Hardten D R, Holland E J, Doughman D J, Nelson J D, Evangelista A W, Ketcham J M
Department of Ophthalmology, University of Minnesota, Minneapolis 55455.
Cornea. 1993 Jul;12(4):282-8. doi: 10.1097/00003226-199307000-00002.
We reviewed the pattern of astigmatism after penetrating keratoplasty and transsclerally sutured posterior chamber lens (TSPCL) placement in 73 patients. Thirty-five patients (48%) had an axis of astigmatism oriented perpendicularly to the haptics of the TSPCL. Twenty-seven patients (37%) had an orientation of astigmatism that was in the same meridian of the haptics of the TSPCL. Eleven patients (15%) had an axis of astigmatism oriented obliquely to the meridian of the haptics of the TSPCL. The distance the haptic fixation sutures were placed behind the limbus appeared to be correlated with the orientation of astigmatism. Patients having the lens fixated within 0.75 mm of the limbus were more likely to have astigmatism oriented perpendicular to the meridian of the haptics of the posterior chamber lens in the early postoperative period. Patients having the lens fixated 2-3 mm posterior to the limbus were more likely to have astigmatism oriented in the same meridian as the haptics of the posterior chamber lens in the early postoperative period. In an eye bank model of TSPCLs during penetrating keratoplasty, the placement of a posterior chamber lens with haptics fixated within 0.75 mm of the limbus significantly widens the recipient bed an average of 0.3 mm in the meridian of the haptics of lens placement (p = 0.02). When the posterior chamber lens haptics were fixated 3 mm posterior to the limbus, the recipient bed was significantly narrowed in the meridian of lens placement an average of 0.2 mm (p = 0.02). It appears that the TSPCLs may have an effect on early postkeratoplasty astigmatism by distorting the corneal wound at the time of keratoplasty.
我们回顾了73例穿透性角膜移植术联合经巩膜缝合后房型人工晶状体（TSPCL）植入术后的散光模式。35例患者（48%）的散光轴垂直于TSPCL的袢。27例患者（37%）的散光方向与TSPCL的袢在同一子午线上。11例患者（15%）的散光轴与TSPCL的袢子午线呈斜向。袢固定缝线在角膜缘后放置的距离似乎与散光方向相关。在术后早期，晶状体固定在角膜缘0.75mm以内的患者更易出现垂直于后房型人工晶状体袢子午线的散光。晶状体固定在角膜缘后2 - 3mm的患者在术后早期更易出现与后房型人工晶状体袢在同一子午线方向的散光。在穿透性角膜移植术中TSPCL的眼库模型中，将袢固定在角膜缘0.75mm以内的后房型人工晶状体植入，在晶状体植入袢的子午线方向上，受体床平均显著增宽0.3mm（p = 0.02）。当后房型人工晶状体袢固定在角膜缘后3mm时，在晶状体植入子午线方向上受体床平均显著变窄0.2mm（p = 0.02）。似乎TSPCL可能在角膜移植时通过扭曲角膜伤口对角膜移植术后早期散光产生影响。
