VERION数字导航系统在散光人工晶状体植入术中的应用
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摘要
目的探讨VERION数字导航系统在散光人工晶状体植入手术中的应用效果。方法将76例老年性白内障患者随机分为观察组和对照组各38例,观察组使用VERION数字导航系统辅助标注定位和手术,对照组使用裂隙灯显微镜进行人工标注定位和手术。比较两组患者最佳矫正视力(BCVA)、角膜散光、术前目标散光值、术后残留散光、散光偏差值、超声乳化能量、角膜内皮丢失率,观察两组患者人工晶状体位置并测量人工晶状体位置与预设轴位的偏差。结果手术前、后,两组患者的角膜散光、BCVA差异均无统计学意义(均P> 0. 05)。与术前比较,术后两组患者的角膜散光差异无统计学意义(P> 0. 05),而两组患者的BCVA均提高(均P <0. 05)。两组患者术前目标散光值、术后残留散光值比较,差异均无统计学意义(均P> 0. 05);但对照组散光偏差值大于观察组(P <0. 05)。术后1 d时,观察组的人工晶状体位置与预设轴位的偏差小于对照组(P <0. 05);术后3个月时,两组人工晶状体位置稳定,与术后1 d比较基本无明显旋转和偏位。两组的超声乳化能量和内皮细胞丢失率差异均无统计学意义(均P> 0. 05)。结论 VERION数字导航系统辅助散光人工晶状体植入术能在手术中实时准确标注手术切口位置、人工晶状体中心和轴位,避免了人工标注可能产生的误差,提高了散光人工晶状体植入手术的准确性。
Objective To explore the effect of VERION digital navigation system applied to intraocular lens implantation for astigmatism. Methods Seventy-six patients with senile cataract were randomly divided into observation group and control group,with 38 cases in each group. The observation group adopted VERION digital navigation system to assist marking,positioning and surgery,while the control group used slit-lamp microscope for manual marking,positioning and surgery. Best corrected visual acuity( BCVA),corneal astigmatism,preoperative target astigmatism,postoperative residual astigmatism,astigmatism deviation,phacoemulsification energy,and corneal endothelium loss rate were compared between the two groups. The position of intraocular lens was observed and the deviation between intraocular lens position and preset axis was measured in the two groups. Results Preoperative or postoperative corneal astigmatism,or BCVA showed no statistically significant difference between the two groups( all P > 0. 05). Compared with the preoperative,postoperative corneal astigmatism presented no statistically significant difference in the two groups( P > 0. 05),whereas,postoperative BCVA was improved( all P < 0. 05). There were no statistically significant differences in preoperative target astigmatism or postoperative residual astigmatism between the two groups( all P > 0. 05);but the control group had a greater astigmatism deviation than the observation group( P < 0. 05). One day after operation,the observation group achieved a minor deviation between intraocular lens position and preset axis compared with the control group( P < 0. 05); three months after operation,both groups reported intraocular lens stationary,without notable rotation or deviation than those on day 1 postoperatively. No statistically significant difference was observed in phacoemulsification energy or corneal endothelium loss rate between the two groups( all P > 0. 05). Conclusion VERION digital navigation system-assisted intraocular lens implantation for astigmatism offers accurate real-time labeling of surgical incision and intraocular lens center and axis during operation,avoiding potential errors caused by manual labeling and improving the accuracy of intraocular lens implantation for astigmatism.
