放射状角膜切开术后白内障手术人工晶状体度数计算进展

doi:10.3760/cma.j.cn441417-20241114-09011

国际医药卫生导报 ›› 2025, Vol. 31 ›› Issue (9): 1461-1465.DOI: 10.3760/cma.j.cn441417-20241114-09011

放射状角膜切开术后白内障手术人工晶状体度数计算进展

植丹琳¹ 霍朝魁^1,2 卢建梅¹ 夏瑞卿¹ 程浩^1,3 曹丹敏^1,3

¹广州医科大学第一临床学院，广州 510000；²深圳市第四人民医院眼科，深圳 518000；³广州医科大学附属第一医院眼科，广州 510000

收稿日期:2024-11-14 出版日期:2025-05-01 发布日期:2025-05-20
通讯作者: 曹丹敏，Email：cdm1732@126.com
基金资助:
广东省医学科学技术研究基金（A2024147）；广州医科大学科研能力提升计划（2024SRP057）；基础研究计划市校（院）企联合资助专题项目（SL2024A03J01543）

Advances in intraocular lens refractive power calculation for cataract surgery following radial keratotomy

Zhi Danlin¹, Huo Chaokui^1,2, Lu Jianmei¹, Xia Ruiqing¹, Cheng Hao^1,3, Cao Danmin^1,3

¹The First Clinical College, Guangzhou Medical University, Guangzhou 510000, China; ²Department of Ophthalmology, The Fourth People's Hospital of Shenzhen, Shenzhen 518000, China; ³Department of Ophthalmology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China

Received:2024-11-14 Online:2025-05-01 Published:2025-05-20
Contact: Cao Danmin, Email: cdm1732@126.com
Supported by:
Medical Science and Technology Research Foundation of Guangdong Province (A2024147); Research Capacity Improvement Program of Guangzhou Medical University (2024SRP057); Special Project Jointly Sponsored by Municipalities, Universities (Institutes), and Enterprises under the Basic Research Program (SL2024A03J01543)

摘要/Abstract

摘要：

放射状角膜切开术（radial keratotomy，RK）是一种在角膜光学区外的旁周边部做若干条（4～24条）非穿透性放射状松解切口（深度80%～90%），间接改变中央角膜曲率，在眼内压作用下使角膜中央前表面相对变平，屈光力降低，通过改变切口数量和深度，可以矫正0～12 D的近视。20世纪70年代到90年代，RK成为广泛采用的近视和散光手术解决方案。然而，RK术后屈光结果变化很大，并伴有许多短期和长期并发症。随着时间的推移，接受RK的患者中，大部分人已经老龄化，需要行白内障手术，这部分患者较常规老年白内障患者年纪轻，对于白内障术后的屈光准确性期望较高。然而，由于RK术后角膜曲率的改变以及角膜表面常不规则，给白内障术前眼部生物学测量和人工晶状体（intraocular lens，IOL）度数的计算带来困难，常规白内障术后屈光度±0.5D的比例高于RK术后。本文就RK术后IOL度数计算困难原因及计算方法展开阐述。

关键词:

放射状角膜切开术, 白内障, 人工晶状体, 屈光力计算

Abstract:

Radial keratotomy (RK) is a procedure in which a number of 4-24 non-penetrating radial release incisions (80%-90% depth) are made in the paracentral periphery outside the optical zone of the cornea, indirectly altering the curvature of the central cornea, resulting in a relative flattening of the central anterior surface of the cornea and a reduction in refractive power under intraocular pressure, and by varying the number and depth of the incisions, it is possible to correct myopia from 0-12 D. RK became a widely adopted surgical solution for myopia and astigmatism from the 1970s to the 1990s. However, refractive outcomes after RK are highly variable and are associated with many short- and long-term complications. Over time, the majority of patients undergoing RK have aged to the point of needing cataract surgery, and this group of patients is relatively young compared to conventional age-related cataract patients with relatively high expectations of post-cataract refractive accuracy. However, the change in corneal curvature after RK and the often irregular corneal surface make it difficult to measure preoperative cataract ocular biology and calculate intraocular lens (IOL) degrees. The proportion of refractive error ±0.5D after conventional cataract surgery is higher than that after RK. In this section, the reasons for the difficulty in calculating IOL after RK and the methods for calculating IOL after RK are discussed.

