Oh Ja Young, Lee Seung Hyeun, Chun Yeoun Sook, Kim Kyoung Woo
Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea.
Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea.
Sci Rep. 2025 Jul 21;15(1):26439. doi: 10.1038/s41598-025-12300-3.
Postoperative astigmatism remains a concern after temporal clear corneal incision (TCCI) cataract surgery, especially in eyes with preexisting corneal astigmatism. This study investigated whether peripheral-to-central corneal thickness ratios can predict anterior corneal astigmatic shifts following surgery and whether these associations vary by preoperative anterior corneal astigmatism type. We retrospectively, analyzed 209 eyes from 137 patients who underwent uneventful phacoemulsification with 2.75 mm TCCI and intraocular lens implantation. Preoperative central corneal thickness (CCT), mid-peripheral corneal thicknesses (MPCT, 5-7 mm), and temporal peripheral corneal thickness (TPCT, 7-10 mm) were measured using anterior segment optical coherence tomography (Visante; Carl Zeiss Meditec, Germany). Patients were categorized into with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism groups based on their preoperative anterior corneal astigmatism. In the WTR group, higher TPCT/CCT and MPCT/CCT ratios showed significant correlations with an increase in postoperative anterior corneal astigmatism (r = 0.293, P = 0.011; r = 0.301, P = 0.009). In the oblique group, MPCT/CCT was correlated with changes in flat, steep, and average anterior keratometry. No significant correlations were observed in the ATR group. Receiver operating characteristic analysis identified TPCT/CCT ≥ 1.118 and MPCT/CCT ≥ 1.046 as thresholds for predicting a ≥ + 0.25 diopter increase in postoperative anterior corneal astigmatism in WTR eyes, demonstrating sensitivities of 95.0% and 87.5% and specificities of 34.3% and 45.7%, respectively. These findings suggest that peripheral-to-central corneal thickness ratios may serve as useful predictors of surgically induced anterior corneal astigmatism in patients with WTR astigmatism and can inform preoperative assessment and surgical planning.
在颞侧透明角膜切口（TCCI）白内障手术后，术后散光仍是一个令人担忧的问题，尤其是在术前就存在角膜散光的眼睛中。本研究调查了周边与中央角膜厚度比是否可以预测手术后前角膜散光的变化，以及这些关联是否因术前前角膜散光类型而异。我们回顾性分析了137例患者的209只眼睛，这些患者均接受了顺利的2.75毫米TCCI超声乳化白内障吸除术和人工晶状体植入术。使用眼前节光学相干断层扫描（Visante；德国卡尔蔡司医疗技术公司）测量术前中央角膜厚度（CCT）、中周边角膜厚度（MPCT，5 - 7毫米）和颞侧周边角膜厚度（TPCT，7 - 10毫米）。根据患者术前前角膜散光情况，将其分为顺规散光（WTR）、逆规散光（ATR）和斜向散光组。在WTR组中，较高的TPCT/CCT和MPCT/CCT比值与术后前角膜散光增加显著相关（r = 0.293，P = 0.011；r = 0.301，P = 0.009）。在斜向散光组中，MPCT/CCT与平坦、陡峭和平均角膜前表面曲率的变化相关。在ATR组中未观察到显著相关性。受试者工作特征分析确定TPCT/CCT≥1.118和MPCT/CCT≥1.046为预测WTR眼睛术后前角膜散光增加≥+0.25屈光度的阈值，敏感性分别为95.0%和87.5%，特异性分别为34.3%和45.7%。这些发现表明，周边与中央角膜厚度比可能是WTR散光患者手术诱发前角膜散光的有用预测指标，并可为术前评估和手术规划提供参考。
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