【摘要】 目的 分析高度近视患者白内障手术前角膜散光特点。方法 本研究为观察性研究，回顾性分析2014年1月至2023年12月在我院行白内障手术的所有患者的临床资料。术前采用光学生物测量仪(IOL-Master)测量眼生物学参数，将患者分为高度近视组[定义为眼轴长度(AL)≥26.00 mm]和对照组(正常AL,22.00 mm≤AL≤25.00 mm)。比较两组患者角膜散光分布特征。结果 在17 325例白内障患者(17 325眼)中，高度近视组患者2 206例(2 206眼),对照组患者13 429例(13 429眼)。在高度近视组中，有1 822眼(82.6%)角膜散光≥0.50 D,1 138眼(51.6%)角膜散光≥1.00 D,623眼(28.2%)角膜散光≥1.50 D和314眼(14.2%)角膜散光≥2.00 D,这些比例均高于对照组(分别为71.9%、35.9%、15.9%和7.3%),差异均有统计学意义(均为P<0.001);在高度近视组中，有1 340眼(60.7%)合并中度散光，147眼(6.7%)合并高度散光，922眼(41.8%)合并顺规型散光，这些比例均高于对照组(分别为48.9%、3.3%和28.2%),差异均有统计学意义(均为P<0.001)。高度近视组中女性患者角膜散光大于男性患者，差异有统计学意义(P=0.001);女性患者斜向型散光所占比例为19.3%,高于男性患者(15.8%),差异有统计学意义(P=0.034),同时逆规型散光的比例随着患者年龄的增长而升高。高度近视组患者顺规型、逆规型及斜向型散光眼的角膜散光分别为(1.26±0.85)D、(1.28±0.81) D和(0.89±0.71)D,均大于对照组[分别为(0.82±0.71)D、(1.06±0.68)D和(0.67±0.53)D)],差异均有统计学意义(均为P<0.001)。在高度近视组斜向型散光眼中角膜散光≥1.00 D、≥1.50 D及≥2.00 D的比例分别为31.8%、12.3%和4.1%,均低于其他2型散光眼，差异均有统计学意义(均为P<0.05),同时这一趋势也与对照组一致。结论 高度近视患者白内障术前角膜散光负担沉重，超过50%患者角膜散光≥1.00 D;同时其角膜散光明显大于正常AL患者，而且中、高度散光的比例也显著高于后者。更多还原

【Abstract】 Objective To evaluate the characteristics of preoperative corneal astigmatism in cataract surgery candidates with high myopia. Methods In this observational study, medical records of consecutive patients who underwent cataract surgery in our hospital between January 2014 and December 2023 were reviewed retrospectively. Biometric parameters of eyes were measured preoperatively by IOL-Master optical biometry. The cataract patients were classified into a high myopia group [defined as axial length(AL)≥26.00 mm] and a control group(normal ALs, 22.00 mm≤AL≤25.00 mm). The characteristics of corneal astigmatism were compared between the two groups. Results Among 17 325 cataract patients(17 325 eyes), 2 206 patients(2 206 eyes) had high myopia and 13 429 patients(13 429 eyes) had no high myopia. In the high myopia group, 1 822 eyes(82.6%) had corneal astigmatism ≥0.50 D, 1 138 eyes(51.6%) had corneal astigmatism ≥1.00 D, 623 eyes(28.2%) had corneal astigmatism ≥1.50 D and 314 eyes(14.2%) had corneal astigmatism ≥2.00 D. These proportions were significantly higher than those in the control group(71.9%, 35.9%, 15.9% and 7.3%, respectively; all P<0.001). In the high myopia group, 1 340 eyes(60.7%) had moderate astigmatism, 147 eyes(6.7%) had high astigmatism and 922 eyes(41.8%) had with-the-rule(WTR) astigmatism. These 3 proportions were all significantly higher than those in the control group(48.9%, 3.3% and 28.2%, respectively; all P<0.001). Among high-myopia patients, the corneal astigmatism was statistically greater in women than that in men(P=0.001), and the proportion of oblique astigmatism was higher in women than that in men(19.3% vs. 15.8%, P=0.034). The proportion of against-the-rule(ATR) astigmatism increased significantly with age. In the high myopia group, the corneal astigmatism of eyes with WTR, ATR and oblique astigmatism was(1.26±0.85) D,(1.28±0.81) D and(0.89±0.71) D, respectively. They were significantly greater than those in the control group [(0.82±0.71) D,(1.06±0.68) D and(0.67±0.53) D, respectively; all P<0.001]. In the high myopia group, there were 31.8%, 12.3% and 4.1% of eyes with corneal astigmatism ≥1.00 D, ≥1.50 D and ≥2.00 D, respectively. All of these 3 proportions were significantly lower than those of eyes with WTR or ATR astigmatism(all P<0.05). This finding is consistent with the tendency in the control group. Conclusion A significant burden of preoperative corneal astigmatism is observed in cataract surgery candidates with high myopia, with more than 50% of the patients having corneal astigmatism ≥1.00 D. The corneal astigmatism of patients with high myopia is significantly greater than that of patients with normal ALs. The proportion of moderate-to-high astigmatism is significantly higher in high-myopia patients than that in patients with normal ALs.更多还原