Key words:

Radial keratotomy, Cataract, , Intraocular lens, , Refractive power calculation

植丹琳霍朝魁卢建梅夏瑞卿程浩曹丹敏.

放射状角膜切开术后白内障手术人工晶状体度数计算进展 [J]. 国际医药卫生导报, 2025, 31(9): 1461-1465.

Zhi Danlin, Huo Chaokui Lu, Jianmei, Xia Ruiqing, Cheng Hao, Cao Danmin.

Advances in intraocular lens refractive power calculation for cataract surgery following radial keratotomy [J]. International Medicine and Health Guidance News, 2025, 31(9): 1461-1465.

参考文献

[1] Wang L, Koch DD. Intraocular lens power calculations in eyes with previous corneal refractive surgery: review and expert opinion[J]. Ophthalmology, 2021, 128(11):e121-e131. DOI: 10.1016/j.ophtha.2020.06.054.

[2] De Bernardo M, Pagliarulo S, Rosa N. Unexpected ocular morphological changes after corneal refractive surgery: a review[J]. Front Med (Lausanne), 2022, 9:1014277. DOI: 10.3389/fmed.2022.1014277.

[3] Alio JL, Abdelghany AA, Abdou AA, et al. Cataract surgery on the previous corneal refractive surgery patient[J]. Surv Ophthalmol, 2016, 61(6):769-777. DOI: 10.1016/j.survophthal.2016.07.001.

[4] Packer M, Brown LK, Hoffman RS, et al. Intraocular lens power calculation after incisional and thermal keratorefractive surgery[J]. J Cataract Refract Surg, 2004, 30(7):1430-1434. DOI: 10.1016/j.jcrs.2004.02.075.

[5] Wang L, Mahmoud AM, Anderson BL, et al. Total corneal power estimation: ray tracing method versus gaussian optics formula[J]. Invest Ophthalmol Vis Sci, 2011, 52(3):1716-1722. DOI: 10.1167/iovs.09-4982.

[6] Swartz T, Marten L, Wang M. Measuring the cornea: the latest developments in corneal topography[J]. Curr Opin Ophthalmol, 2007, 18(4):325-333. DOI: 10.1097/ICU.0b013e3281ca7121.

[7] Gobbi PG, Carones F, Brancato R. Keratometric index, videokeratography, and refractive surgery[J]. J Cataract Refract Surg, 1998, 24(2):202-211. DOI: 10.1016/s0886-3350(98)80201-0.

[8] Koch DD, Wang L. Calculating IOL power in eyes that have had refractive surgery[J]. J Cataract Refract Surg, 2003, 29(11):2039-2042. DOI: 10.1016/j.jcrs.2003.10.009.

[9] Chong J, Dupps WJ. Corneal biomechanics: measurement and structural correlations[J]. Exp Eye Res, 2021, 205:108508. DOI: 10.1016/j.exer.2021.108508.

[10] Baldwin HC, Marshall J. Growth factors in corneal wound healing following refractive surgery: a review[J]. Acta Ophthalmol Scand, 2002, 80(3):238-247. DOI: 10.1034/j.1600-0420.2002.800303.x.

[11] Meduri A, Urso M, Signorino GA, et al. Cataract surgery on post radial keratotomy patients[J]. Int J Ophthalmol, 2017, 10(7):1168-1170. DOI: 10.18240/ijo.2017.07.23.

[12] McDonnell PJ, Nizam A, Lynn MJ, et al. Morning-to-evening change in refraction, corneal curvature, and visual acuity 11 years after radial keratotomy in the prospective evaluation of radial keratotomy study. The PERK Study Group[J]. Ophthalmology, 1996, 103(2):233-239. DOI: 10.1016/s0161-6420(96)30711-2.

[13] Geggel HS. Intraocular lens power selection after radial keratotomy: topography, manual, and IOLMaster keratometry results using Haigis formulas[J]. Ophthalmology, 2015, 122(5):897-902. DOI: 10.1016/j.ophtha.2014.12.002.

