| Objective:Tocompare the difference on corneal astigmatism and on healing between different clear corneal incisions.Methods:This study selected 72 age-related cataract patients with 80 eyes in our hospital treated with phacoemulsification and foldable intraocular lens implantation. These subjects were divided into four groups randomly according to the cut direction and incision configuration. The A1 group and A2 group placed clear corneal incision at the steepest corneal meridian.The B1 group and B2 group placed clear corneal incision on 11 o’clock. Single plane clear corneal incision for A1 group and B1 group, biplane clear corneal incision for A2 group and B2 group. All the corneal incisions were within form the limbus 1mm and size 3mm. Application of AS-OCT to observe wound healing and Pentacam to measure the corneal astigmatism and axis at one day before operation and one day, one week, one month after the surgery respectively. The astigmatism treatment outcomes were evaluated based on the standardized vector analysis which was recommended by the American National Standards Institute(ANSI).Results:1.The Gender、Age and Diseased eyes had no significant difference in each groups.2.The four groups had no significant difference in IOP at preoperative and postoperative various stages.Different subgroups with no statistical significant.3.The preoperative one day, four groups of log MAR UCVA respectively, A1 group 0.22±0.12, A2 group 0.22±0.11, B1 group 0.21±0.13, B2 group 0.18±0.09, no statistical differences. The naked vision in groups A1、A2 were significantly better than groups B1、B2 in postoperative one day、one week and one month(P<0.05).There was no statistical difference in groups A1 and A2 or in groups B1 and B2.4.Comparison of the astigmatism status of four groups:Mean magnitude of astigmatism of the four groups preoperative: A1 group 0.84±0.27 D; A2 group 0.84±0.35 D; B1 group 0.82±0.29 D; B2 group 0.86±0.38 D, with no statistical significant between four groups.4.1 One month after surgery, the mean of |SIRC| in A1 group was 0.74±0.23; A2 group was 0.89±0.27D; B1 group was 0.46±0.13D; B2 group was 0.51±0.14 D. The |SIRC| in steepest corneal meridian incisions were significantly higher than that on 11 o’clock incisions, at the same time, biplane clear corneal incisions were significantly higher than single plane clear corneal incisions(P<0.05).4.2 The mean of |EV| at postoperative one month of the four groups respectively, A1 group 0.69±0.30 D; A2 group 0.70±0.30 D; B1 group 0.92±0.32 D; B2 group 0.96±0.37 D. The results in A1 and A2 groups were significantly lower than in B1 and B2 groups(P<0.05). But there was no statistical difference in groups A1 and A2 or in groups B1 and B2.4.3 The mean of EM at postoperative one month of the four groups respectively, A1 group 0.16±0.41 D; A2 group 0.26±0.37 D; B1 group 0.44±0.32D; B2 group 0.42±0.37 D. The results in A1 and A2 groups were significantly lower than in B1 and B2 groups(P<0.05). But there was no statistical difference in groups A1 and A2 or in groups B1 and B2.4.4 The mean of CR at postoperative one month of the four groups respectively, A1 group 0.68±0.32; A2 group 0.85±0.27; B1 group 0.47±0.10; B2 group 0.43±0.13. A1group>A2group>B1、B2groups, there was no statistical difference in groups B1 and B2.4.5 The mean of ER at postoperative one month of the four groups respectively, A1 group 0.86±0.34; A2 group 0.95±0.51; B1 group 1.19±0.47; B2 group 1.22±0.49.The results in A1 and A2 groups were significantly lower than in B1 and B2 groups(P<0.05). But there was no statistical difference in groups A1 and A2 or in groups B1 and B2.4.6 The mean of EA at postoperative one month of the four groups respectively, A1 group 9.1±15.8°, 55% eyes had |EA| within 15 degree; A2 group 9.4±13.0°, 60% eyes had |EA| within 15 degree; B1 group 19.4±30.5°, 19% eyes had |EA| within 15 degree; B2 group 16.6±34.3°, 11% eyes had |EA| within 15 degree. The results in A1 and A2 groups were significantly lower than in B1 and B2 groups(P<0.05). But There was no statistical difference in groups A1 and A2 or in groups B1 and B2.5.Comparison of the AS-OCT index of two groups at different times:5.1 The mean corneal incisional thickness of the four groups before surgery were 706.05±15.54μm; 707.52±15.84μm; 706.38±15.40μm; 706.06±14.77μm, respectively, with no statistically significant difference between them. The corneal incisional thickness of groups A1 and A2 were statistically significant thicker than groups B1 and B2(P<0.05) on the first day after surgery, but there was no statistical difference in groups A1 and A2 or in groups B1 and B2. There was no statistically significant difference between the four groups in other times.5.2.Difference comparisons of the incidence of corneal endothelial gaping and of the healing rates: The incidence of corneal endothelial gaping of the four groups were80%、66.7%、71.4%、66.7%, at one day, At one week, the A1 group was 65% and the same index of the A2 group was 42.9%, B1 group was 57.1%, B2 group was 38.9%, with no statistically significant difference. The healing rate of the four groups corneal endothelial gaping were 80%、90.5%、71.4%、94.4%, they are not significantly different.5.3 Difference comparisons of the corneal descemet membrane detachments and of the healing rates: The first postoperative day, 1 week the descemet membrane detachment incidence of the four groups were A1 group:40%、25%, A2 group:42.9%、33.3%, B1 group:38.1%、33.3%, B2 group:38.9%、33.3%, no significant difference within groups.1 month after surgery all the subjects descemet membrane detachment healed.5.4 There were no corneal epithelial gaping occurred in four groups.Conclusion:1 The clear corneal incision made on the steepest meridian can achieved better astigmatism outcome and better visual acuity. Meanwhile, the biplane clear corneal incisions on a meridian showed more spreading effect and get higher correction rate.2.The single plane clear corneal incision and biplane clear corneal incision on the steepest meridian and on 11:00 o’clock have similar closure in phacoemulsification. |
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