D。没有患者需要二次手术来重新定位旋转的人工晶状体。在使用极坐标图的矢量分析中，顺规散光有过矫倾向，逆规散光有欠矫倾向。
白内障手术患者使用散光型人工晶状体可显著降低散光。通过外科医生特异性确定手术诱导散光和主角膜切口的 flattening 效应，可能会有进一步改善。此外，使用直接测量角膜后表面曲率并允许通过现代公式自动确定散光型人工晶状体度数而无需手动输入数据的光学生物测量仪，可能会降低人为误差风险并改善视觉和屈光结果。
