Gross R H, Poulsen E J, Davitt S, Schwab I R, Mannis M J
Department of Ophthalmology, University of California, Davis, Sacramento 95816-7051, USA.
Am J Ophthalmol. 1997 May;123(5):636-43. doi: 10.1016/s0002-9394(14)71076-1.
We compared surgically induced astigmatism after penetrating keratoplasty performed by supervised cornea fellows and experienced cornea surgeons.
Data were collected by retrospective chart review of 166 cases (166 eyes) of penetrating keratoplasty: 63 performed by two cornea surgeons and 103 by four cornea fellows. Astigmatism was calculated using scalar and vector methods. Vector analysis was performed on 109 of 166 eyes. Two techniques were compared: intraoperative keratometry and suture adjustment and the torque-antitorque running suture technique with no intraoperative keratometry or suture adjustment.
Mean surgically induced scalar astigmatism changed from preoperative astigmatism by 3.27 diopters (fellows) and 2.94 diopters (attending surgeons). In 109 cases, surgically induced vector cylinder changed from peroperative astigmatism by 4.21 diopters at 98 degrees (fellows) and 4.25 diopters at 114 degrees (surgeons). Surgically induced vector astigmatism changed from preoperative astigmatism by 4.67 diopters at 93 degrees in the first 6 months (fellows) and by 3.79 diopters at 103 degrees in the second 6 months. Analysis of x-axis and y-axis components of the surgically induced vector cylinder showed that the majority of the astigmatism was induced in the y-axis and that this difference was significant (P < .001) in all comparisons, independent of technique or surgeon group.
Penetrating keratoplasty performed by supervised cornea fellows resulted in similar rates of surgically induced vector astigmatism, surface asymmetry, and surface regularity as that by experienced surgeons. Fellows induced significantly more with-the-rule astigmatism, but this tendency decreased with further training. Penetrating keratoplasty astigmatic outcomes were not significantly different whether or not intraopertive keratometry and suture adjustment were utilized. This study supports the concept that increased experience with corneal transplantation improves the outcome of penetrating keratoplasty by using the criterion of postoperative astigmatism as a measures.
我们比较了在角膜专科住院医师和经验丰富的角膜外科医生监督下进行穿透性角膜移植术后手术诱导的散光情况。
通过回顾性病历审查收集了166例（166只眼）穿透性角膜移植术的数据：63例由两位角膜外科医生进行，103例由四位角膜专科住院医师进行。使用标量和矢量方法计算散光。对166只眼中的109只眼进行了矢量分析。比较了两种技术：术中角膜曲率测量和缝线调整，以及不进行术中角膜曲率测量或缝线调整的扭矩-反扭矩连续缝线技术。
手术诱导的平均标量散光与术前散光相比，专科住院医师组改变了3.27屈光度，主治医生组改变了2.94屈光度。在109例病例中，手术诱导的矢量柱镜与术前散光相比，专科住院医师组在98度时改变了4.21屈光度，主治医生组在114度时改变了4.25屈光度。手术诱导的矢量散光与术前散光相比，专科住院医师组在前6个月93度时改变了4.67屈光度，在后6个月103度时改变了3.79屈光度。对手术诱导的矢量柱镜的x轴和y轴分量分析表明，大部分散光在y轴上诱导产生，并且在所有比较中这种差异均具有统计学意义（P <.001），与技术或手术医生组无关。
在角膜专科住院医师监督下进行的穿透性角膜移植术导致的手术诱导矢量散光、表面不对称和表面规则性发生率与经验丰富的医生相似。专科住院医师诱导的顺规散光明显更多，但随着进一步培训这种趋势有所下降。无论是否使用术中角膜曲率测量和缝线调整，穿透性角膜移植术的散光结果均无显著差异。本研究支持这样一种观点，即通过将术后散光标准作为衡量指标，增加角膜移植经验可改善穿透性角膜移植术的结果。
