| Objective:To explore whether phacoemulsification combined with personalized corneal incision can effectively reduce patients’ corneal astigmatism under the premise of ensuring safety,and provide more and more reasonable strategies for cataract surgeons to correct astigmatism.Methods: Select 162 patients(162 eyes)diagnosed with age-related cataract and corneal astigmatism ≥0.75 D in the First Affiliated Hospital of Bengbu Medical College from June 2019 to December 2020.The 45 eyes with 0° < steep axial direction < 45°were divided into:: 26 eyes in the experimental group A and 19 eyes in the control group a;57 eyes with 45°≤ steep axial direction < 90° were divided into 30 eyes in the experimental group B and 27 eyes in the control group b;60 eyes with 90°≤ steep axial direction ≤180° were divided into 35 eyes in the experimental group C and 25 eyes in the control group c.All control groups received phacoemulsification with A 2.8mm incision of 135° clear cornea.Group A of experimental group received phacoemulsification with A 2.8mm main incision of 180° clear cornea,group B received phacoemulsification with A 2.8mm main incision of 90° clear cornea,and group C received phacoemulsification with A 2.8mm main incision of steep-axis clear cornea.Corneal astigmatism value,astigmatism axis,naked visual acuity,best corrected visual acuity,anterior chamber depth and central corneal thickness were recorded preoperatively,1 week postoperatively,1 month postoperatively and 3 months postoperatively.The safety and postoperative effects of phacoemulsification with personalized corneal incision and conventional corneal incision were compared.Results: 1.0° < steep axial < 45° : 180° transparent corneal incision can correct the patient’s corneal astigmatism.At 3 months after surgery,the patient’s corneal astigmatism decreased by 0.26 D on average,while the steep axial direction increased by 6.65° on average in the vertical direction.The 135° conventional corneal incision aggravated the patient’s corneal astigmatism,with a mean 0.42 D increase in astigmatism 3 months after surgery and a 20.16° increase in the steep-axial vertical direction.2.45°≤ steep axial direction < 90° : the 90° transparent corneal incision can correct the patients’ preoperative corneal astigmatism.At 3 months after surgery,the patients’ corneal astigmatism decreased by 0.12 D on average,and the steep axial direction decreased by 12.50° on average in horizontal direction.The 135° conventional corneal main incision aggravated the patient’s corneal astigmatism,which increased by 0.22 D on average 3 months after surgery and decreased by 15.38° in the steep axial direction horizontally.3.90° < steep axial ≤180° : the main incision of the steep-axis transparent cornea could correct the patients’ preoperative corneal astigmatism.At 3 months after surgery,the average decrease of the corneal astigmatism was 0.57 D,and the steep-axis was stable after surgery,with no significant difference from that before surgery(P >0.05).The 135° conventional corneal main incision aggravated the patient’s corneal astigmatism,which increased by 0.04 D on average and decreased by 8.64° in the steepaxial horizontal direction 3 months after surgery.4.From 1 month after surgery,the naked visual acuity of all the experimental groups was higher than that of the control group,and the difference was statistically significant(P < 0.05).The best corrected visual acuity in all experimental groups was higher than that in control group,but the difference was not statistically significant(P >0.05).5.6 groups was significantly increased after surgery,and the difference was statistically significant compared with that before surgery(P < 0.05).The central corneal thickness of 6 groups increased at 1 week after surgery,and the difference was statistically significant compared with that before surgery(P < 0.05),and all groups basically recovered to the preoperative state at 1 month after surgery.The changes of anterior chamber depth and central corneal thickness were the same among 6 groups,but there was no significant difference(P > 0.05).Conclusion:1.The operation method of phacoemulsification combined with personalized corneal incision is safe;2.When the patient was 0° < steep axial < 45°,a transparent corneal incision in the direction of 180° was selected to correct the patient’s corneal astigmatism in a small extent;3.When the patient’s 45°≤ steep axial direction < 90°,select a transparent corneal incision in the 90° direction to correct the patient’s corneal astigmatism in a small amplitude;4.When the patient is 90° < the steep axial direction ≤180°,the transparent corneal incision in the steep axial direction can effectively reduce the patient’s corneal astigmatism,and the axial direction of the astigmatism is more stable;5.Phacoemulsification combined with personalized corneal incision can improve the recovery of postoperative naked eye vision;6.The combination of phacoemulsification and personalized corneal incision does not cause postoperative anterior chamber depth and central corneal thicknessAdditional negative effects. |
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