Objective To explore the effect of VERION digital navigation system applied to intraocular lens implantation for astigmatism. Methods Seventy-six patients with senile cataract were randomly divided into observation group and control group,with 38 cases in each group. The observation group adopted VERION digital navigation system to assist marking,positioning and surgery,while the control group used slit-lamp microscope for manual marking,positioning and surgery. Best corrected visual acuity( BCVA),corneal astigmatism,preoperative target astigmatism,postoperative residual astigmatism,astigmatism deviation,phacoemulsification energy,and corneal endothelium loss rate were compared between the two groups. The position of intraocular lens was observed and the deviation between intraocular lens position and preset axis was measured in the two groups. Results Preoperative or postoperative corneal astigmatism,or BCVA showed no statistically significant difference between the two groups( all P > 0. 05). Compared with the preoperative,postoperative corneal astigmatism presented no statistically significant difference in the two groups( P > 0. 05),whereas,postoperative BCVA was improved( all P < 0. 05). There were no statistically significant differences in preoperative target astigmatism or postoperative residual astigmatism between the two groups( all P > 0. 05);but the control group had a greater astigmatism deviation than the observation group( P < 0. 05). One day after operation,the observation group achieved a minor deviation between intraocular lens position and preset axis compared with the control group( P < 0. 05); three months after operation,both groups reported intraocular lens stationary,without notable rotation or deviation than those on day 1 postoperatively. No statistically significant difference was observed in phacoemulsification energy or corneal endothelium loss rate between the two groups( all P > 0. 05). Conclusion VERION digital navigation system-assisted intraocular lens implantation for astigmatism offers accurate real-time labeling of surgical incision and intraocular lens center and axis during operation,avoiding potential errors caused by manual labeling and improving the accuracy of intraocular lens implantation for astigmatism.
引文
[1] Yoo A,Yun S,Kim JY,et al. Femtosecond laser-assisted arcuate keratotomy versus toric IOL implantation for correcting astigmatism[J]. J Refract Surg,2015,31(9):574-578.
[2]杨宁.白内障术后角膜散光矫正的研究进展[J].临床眼科杂志,2012,20(1):82-85.
[3]王丰刚,陈绪攀,林晓盈,等. Acrysof Toric IOL植入矫正白内障患者角膜散光的早期临床效果研究[J].临床眼科杂志,2012,20(5):415-417.
[4] Webers VSC,Bauer NJC,Visser N,et al. Image-guided system versus manual marking for toric intraocular lens alignment in cataract surgery[J]. J Cataract Refract Surg,2017,43(6):781-788.
[5]葛坚,王宁利.眼科学[M]. 3版.北京:人民卫生出版社,2015:228-230.
[6] De Bernardo M,Zeppa L,Cennamo M,et al. Prevalence of corneal astigmatism before cataract surgery in Caucasian patients[J]. Eur J Ophthalmol,2014,24(4):494-500.
[7]李亚东,郑广瑛,张萌,等.年龄相关性白内障术前角膜屈光状态与非球面性特征及相互关系分析[J].中国实用眼科杂志,2015,33(4):350-353.
[8]徐力,郑丹莹,罗莉霞,等. OCCI与TCCI手术切口植入Acrysof Toric人工晶状体的临床对比研究[J].中华眼科杂志,2010,46(3):243-248.
[9] Hennig A,Kumar J,Yorston D,et al. Sutureless cataract surgery with nucleus extraction:outcome of a prospective study in Nepal[J]. Br J Ophthalmol,2003,87(3):266-270.
[10]刘菲,叶剑,荣运久,等. Acry Sof Toric人工晶状体治疗白内障合并角膜散光[J].中华眼视光学与视觉科学杂志,2012,14(9):558-560.
[11] Ma JJ,Tseng SS. Simple method for accurate alignment in toric phakic and aphakic intraocular lens implantation[J]. J Cataract Refract Surg,2008,34(10):1 631-1 636.
[12] Hasegawa Y,Okamoto F,Nakano S,et al. Effect of preoperative corneal astigmatism orientation on results with a toric intraocular lens[J]. J Cataract Refract Surg,2013,39(12):1 846-1 851.
[13]巫雷,王文惠.数字导航系统在散光矫正型人工晶状体植入术中的应用[J].中华眼外伤职业眼病杂志,2017,39(9):641-644.
[14]张蓓,邓国华,周栋,等. Verion导航与手动标记对Toric人工晶状体植入术后角膜散光矫正的影响[J].中华眼视光学与视觉科学杂志,2018,20(4):227-231.
[15] Elhofi AH,Helaly HA. Comparison between digital and manual marking for toric intraocular lenses:a randomized trial[J]. Medicine(Baltimore),2015,94(38):e1618.
