目的：比较不同术式联合Toric IOL植入术治疗硬核年龄相关性白内障的疗效。

方法：回顾性研究。选取2020-01/2021-12我院确诊为硬核年龄相关性白内障患者104例104眼，按照不同手术方式分为超声乳化组52眼采用超声乳化术联合Toric IOL植入术，小切口组52眼采用小切口水平空间劈核术联合Toric IOL植入术。比较两组患者手术前后最佳矫正远视力(BCDVA)、角膜散光、角膜内皮细胞数量和正常六边形细胞比例、泪膜功能及并发症情况。

结果：术前和术后3mo两组患者BCDVA(LogMAR)比较均无差异(均P>0.05)； 术后1wk，小切口组患者BCDVA(LogMAR)优于超声乳化组(0.15±0.04 vs 0.20±0.05，P<0.001\〗。两组患者各组内术后1wk，3mo角膜散光均低于术前，术后3mo低于术后1wk(均P<0.05)，而两组间手术前后角膜散光比较均无差异(均P>0.05)。术后1wk、3mo，小切口组患者角膜内皮细胞数量高于超声乳化组(术后1wk：2363.8±315.3 vs 2231.4±326.4cells/mm²，P<0.05； 术后3mo：2414.6±245.7 vs 2322.9±221.0cells/mm²，P<0.05)。术前、术后1wk两组角膜正常六边形细胞比例比较均无差异(均P>0.05)； 术后3mo，小切口组正常六边形细胞比例高于超声乳化组(21.77%±1.91% vs 20.59%±1.65%，P<0.001)。术前、术后3mo时两组BUT和OSDI评分的比较无差异(P>0.05)； 术后1wk小切口组患者BUT长于超声乳化组(6.8±0.8 vs 5.9±1.0s，P<0.001)，OSDI评分低于超声乳化组(17.62±5.47 vs 20.34±6.18分，P<0.05)。小切口组术后并发症发生率低于超声乳化组(3.9% vs 17.3%，P<0.05)。

结论：小切口水平空间劈核术联合Toric IOL植入术可明显改善硬核年龄相关性白内障患者视力及散光，对角膜内皮和泪膜功能损伤轻微。

METHODS:According to retrospective study, 104 patients(104 eyes)with age-related hard nuclear cataract confirmed in the hospital between January 2020 and December 2021 were enrolled. They were divided into phacoemulsification group(52 eyes, phacoemulsification combined with Toric IOL implantation)and small-incision group(52 eyes, small-incision split nuclear technique in horizontal space combined with Toric IOL implantation)according to different surgical methods. The best corrected distance visual acuity(BCDVA), corneal astigmatism, number of corneal endothelial cells, proportion of normal hexagonal cells, tear film function and complications were compared between the two groups.

RESULTS:There was no significant difference in BCDVA(LogMAR)between the two groups before and at 3mo after surgery(all P>0.05), while BCDVA(LogMAR)was better in small-incision group than phacoemulsification group at 1wk after surgery(0.15±0.04 vs. 0.20±0.05, P<0.001). The corneal astigmatism of the patients in both groups was lower at 1wk and 3mo after surgery than that before surgery, and it was lower at 3mo than 1wk after surgery(all P<0.05), while there was no significant difference in corneal astigmatism between the two groups before and after surgery(all P>0.05). At 1wk and 3mo after surgery, number of corneal endothelial cells in small-incision group was more than that in phacoemulsification group(1wk after surgery: 2363.8±315.3 vs. 2231.4±326.4 cells/mm², P<0.05; 3mo after surgery: 2414.6±245.7 vs. 2322.9±221.0 cells/mm², P<0.05). Before and at 1wk after surgery, there was no significant difference in the proportion of normal hexagonal cells between the two groups(all P>0.05). At 3mo after surgery, proportion of normal hexagonal cells in small-incision group was higher than that in phacoemulsification group(21.77%±1.91% vs. 20.59%±1.65%, P<0.001). Before and at 3mo after surgery, there was no difference in break up time(BUT)or ocular surface disease index(OSDI)score between the two groups(P>0.05). At 1wk after surgery, BUT in small-incision group was longer than that in phacoemulsification group(6.8±0.8 vs. 5.9±1.0s, P<0.001)and OSDI score was lower than that in phacoemulsification group(17.62±5.47 vs. 20.34±6.18 points, P<0.05). The incidence of postoperative complications in small-incision group was lower than that in phacoemulsification group(3.9% vs. 17.3%, P<0.05).

CONCLUSION: Small-incision split nuclear technique in horizontal space combined with Toric IOL implantation can significantly improve visual acuity and astigmatism in patients with age-related cataract, with slight damage to corneal endothelium and tear film function.