Mandel M R, Shapiro M B, Krachmer J H
Am J Ophthalmol. 1987 Mar 15;103(3 Pt 2):441-7. doi: 10.1016/s0002-9394(14)77768-2.
We performed a prospective study of relaxing incisions with augmentation sutures in 21 patients who were unable to wear spectacles or contact lenses after penetrating keratoplasty because of high astigmatism. The mean preoperative astigmatism was 9.37 diopters (range, 4.50 to 14.50 diopters), and the mean postoperative astigmatism was 3.73 diopters (range, 0.00 to 7.00 diopters). The net decrease in astigmatism was 6.56 diopters (range, 1.00 to 11.00 diopters), which represents a 67% decrease in astigmatism. The mean vector corrected change in astigmatism was 8.40 diopters (86%). These results were compared with those of our previous study of relaxing incisions without sutures. Overall, there was a significantly greater decrease in astigmatism (67% vs 47%, P = .009) when augmentation sutures were placed 90 degrees away from the relaxing incisions. Furthermore, in patients with more than 8.50 diopters of astigmatism, relaxing incisions with sutures yielded a much greater reduction in astigmatism compared with relaxing incisions without sutures (70% with sutures vs 39% without sutures, P = .002). We recommend relaxing incisions with augmentation sutures as the initial surgical procedure in eyes with more than 8.50 diopters of astigmatism.
我们对21例穿透性角膜移植术后因高度散光而无法佩戴眼镜或隐形眼镜的患者进行了一项前瞻性研究，采用松弛切口联合增强缝线技术。术前平均散光为9.37屈光度（范围为4.50至14.50屈光度），术后平均散光为3.73屈光度（范围为0.00至7.00屈光度）。散光净减少量为6.56屈光度（范围为1.00至11.00屈光度），这代表散光减少了67%。散光的平均矢量校正变化为8.40屈光度（86%）。这些结果与我们之前关于无缝线松弛切口的研究结果进行了比较。总体而言，当增强缝线置于距松弛切口90度处时，散光减少更为显著（67%对47%，P = .009）。此外，对于散光超过8.50屈光度的患者，与无缝线的松弛切口相比，有缝线的松弛切口导致散光减少幅度更大（有缝线者为70%，无缝线者为39%，P = .002）。我们建议对于散光超过8.50屈光度的眼睛，将松弛切口联合增强缝线技术作为初始手术方法。
