角膜球面像差引导下个体化IOL植入术后视觉质量

摘要

Objective To evaluate the optical quality of corneal spherical aberration-guided customized intraocular lens implants.Methods In a prospective study,64 age-related cataract patients (82 eyes) were selected for implantation of different spherical aberration intraocular lenses based on preoperative corneal spherical aberrations and measurements at the 6-mm pupil diameter (i-Trace).Patients were divided into four groups based on the predicted postoperative total spherical aberrations: group A:-0.15--0.05 μm (12 eyes),group B:-0.05-0.05 μm (24 eyes),group C:0.05-0.15 μm (25 eyes),group D: 0.15-0.5 μm (21 eyes).Uncorrected and best corrected visual acuity,wavefront aberration,MTF (modulation transfer function) curve and contrast sensitivity were measured 3 months after surgery.Data were analyzed with one-way ANOVA and paired t test.Results The total wavefront aberrations and higher order aberrations of group B and group C were much lower than that of group A and group D.There was a statistically significant difference among the four groups at spatial frequencies of 5,10,25,30 c/d of the MTF curve and in most contrast sensitivity spatial frequencies.And there was a statistically significant difference between group B and group C in contrast sensitivity spatial frequencies of 6.0,12.0,18.0 c/d (3 cd/m2,Glare).Conclusion Measurement of preoperative corneal spherical aberrations is helpful for selecting intraocular lenses.Corneal spherical aberration-guided customized intraocular lens implantation will be a new method for improving postoperative optical quality.%目的 评价角膜球面像差引导下个体化人工晶状体(IOL)植入术后视觉质量,并探讨这一方法的可行性.方法 前瞻性病例研究.行白内障超声乳化联合折叠式IOL植入术的年龄相关性白内障患者64例(82眼),术前1 d应用i-Trace视觉功能分析仪测量患者6.0 mm瞳孔直径下的角膜球面像差值,植入不同球面像差的IOL.根据全眼预测保留球面像差值将患者分为4组,A组:-0.15～-0.05 μm(12眼)；B组:-0.05～0.05 μm(24眼)；C组:0.05～0.15 μm(25眼)；D组:0.15～0.5 μm(21眼).术后3个月对患者进行裸眼视力及最佳矫正视力、波前像差、调制传递函数曲线及对比敏感度的检查.运用单因素方差分析、配对t检验方法对获得的数据进行统计学分析.结果 术后3个月4组之间像差值比较,B组及C组的全眼总像差及高阶像差均明显低于A组与D组,组间差异有统计学意义(F=4.453、3.699,P＜0.05).4组调制传递函数值比较,在低频5、10,高频25、30 c/d空间频率下组间差异有统计学意义(F=3.96、3.32、3.09、4.56,P＜0.05).4组对比敏感度比较,在暗视无眩光状态下的中频6.0 c/d,高频12.0、18 c/d空间频率,明视眩光状态下的高频12.0、18.0 c/d空间频率,暗视眩光状态下的所有空间频率B组与A、D组,C组与A、D组之间差异有统计学意义,且在暗视眩光状态下的中频6.0 c/d,高频12.0、18.0 c/d空间频率下C组对比敏感度值明显高于B组,组间差异有统计学意义.结论 术前测量角膜球面像差可以为白内障患者IOL的选择提供良好的依据,角膜球面像差引导下个体化IOL的植入为白内障患者术后视觉质量的提高提供了新的思路和方向.