目的：比较术前伴有角膜散光的白内障患者在植入球面散光矫正型人工晶状体和非球面散光矫正型人工晶状体术后的裸眼视力，并探讨术前角膜散光的程度对散光矫正型人工晶状体植入术后裸眼远视力的提高程度的影响。

方法：收集患者44例57眼的病例资料，其中球面组有23例27眼，非球面组有21例30眼，记录术前及术后1d裸眼远视力(UDVA)、术前角膜散光度数、人工晶状体型号及等效球镜度数、术中人工晶状体轴位。比较两组术前与术后1d裸眼远视力(LogMAR)差别以及术后1d裸眼视力0.4以上患者的比例，并按散光度数进行分层，散光度数小于2.0D为低散光层，散光度数≥2.0D为中高散光层，比较两组术后裸眼远视力的提高效果。

结果：球面组和非球面组术后1d裸眼远视力0.4以上患者比例分别为92.6%、93.3%，与术前14.8%、13.3%相比明显增加。两组术前、术后1d裸眼远视力比较，差异无统计学意义(P>0.05)； 两组术后1d裸眼远视力与术前相比均明显提高，差异有统计学意义(P<0.01)。各散光层内两种人工晶状体植入术后裸眼视力的差异无统计学意义(P>0.05)； 植入术后1d裸眼远视力与术前相比均明显提高，差异有统计学意义(P<0.01)。术前不同程度散光的白内障患者在植入散光矫正型人工晶状体后，术后裸眼远视力之间的差异无统计学意义(P>0.05)； 植入术后1d裸眼远视力与术前相比均明显提高，差异有统计学意义(P<0.01)。

结论：球面及非球面散光矫正型人工晶状体植入可以有效地提高白内障合并角膜散光患者的裸眼远视力，但在提高裸眼视力方面，非球面散光矫正型人工晶状体并不优于球面散光矫正型人工晶状体。

AIM: To evaluate the uncorrected visual acuity after implantation of spherical astigmatism intraocular lens(IOL)and aspheric astigmatism intraocular lens in cataract surgery of patients with preoperative corneal astigmatism.

METHODS: Fifty-seven eyes of 44 patients were divided into two groups according to Toric intraocular lens types: spherical group with 23 patients(27 eyes), aspheric group with 21 patients(30 eyes). Uncorrected distance visual acuity(UDVA)preoperatively and at postoperative 1d, preoperative corneal astigmatism, intraocular lens type and spherical equivalent, IOL cylinder axis position were recorded. We compared the two groups of uncorrected distance logMAR visual acuity visual differences at preoperative and postoperative 1d and calculated the proportion of patients with UDVA over 0.4 at postoperative 1d, then divided patients into two layers in accordance with astigmatism degree with less than 2.0D as low astigmatism layer and more than 2.0D as high astigmatism layer and compared the improving effect of two groups of postoperative UDVA according to the preoperative corneal astigmatism.

RESULTS: In spherical and aspheric group, the rate of patients at postoperative 1d with UDVA better than 0.4 were 92.6% and 93.3%, which were significantly increased compared with preoperative 14.8% and 13.3% respectively. The LogMAR UDVA of two groups at postoperative 1d compared with preoperative were significantly improved, and the differences were statistically significant(P<0.01). There was no significant difference in LogMAR UDVA at preoperative and postoperative 1d between two groups(P>0.05). Within every astigmatism layer, there was no statistical significance between two intraocular lens in improved degree of the postoperative UDVA(P>0.05); the LogMAR UDVA of every group at postoperative 1d compared with its preoperative were significantly improved, the difference was statistically significant(P<0.01). Within every group, the difference of improving effect of postoperative UDVA between different preoperative astigmatism had no statistical significance(P>0.05); the LogMAR UDVA of every layer at postoperative 1d compared with its preoperative were significantly improved, the difference was statistically significant(P<0.01).

CONCLUSION: Spherical and aspheric Toric IOL implantation can both effectively improve the UDVA in cataract surgery of patients with preoperative corneal astigmatism. But in terms of improving the UDVA, aspheric Toric intraocular lens is not better than that of spherical.

国家自然科学基金项目(No.81300786,81460163,81400427); 教育部博士学科点基金(No.20133601120012); 陕西省青年科技新星项目(No.2016KJXX-12); 陕西省自然科学基金项目(No.2016JM8029); 西安交通大学基本科研业务费专项科研项目(No.1191320094); 江西省科技厅项目(No.20142BAB215029,20132BAB205024,20142BDH80005); 江西省教育厅科技项目(No.GJJ14094,GJJ13175)