[14] Determining the power of an intraocular lens to achieve a postoperative correction of -1.00[J]. Refract Corneal Surg, 1989, 5(3):202-203.

[15] Feiz V, Mannis MJ. Intraocular lens power calculation after corneal refractive surgery[J]. Curr Opin Ophthalmol, 2004, 15(4):342-349. DOI: 10.1097/00055735-200408000-00011.

[16] Aramberri J. Intraocular lens power calculation after corneal refractive surgery: double-K method[J]. J Cataract Refract Surg, 2003, 29(11):2063-2068. DOI: 10.1016/s0886-3350(03)00957-x.

[17] Awwad ST, Dwarakanathan S, Bowman RW, et al. Intraocular lens power calculation after radial keratotomy: estimating the refractive corneal power[J]. J Cataract Refract Surg, 2007, 33(6):1045-1050. DOI: 10.1016/j.jcrs.2007.03.018.

[18] Tang M, Li Y, Huang D. An intraocular lens power calculation formula based on optical coherence tomography: a pilot study[J]. J Refract Surg, 2010, 26(6):430-437. DOI: 10.3928/1081597X-20090710-02.

[19] Ma JX, Tang M, Wang L, et al. Comparison of newer IOL power calculation methods for eyes with previous radial keratotomy[J]. Invest Ophthalmol Vis Sci, 2016, 57(9):OCT162-OCT168. DOI: 10.1167/iovs.15-18948.

[20] Abulafia A, Hill WE, Koch DD, et al. Accuracy of the Barrett True-K formula for intraocular lens power prediction after laser in situ keratomileusis or photorefractive keratectomy for myopia[J]. J Cataract Refract Surg, 2016, 42(3):363-369. DOI: 10.1016/j.jcrs.2015.11.039.

[21] Turnbull AMJ, Crawford GJ, Barrett GD. Methods for intraocular lens power calculation in cataract surgery after radial keratotomy[J]. Ophthalmology, 2020, 127(1):45-51. DOI: 10.1016/j.ophtha.2019.08.019.

[22] Wang L, Koch DD. Intraocular lens power calculations in eyes with previous corneal refractive surgery: review and expert opinion[J]. Ophthalmology, 2021, 128(11):e121-e131. DOI: 10.1016/j.ophtha.2020.06.054.

[23] Patel P, Ashena Z, Vasavada V, et al. Comparison of intraocular lens calculation methods after myopic laser-assisted in situ keratomileusis and radial keratotomy without prior refractive data[J]. Br J Ophthalmol, 2022, 106(1):47-53. DOI: 10.1136/bjophthalmol-2020-317681.

[24] Camellin M, Calossi A. A new formula for intraocular lens power calculation after refractive corneal surgery[J]. J Refract Surg, 2006, 22(2):187-199. DOI: 10.3928/1081-597X-20060201-18.

[25] Srujana D, Shankar S, Bhanot R, et al. Ray tracing biometry in post radial keratotomy eye[J]. Eur J Ophthalmol, 2023, 33(4):NP19-NP22. DOI: 10.1177/11206721221102268.

[26] Gouvea L, Sioufi K, Brown CE, et al. Refractive accuracy of Barrett True-K vs intraoperative aberrometry for IOL power calculation in post-corneal refractive surgery eyes[J]. Clin Ophthalmol, 2021, 15:4305-4315. DOI: 10.2147/OPTH.S334489.

[27] Debellemanière G, Dubois M, Gauvin M, et al. The PEARL-DGS formula: the development of an open-source machine learning-based thick IOL calculation formula[J]. Am J Ophthalmol, 2021, 232:58-69. DOI: 10.1016/j.ajo.2021.05.004.

[28] Ferrara S, Crincoli E, Savastano A, et al. Refractive outcomes with new generation formulas for intraocular lens power calculation in radial keratotomy patients[J]. Cornea, 2024, 43(2):178-183. DOI: 10.1097/ICO.0000000000003301.

放射状角膜切开术后白内障手术人工晶状体度数计算进展

Advances in intraocular lens refractive power calculation for cataract surgery following radial keratotomy

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