国际眼科纵览 ›› 2025, Vol. 49 ›› Issue (4): 259-264.doi: 10. 3760/cma.j.cn115500-20250219-25404

• 综述 • 上一篇    下一篇

白内障手术联合弧形角膜切开术矫正散光

张琦 王震宇 宋旭东   

  1. 首都医科大学附属北京同仁医院 北京同仁眼科中心 眼科学与视觉科学北京市重点实验室,北京 100730
  • 收稿日期:2025-02-19 出版日期:2025-08-22 发布日期:2025-08-12
  • 通讯作者: 宋旭东,Email:drxdsong@sina.com E-mail:drxdsong@sina.co
  • 基金资助:
    国家自然科学基金(82271067)

Cataract surgery combined with curved corneal incision for correcting astigmatism

Zhang Qi, Wang Zhenyu, Song Xudong   

  1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing 100730, China
  • Received:2025-02-19 Online:2025-08-22 Published:2025-08-12
  • Contact: Song Xudong, Email: drxdsong@sina.com E-mail:drxdsong@sina.co
  • Supported by:
    National Natural Science Foundation of China (82271067)

摘要: 弧形角膜切开术(arcuate keratotomy,AK)是白内障手术中矫正角膜散光的重要方法之一。它适用于角膜结构无异常术前规则性角膜散光1.0~1.5 D者。AK矫正效果受切口长度、切口深度、切口位置、术前散光类型、术前散光程度等因素的影响。相比手工AK,飞秒激光辅助弧形角膜切开术(femtosecond laser-assisted astigmatic keratotomy,FSAK)具有更高的矫正精度和长期稳定性,并在某些情况下可替代散光矫正型人工晶状体(Toric introcular lens,Toric IOL)。根据切削深度不同,FSAK分为穿透性和基质内FSAK,前者矫正能力更强,后者安全性更高。研究表明,其疗效受切口位置、角膜生物力学及术后愈合影响。未来,优化诺模图和结合个性化规划可进一步提升FSAK的矫正效果,使其在白内障合并散光的矫正治疗领域中具有广阔前景。

关键词: 弧形角膜切开术, 白内障, 散光, 飞秒激光

Abstract: Arcuate keratotomy (AK) is an important method for correcting corneal astigmatism during cataract surgery. It is suitable for patients with normal corneal structure and preoperative regular corneal astigmatism of 1.0 to 1.5 diopters. The effectiveness of AK is influenced by factors such as incision length, incision depth, incision location, the type of preoperative astigmatism, and the degree of preoperative astigmatism. Compared to manual AK, femtosecond laser-assisted astigmatic keratotomy (FSAK) offers higher correction accuracy and long-term stability and can serve as an alternative to Toric intraocular lenses (Toric IOL) in certain cases. Based on the depth of the incision, FSAK is classified into penetrating and intrastromal FSAK, with the former providing greater corrective power and the latter offering higher safety. Studies have shown that its efficacy is influenced by incision location, corneal biomechanics, and postoperative wound healing. In the future, optimizing nomograms and integrating personalized planning may further enhance the corrective effectiveness of FSAK, making it a promising approach for managing astigmatism in cataract patients.

Key words: Arcuate keratotomy, Cataract, Astigmatism, Femtosecond laser