目的：比较超声乳化白内障摘除联合Toric人工晶状体植入术与球面人工晶状体植入术联合周边角膜切开术矫正老年性白内障患者术前散光的疗效。

方法：连续纳入老年性白内障住院手术患者54例54眼，男27例，女27例，平均年龄70.04±9.08(50～87)岁。A组(0.75D≤散光≤1.50D)30例， B组(1.75D≤散光≤2.50D)24例。每组患者随机分配进行周边角膜切开术(PCRIs)和Toric人工晶状体植入术矫正术前散光，比较两种手术方式术后6mo患者的裸眼视力(UCVA)、最佳矫正视力(BCVA)、残余散光(|EV|)、散光矫正量(|SIRC|)、散光矫正率(CR)。比较两种手术方式术后6mo与术后1mo的UCVA和|EV|的变化。

结果：术后6mo，所有患者的BCVA均达0.6以上。PCRIs 与Toric-IOL术后BCVA达到0.8以上者在A组中分别为86.7% vs 93.3%(P>0.05)，B组分别为75% vs 91.7%(P=0.59)，两种术式在两散光组中间差异均无统计学意义。术后6mo，PCRIs与Toric-IOL两种术式患者的UCVA、|EV|、|SIRC|、CR在A组患者中分别为0.70±0.21 vs 0.76±0.17(P=0.81)、0.48±0.22 vs 0.37±0.19(P=0.13)、0.87±0.30 vs 0.92±0.38(P=0.71)、0.75±0.16 vs 0.78±0.19(P=0.56)，两种术式间各参数差异均无统计学意义； B组患者中分别为0.50±0.15 vs 0.78±0.11(P<0.01)、1.17±0.36 vs 0.54±0.33(P<0.01)、1.08±0.27 vs 1.68±0.32(P<0.01)、0.51±0.13 vs 0.81±0.14(P<0.01)，两种术式间各参数差异均有统计学意义。A组中PCRIs术后1mo与术后6mo的UCVA、|EV|在分别为0.77±0.23 vs 0.70±0.21(P=0.09)、0.50±0.23 vs 0.48±0.22(P=0.58)，Toric-IOL术后分别为0.77±0.223 vs 0.76±0.17(P=0.81)、0.40±0.18 vs 0.37±0.19(P=0.55)，各参数间差异无统计学意义； B组患者中PCRIs术后1mo与术后6mo的UCVA、|EV|分别为0.63±0.17 vs 0.50±0.15(P<0.01)、0.81±0.34 vs 1.17±0.36(P<0.01)，Toric-IOL术分别为0.81±0.12 vs 0.78±0.11(P=0.08)、0.48±0.31 vs 0.54±0.33(P<0.01)，各参数间差异有统计学意义。

结论：PCRIs与Toric-IOL两种手术方式矫正老年性白内障患者术前散光安全、有效。两种手术方式矫正低度数散光(0.75～1.50D)的疗效无差异，术后6mo内疗效稳定； Toric-IOL术矫正较高度数散光(1.75～2.50D)的疗效优于PCRIs； 两种术式的疗效在术后6mo均有所回退，PCRIs回退较严重。

AIM: To compare phacoemusification combined Toric intraocular lens implantation(Toric-IOL)with spherical intraocular lens implantation combined peripheral corneal relaxing incisions(PCRIs)for astigmatism correction in elderly patients before having cataract surgery.

METHODS: This randomized prospective clinical study comprised eyes with more than 0.75 diopter(D)of preexisting corneal astigmatism. Totally 54 patients(54 eyes), 27 males and 27 females, with mean age 70.04±9.08 years, were enrolled consecutively to group A(n=30)(0.75D-1.50D)and group B(n=24)(1.75D-2.50D)according to the corneal astigmatism. In each group patients were randomized to undergo Toric-IOL implantation or PCRLs in the steep axis with spherical IOL implantation. Uncorrected visual acuity(UCVA), best-corrected visual acuity(BCVA), error of vector(|EV|), surgery induced refraction correction(|SIRC|)and correction rat(CR)were measured 1 month and 6 months postoperatively.

RESULTS: Six months postoperatively, all 54 eyes got the BCVA≥0.6. Patients underwent PCRIs and Toric-IOL with BCVA≥0.8 were 86.7% vs 93.3%(P>0.05)in group A and 75% vs 91.7%(P=0.59)in group B respectively. UCVA, |EV|, |SIRC| and CR in patients underwent PCRIs and Toric-IOL were not significantly different by 0.70±0.21 vs 0.76±0.17(P=0.81), 0.48±0.22 vs 0.37±0.19(P=0.13), 0.87±0.30 vs 0.92±0.38(P=0.71),0.75±0.16 vs 0.78±0.19(P=0.56)respectively in group A; It were significantly different by 0.50±0.15 vs 0.78±0.11(P<0.01), 1.17±0.36 vs 0.54±0.33(P<0.01), 1.08±0.27 vs 1.68±0.32(P <0.01), 0.51±0.13 vs 0.81±0.14(P <0.01)respectively in group B. Difference of UCVA and |EV| between 1 month and 6 months were not significant in patients in group A, but were significant in group B, regardless of PCRIs or Toric-IOL surgery. In group A,UCVA and |EV| measured 1 month and 6 months post-operation were 0.77±0.23 vs 0.70±0.21(P=0.09),0.50±0.23 vs 0.48±0.22(P=0.58)respectively in PCRIs patients and 0.77±0.223 vs 0.76±0.17(P=0.81), 0.40±0.18 vs 0.37±0.19(P=0.55)respectively in Toric-IOL patients. In group B, UCVA and |EV| measured 1 month and 6 months post-operation were 0.63±0.17 vs 0.50±0.15(P<0.01), 0.81±0.34 vs 1.17±0.36(P<0.01)respectively in PCRIs patients and 0.81±0.12 vs 0.78±0.11(P=0.08), 0.48±0.31 vs 0.54±0.33(P<0.01)respectively in Toric-IOL patients.

CONCLUSION: Toric-IOL implantation and PCRIs were both safe and effective for astigmatism correction in elderly patients before having cataract surgery. The efficacy and stability of astigmatism correction were equal in low astigmatic patients. Toric-IOL implantation achieved an enhanced effect over PCRIs in higher astigmatic patients. Both of the surgeries had the refractive regression after 6 months and PCRIs regressed more obviously.

广东省科技计划项目(No.2011B080701033; No.2012B031800294)