手工与飞秒激光弧形角膜切开术矫正白内障散光效果比较

Comparison of manual and femtosecond laser arcuate keratotomy for correction of corneal astigmatism in patients undergoing cataract surgery

摘要

目的 比较前穿透型飞秒激光弧形角膜切开术(femtosecond laser-assisted arcuate keratotomy, FSAK)与手工弧形角膜切开术(manual arcuate keratotomy, mAK)对矫正白内障患者的轻中度规则性角膜散光效果。方法 非随机队列研究共纳入54眼，其中22眼行角膜定深刀mAK，32眼接受FSAK。两组均联合超声乳化白内障吸除及非散光型人工晶状体植入。比较两组术后3个月的视力及角膜散光的变化，采用Alpins矢量分析法比较两组的目标诱导散光量(target-induced astigmatism, TIA)、手术诱导散光量(surgery-induced astigmatism, SIA)、差异矢量(difference vector, DV)及矫正指数(correction index, CI)等指标，采用独立样本t检验比较两组散光矫正效果。结果 mAK组散光由(1.26±0.27)D降至(0.90±0.59)D，FSAK组由(1.24±0.27)D降至(0.70±0.37)D，两组差异无统计学意义(P=0.133)。Alpins分析示mAK组的SIA、DV、CI均高于FSAK组(P=0.238、P=0.133、P=0.191)，两组均呈欠矫趋势，差异无统计学意义，但mAK组较大的标准差提示其可控性及可预测性较差。mAK组观察到1例角膜穿透。结论 FSAK与mAK均能有效矫正白内障患者低中度数规则性角膜散光，FSAK在安全性与手术可预测性方面更具优势，但费用更高。

Abstract

Objective To compare the effectiveness of penetrating femtosecond laser-assisted arcuate keratotomy (FSAK) and manual arcuate keratotomy (mAK) in correcting mild-to-moderate regular corneal astigmatism in cataract patients. Methods This non-randomised cohort study involving 54 eyes, including 22 eyes that underwent mAK using a corneal depth marker knife and 32 eyes that received penetrating FSAK. Both groups underwent combined phacoemulsification and implantation of non-toric intraocular lenses. The primary outcomes included postoperative visual acuity and changes in corneal astigmatism at three months. Alpins vector analysis was used to compare target-induced astigmatism (TIA), surgically induced astigmatism (SIA), difference vector (DV), and correction index (CI) between the two groups. An independent-samples t-test was employed to compare the effects of astigmatism correction. Results Astigmatism in the mAK group decreased from (1.26±0.27) D to (0.90±0.59) D, while the FSAK group decreased from (1.24±0.27) D to (0.70±0.37) D, with no statistically significant difference between the two groups (P=0.133). Alpins analysis revealed that the SIA, DV, and CI of the mAK group were all higher than the FSAK group (P=0.238, P=0.133, P=0.191). Both groups showed a tendency toward undercorrection. Although intergroup differences were not statistically significant, the larger standard deviations observed in the mAK group indicated diminished controllability and predictability. One case of corneal perforation was observed in the mAK group. Conclusion Both FSAK and mAK can successfully correct mild-to-moderate regular astigmatism in cataract patients. However, FSAK exhibits superior safety and surgical predictability, albeit at a higher cost.

关键词

飞秒激光 / 角膜定深刀 / 弧形角膜切开术 / 角膜散光 / 白内障手术

Key words

Femtosecond laser / Corneal depth knife / Arcuate keratotomy / Corneal astigmatism / Cataract surgery

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基金资助

爱尔眼科集团科研基金资助项目(AF2202D11)

爱尔眼科集团科研基金资助项目(AGF2302D17)