目的：观察Toric人工晶状体(Toric IOL)植入术矫正角膜散光的临床疗效，并对残余散光和角膜散光进行矢量分析。

方法：回顾性病例观察研究。选取2018-09/2019-10于我院行白内障超声乳化摘除联合Toric IOL植入术的白内障患者63例77眼。术后1wk，1、3mo观察裸眼远视力(UCDVA)、最佳矫正远视力(BCDVA)、主觉验光的残余散光，散瞳后采用OPD-scanⅢ测量Toric IOL轴位，计算IOL轴位偏差度(LAD)。

结果：术后1wk，1、3mo，本组患者UCDVA(LogMAR)分别为0.22(0.15，0.40)、0.30(0.15，0.40)、0.30(0.15，0.40)，均较术前UCDVA\〖0.82(0.60，1.22)\〗、BCDVA\〖0.52(0.30，0.70)\〗明显改善(P<0.008)； 残余散光分别为0.75(0.50，1.00)、0.75(0.38，1.00)、0.50(0.25，1.00)D，均较术前角膜散光\〖2.19(1.73，2.69)D\〗明显下降(P<0.008)。术后3mo，UCDVA(LogMAR)≤0.301的患者占比69%，残余散光≤0.75D的患者占比73%。术后1wk，1、3mo，本组患者LAD中位数分别为2.0°、2.0°、3.0°，LAD≤5°的患者占比分别为81%、82%、77%，最大LAD值为11°。散光矢量分析显示，本组患者术前角膜散光为2.31±0.80D，质心值为1.44D@177°±1.99D； 预测术后残余散光为0.14±0.17D，质心值为0.02D@58°±0.22D； 术后3mo残余散光为0.69±0.53D，质心值为0.05D@142°±0.88D。

结论：Toric IOL可以有效矫正白内障患者角膜散光且具有良好的旋转稳定性。散光矢量分析可直观显示预测术后散光与实际残余散光的差异，有利于分析优化角膜散光的测量、IOL度数计算、手术设计、术后观察等环节。

METHODS: A retrospective case observation study. A total of 63 patients with 77 eyes who underwent phacoemulsification combined with Toric IOL implantation in our hospital from September 2018 to October 2019 were selected. LogMAR uncorrected distance visual acuity(UCDVA), best corrected distance visual acuity(BCDVA), residual astigmatism of subjective refraction were observed after operation in 1wk, 1mo, and 3mo. And after dilated pupil, the Toric IOL axis position was measured by OPD-scanⅢ, and compared with the target axis position(LAD).

RESULTS: The median(interquartile range)of UCDVA at 1wk, 1mo, and 3mo after operation were 0.22(0.15, 0.40), 0.30(0.15,0.40),and 0.30(0.15, 0.40), which were better than those of UCDVA \〖0.82(0.60, 1.22)\〗 and BCDVA \〖0.52(0.30, 0.70)\〗 before operation(P<0.008). The residual astigmatism was 0.75(0.50, 1.00), 0.75(0.38, 1.00), 0.50(0.25, 1.00)D, respectively, which was significantly lower than that of preoperative corneal astigmatism \〖2.19(1.73, 2.69)D\〗(P<0.008). At 3mo after surgery, the proportion of UCDVA(LogMAR)≤0.301 was 69%; the proportion of residual astigmatism ≤0.75D was 73%. The median LAD at 1wk, 1mo, and 3mo after surgery were 2.0°, 2.0°, and 3.0°; 81%, 82%, 77% were less than 5°. The maximum LAD value is 11°. Astigmatism vector analysis: preoperative corneal astigmatism was 2.31±0.80D, centroid value was 1.44D@177°±1.99D; Predicted postoperative residual astigmatism was 0.14±0.17D, centroid value was 0.02D@58°±0.22D; residual astigmatism at 3mo after operation was 0.69±0.53D, centroid value was 0.05D@142°±0.88D.

CONCLUSION: Toric IOL can effectively correct corneal astigmatism in patients with cataract and has good rotational stability. Astigmatism vector analysis can directly show the difference between predicting postoperative astigmatism and actual residual astigmatism, which is helpful to analyze and optimize the measurement of corneal astigmatism, calculation of IOL degree, surgical design, postoperative observation.