球面人工晶状体与非球面人工晶状体临床应用效果的Meta分析

Meta-analysis of Randomized Controlled Trials Comparing Aspheric Intraocular Lenses with Spherical Intraocular Lenses in the Treatment of Cataract Surgery

目的系统评价球面人工晶状体(IOL)与非球面IOL的临床应用效果。方法采用Cochrane系统评价方法,计算机检索CENTRAL(Cochrane图书馆2008第3期)、MEDLINE(2000～2008年10月)、EMbase(2000～2008年10月),纳入球面IOL与非球面IOL对照的超声乳化白内障吸出联合IOL植入的随机对照试验。由两名评价员分别提取资料,评价方法学质量后,采用RevMan5.0软件进行Meta分析。结果共纳入14个随机对照试验(1383只眼)。按非球面IOL的球差不同分三个亚组进行Meta分析。结果显示:①术后最好矫正视力:AcrySofIQIOL亚组两组间差异有统计学意义[WMD=–0.02,95%CI(–0.03,–0.01),P<0.0001];TecnisZ9000IOL亚组两组间差异有统计学意义[WMD=0.02,95%CI(0.01,0.03),P=0.002];非球面TecnisIOL与非球面AkreosAOIOL亚组两组间差异无统计学意义[WMD=0.00,95%CI(–0.02,0.03),P=0.71]。②术后球面像差:AcrySofIQIOL亚组两组间差异有统计学意义[WMD=–0.06,95%CI(–0.08,–0.05),P<0.00001];TecnisZ9000IOL亚组两组间差异有统计学意义[WMD=–0.06,95%CI(–0.08,–0.05),P<0.00001];非球面TecnisIOL与非球面AkreosAOIOL亚组两组间差异有统计学意义[WMD=–0.07,95%CI(–0.11,–0.03),P=0.0002]。③术后高阶像差:非球面IOL与球面IOL植入术后高阶像差差异有统计学意义[WMD=–0.05,95%CI(–0.07,–0.02)]。④术后对比敏感度:非球面IOL能改善术后对比敏感度,尤其在暗视条件下更为明显,但也有研究认为二者无显著性差异。⑤术后视觉质量及不良视觉反应:非球面IOL术后视觉效果更好,但两组差异无统计学意义。结论现有有限证据表明,非球面IOL比球面IOL有较好的临床应用效果。但对比敏感度等结论仍不一致。扩大样本量,延长随访时间,观察对比敏感度的变化是必要的。对不同球差的非球面IOL临床效果研究较少,应开展大样本的随机对照试验,观察其临床效果。

Objective To compare the effectiveness of aspheric intraocular lenses（IOL）versus spherical IOL in the treatment of cataract.Method Randomized controlled trials comparing aspheric IOL with spherical IOL were identified by searching PubMed（2000 to October,2008）,EMbase（2000 to October,2008）,MEDLINE（2000 to October,2008）,and The Cochrane Library（Issue 3,2008）.Two reviewers independently assessed trials for eligibility and quality,as well as the extracted data.Data were synthesized using RevMan software（release 5）provided by the Cochrane Collaboration. Results A total of 14 trials （1383 eyes） were included for systematic review, and 11 out of 14 studies were included in the meta-analysis. Subgroup analyses were used according to different aberrations of aspheric IOL. The results showed a significant difference in the mean best corrected visual acuity at 3 months after cataract surgery in the AcrySof IQ IOL group with WMD -0.02, 95% CI -0.03 to -0.01（P〈0.0001）. It showed a significantly worse difference in the mean of the best corrected visual acuity at 3 months after cataract surgery in the AcrySof IQ IOL group with WMD -0.02, 95%CI -0.03 to -0.01 （P〈0.000 1）. It showed a significant worse in the mean the best corrected visual acuity in the Tecnis Z9000 IOL group with WMD 0.02, 95%CI 0.01 to 0.03 （P=0.002）; and there was no significant difference between the two groups with WMD 0.00, 95%CI -0.02 to -0.03 （P=0.71）. The results did display markedly less spherical aberration and total higher order aberrations than eyes implanted with the traditional spheric IOL in all subgroups （WMD -0.06, 95%CI -0.07 to -0.06, P〈0.000 01, WMD -0.06, 95%CI -0.07 to -0.02, P〈0.000 1, respectively）. The majority of studies suggested significant improvement in the aspheric IOL group in contrast sensitivity, especially at mesopic low spatial frequencies, although some trials showed no significant difference. Conclusion The effectiveness of aspheric IOL is superior to spherical IOL during cataract surgery. No differences in aspheric IOL with different aberration are found in this series, and further study is required,