零球差非球面人工晶状体和球面人工晶状体植入术后视觉质量的对比研究

摘要

背景 零球差非球面人工晶状体(IOL)本身不会增加IOL植入眼的球差,理论上能够改善术眼的视觉质量.目的 比较零球差非球面IOL植入眼与球面IOL植入眼的视觉功能及波前像差,分析零球差设计对IOL植入眼视觉质量的影响.方法 采用前瞻性病例对照研究设计.收集2008年12月至2009年3月在温州医学院附属眼视光医院诊断的年龄相关性白内障的患者52例80跟,按照随机数字表法将患者随机分为零球差非球面IOL组和球面IOL组,每组40眼,分别在常规白内障超声乳化术术中植入零球差非球面IOL(Akreos AO)或球面IOL.所有患者均在术前1d,术后1d、1周、1个月及3个月时进行眼科常规检查,在裂隙灯显微镜下观察术眼眼前后节情况,测量眼压,记录裸眼视力,应用Tracey波前像差仪在术前1d检查角膜前表面波前像差,术后3个月随访时检查最佳矫正远视力(LogMAR视力),行对比敏感度、焦点深度及波前像差检查,并对2组结果进行比较.结果 2组患者术前的人口基线特征比较差异均无统计学意义(P＞0.05).术后3个月零球差非球面IOL组的最佳矫正LogMAR远视力为-0.03±0.08,球面IOL组为-0.02±0.10,2组比较差异无统计学意义(t=-0.50,P=0.61)；零球差非球面IOL组术眼在暗视(12.0 c/d)及暗视+周边眩光(3.0、6.0、18.0 c/d)条件下的对比敏感度分别为12.42±13.16、42.58±24.96、30.19±25.64和3.03±5.49,球面IOL组分别为5.59+8.11、28.74±18.69、17.07±19.35和0.22±1.15,相同条件下2组比较差异均有统计学意义(P＜0.05)；零球差非球面IOL组术眼的平均焦点深度(3.48±1.07)D,球面IOL组为(3.20±0.77)D,差异无统计学意义(t=l.15,P=0.25).术后3个月在5.0 mm瞳孔分析直径下,零球差非球面IOL组的全眼球差为(0.13±0.07)μm,球面IOL组为(0.21 +0.07)μm,差异有统计学意义(t=-4.19,P=0.00),术后3个组间术眼的全眼总高阶像差、彗差及三叶草像差比较,差异均无统计学意义(P＜0.05).结论 零球差非球面IOL植入眼视觉质量明显优于球面IOL植入眼.%Background Zero spherical aberration intraocular lenses(IOL)is designed to prevent the addition of positive spherical aberration after surgery.Research indicated that some positive spherical aberration can provide better depth distance of focus and pseudoaccommodation.Objective The present study was to compare the visual function and wavefront aberrations in pseudophakic eyes with zero spherical aberration IOL and spherical IOL.Methods A prespective case-controlled study was designed.Eighty eyes of 52 patients with age-related cataract were enrolled and divided into two matched groups based on random number table method.The regular phacoemulsification was performed on the eyes,and a zero spherical aberration IOL(Akreos AO)was implanted in the test group and a spherical IOL was used in the control group(Akreos Adapt IOL).The corrected distance visual acuity(CDVA),contrast sensitivity,depth of focus and wavefront aberrations were recorded and compared at 3 months after cataract surgery between these two groups.The trail was approved by the Ethic Committee of Eye Hospital of Wenzhou Medical College,and written informed consent was obtained from each patient prior to the program.Results The clinical demography from the two groups was matched(P ＞ 0.05).There were no significant difference in the CDVA (LogM AR)(-0.03 ±0.08 versus-0.02+0.10)(t =-0.50,P =0.61)and in depth of focus(3.48± 1.07 DS versus 3.20±0.77 DS)(t =1.15,P=0.25)between the zero spherical aberration IOL group and the spherical IOL group.The contrast sensitivities under the mesopic condition at 12.0 c/d and mesopic with glare at 3.0,6.0,18.0 c/d were 12.42 ± 13.16,42.58 ±24.96,30.19± 25.64 and 3.03 ± 5.49 in the zero spherical aberration IOL group,and those in the spherical IOL group were 5.59 ± 8.11,28.74 ± 18.69,17.07 ± 19.35 and 0.22 ± 1.15 without significant differences between these two groups(P＜0.05).Under the 5.0 mm pupil analyzing zone,the spherical aberration in zero spherical aberration IOL group was(0.13 ±0.07)μm,showing a significant reduction in comparison with spherical IOL group(0.21 + 0.07 μm)(P ＜ 0.05).No evidently differences were found in total high-order aberration,coma aberration and trefoil aberration(P＞0.05),but the sphere aberration was considerably lower in the zero spherical aberration IOL group compared with spherical IOL group(t=-4.19,P＝0.00).Conclusions The visual quality of the eyes implanted zero spherical aberration IOL is significantly better than ones implanted with spherical IOL.