如何提高Toric IOL旋转稳定性

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减少残余散光
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• 63%患者的残余散光
≤0.50度
• 87%患者的残余散光
≤1.00度
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For International (non-USA) use only
Toric Implantable Collamer Lens (Staar Surgical)
(PC phakic IOL)
Speculated toric pIOL rotation. When a toric pIOL is fixated in the horizontal position, the 4 haptic plates are properly fixated in the ciliary sulcus (A). Conversely, when a toric pIOL is fixated after the angle off the horizontal axis is adjusted, the 2 haptic plates closest to the vertical position tend to be loosely fixated (B).
手动角膜曲率
苏州六六公司
IOLMaster(5.0)
角膜地形图
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确定散光轴位——不同设备测量的差异
10°以内
手动或自动角膜曲率计确定散光幅度大小 角膜地形图确定轴位
>10°
慎用Toric晶体，尤其是较大的散光
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角膜标记
确保术前角膜缘处做好精确的晶体放置参考标记，以在 术毕时确定IOL位置
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角膜散光分布
低度0.5 – 1.0D 27%
N = 10,411
中度1.0 – 2.0D 25%
重度 >2.0 D 10%
患者%
Cylinder散光D ( < )
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测量角膜曲率的常用仪器
手动角膜曲率计 自动角膜曲率计（电脑验光仪、IOL Master） 角膜地形图
自动角膜曲率计 TOPCON
2. Mingo-Botin D, et al. Comparison of toric intraocular lenses and peripheral corneal relaxing incisions to treat astigmatism during cataract surgery. J Cataract Refract Surg. 2010;36:1700–8.
3. Kim MH, et al. Long-term efficacy and rotational stability of AcrySof toric intraocular lens implantation in cataract surgery. Korean J Ophthalmol. 2010;24:207–12.
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散光型号选择规则
规则一：循规散光——欠矫；逆规散光——过矫1 规则二：选择最小残余散光，小型号晶体型号2
histological sections. J Cataract Refract Surg 2000; 26:1792–1806
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角膜散光的分类
规则散光： 最大与最小屈光力的轴相互垂直
AcrySof® Toric的适应症
不规则散光：最大与最小屈光力的轴不相互垂直
可能为手术、外伤、炎症、瘢痕组织或发育异常 AcrySof® Toric的禁忌症
Mori T, et al. Factors affecting rotation of a posterior chamber collagen copolymer toric phakic intraocular lens. J Cataract Refract Surg 2012; 38:568–573
with Corneal Astigmatism. Ophthalmology 2015;122:39-47
旋转稳定性
AcrySof® IQ Toric 确保最小旋转– 植入后6个月平均旋转小于4º
2
➢ 81.1%患者的轴位偏向 ≤5º ➢ 97.1%患者的轴位偏向 ≤10º
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For International (non-USA) use only
• IOL和囊袋之间纤维连接蛋白的粘合度 • 袢周围囊袋的纤维化
Linnola RJ, et al. Adhesion of fibronectin, vitronectin, laminin, and collagen type IV to intraocular lens materials in pseudophakic human autopFra Baidu biblioteky eyes. Part 1:
Toric IOL术后残存散光
➢ 0.95±0.66 D ➢ 0.62±0.41 D ➢ 0.28±0.21 D
1. Entabi M, et al. Injectable 1-piece hydrophilic acrylic toric intraocular lens for cataract surgery: efficacy and stability. J Cataract Refract Surg. 2011;37:235–40.
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旋转稳定性 Rotational stability
1. IOL:
• IOL材料:亲水、疏水、硅胶、粘性 • IOL设计：囊袋收缩挤压袢可致旋转 • IOL袢的构型
2. 晶体囊袋大小与IOL直径，顺规性散光 3. 术中操作技术：CCC/OVD/散光轴 4. 术后囊袋收缩：
• 纤维连接蛋白(fibronectin), 玻璃体结合蛋白 (vitronectin),IV型胶原(collagen type IV)
如何提高Toric IOL旋转稳定性
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Toric IOLs
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A summary of published data on toric IOL rotation
Waltz, KL, et al. Clinical Outcomes of TECNIS Toric Intraocular Lens Implantation after Cataract Removal in Patie4nts