[16] Chang DF. Comparative rotational stability of single-piece open-loop acrylic and plate-haptic silicone toric intraocular lenses[J]. J Cataract Refract Surg,2008,34(11):1 842-1 847.
[17]李瑾,赵云娥,李军花,等. Acrysof Toric人工晶状体植入矫正白内障术前角膜散光的短期观察[J].中华眼科杂志,2010,46(6):513-517.
[18]汤欣,宋慧. Toric人工晶状体临床应用中值得关注的问题[J].中华眼科杂志,2013,49(5):392-394.
[19]陈薇,禤中宁,黄瑛,等.眼位训练在提高数字导航下白内障手术效果的研究[J].微创医学,2017,12(6):781-782,791.
[2]杨宁.白内障术后角膜散光矫正的研究进展[J].临床眼科杂志,2012,20(1):82-85.
[3]王丰刚,陈绪攀,林晓盈,等. Acrysof Toric IOL植入矫正白内障患者角膜散光的早期临床效果研究[J].临床眼科杂志,2012,20(5):415-417.
[4] Webers VSC,Bauer NJC,Visser N,et al. Image-guided system versus manual marking for toric intraocular lens alignment in cataract surgery[J]. J Cataract Refract Surg,2017,43(6):781-788.
[5]葛坚,王宁利.眼科学[M]. 3版.北京:人民卫生出版社,2015:228-230.
[6] De Bernardo M,Zeppa L,Cennamo M,et al. Prevalence of corneal astigmatism before cataract surgery in Caucasian patients[J]. Eur J Ophthalmol,2014,24(4):494-500.
[7]李亚东,郑广瑛,张萌,等.年龄相关性白内障术前角膜屈光状态与非球面性特征及相互关系分析[J].中国实用眼科杂志,2015,33(4):350-353.
[8]徐力,郑丹莹,罗莉霞,等. OCCI与TCCI手术切口植入Acrysof Toric人工晶状体的临床对比研究[J].中华眼科杂志,2010,46(3):243-248.
[9] Hennig A,Kumar J,Yorston D,et al. Sutureless cataract surgery with nucleus extraction:outcome of a prospective study in Nepal[J]. Br J Ophthalmol,2003,87(3):266-270.
[10]刘菲,叶剑,荣运久,等. Acry Sof Toric人工晶状体治疗白内障合并角膜散光[J].中华眼视光学与视觉科学杂志,2012,14(9):558-560.
[11] Ma JJ,Tseng SS. Simple method for accurate alignment in toric phakic and aphakic intraocular lens implantation[J]. J Cataract Refract Surg,2008,34(10):1 631-1 636.
[12] Hasegawa Y,Okamoto F,Nakano S,et al. Effect of preoperative corneal astigmatism orientation on results with a toric intraocular lens[J]. J Cataract Refract Surg,2013,39(12):1 846-1 851.
[13]巫雷,王文惠.数字导航系统在散光矫正型人工晶状体植入术中的应用[J].中华眼外伤职业眼病杂志,2017,39(9):641-644.
[14]张蓓,邓国华,周栋,等. Verion导航与手动标记对Toric人工晶状体植入术后角膜散光矫正的影响[J].中华眼视光学与视觉科学杂志,2018,20(4):227-231.
[15] Elhofi AH,Helaly HA. Comparison between digital and manual marking for toric intraocular lenses:a randomized trial[J]. Medicine(Baltimore),2015,94(38):e1618.
[16] Chang DF. Comparative rotational stability of single-piece open-loop acrylic and plate-haptic silicone toric intraocular lenses[J]. J Cataract Refract Surg,2008,34(11):1 842-1 847.
[17]李瑾,赵云娥,李军花,等. Acrysof Toric人工晶状体植入矫正白内障术前角膜散光的短期观察[J].中华眼科杂志,2010,46(6):513-517.
[18]汤欣,宋慧. Toric人工晶状体临床应用中值得关注的问题[J].中华眼科杂志,2013,49(5):392-394.
[19]陈薇,禤中宁,黄瑛,等.眼位训练在提高数字导航下白内障手术效果的研究[J].微创医学,2017,12(6):781-782,791.