非球面人工晶状体随机临床对照研究的Meta分析

Meta-analysis of clinical randomized controlled trials on aspherical intraocular lens

目的探讨非球面人工晶状体（IOL）对波前像差的影响。方法对非球面IOL随机临床对照研究进行Meta分析。检索Medline、中国期刊全文数据库、中国生物医学期刊数据库中有关白内障超声乳化联合非球面与传统球面IOL植入的随机临床对照试验，对纳入文献的患者术后最佳矫正视力及波前像差进行同质性检验和合并效应量的检验。结果15篇随机临床对照试验的文献，其中非球面IOL436只眼，球面IOL452只眼。眼球总体球差（总体Z：）、内部球差（内部z：）、高阶像差、总像差及眼内彗差非球面IOL组均较球面IOL组降低，总体加权的平均差值及95％可信区间分另4为-0．12（-0．13，-0．11）；-0．08（-0．09，-0．07）；-0．07（-0．10，-0．04）；-0．56（-0．73，-0．39）；-0．06（-0．10，-0．01），差异有统计学意义（P〈0．05）。最佳矫正视力、总体彗差、总体三叶草像差两组比较差异无统计学意义（P〉0．05），总体加权的平均差值及95％可信区间分别为0．12（-0．06，-0．29）；0．02（-0．01，0．04）；0．00（-0．04，0．05）。结论非球面IOL较球面IOL能够降低人眼球差；彗差的变化及术后由于角膜切口所引致的像差变化程度尚需进-步探讨。

Objective To evaluate the effects of aspherical intraocular lens （IOL） on the wavefront aberration by using meta analysis. Methods Trials were identified by searching the following electronic database for clinical randomized controlled trials about aspherical IOL and wavefront aberration： Medline, Chinese Medical Current Contents （CMCC）, China National Knowledge Infrastructure （CNKI）. Data were combined for meta-analysis using weighted mean difference （WMD） for discontinuous data. Results Fifteen clinical randomized controlled trials with 436 eyes were included in the aspherical IOL group and 452 eyes in the spherical IOL group. The tota[ Z0, internal Z0, total aberration, high-order aberrations （HOA） and the internal coma in the aspherical IOL group were lower than those of the conventional spherical IOL group. There was significant difference between these two groups（P 〈 0. 05 ）. The WMD and 95% confidence internals （CI） were - 0. 12 （ - 0. 13 to - 0. 11 ） ; - 0. 08 （ - 0. 09 to - 0. 07） ; - 0. 07 （-0.10to -0.04）;-0.56（-0.73 to -0.39）and -0.06 （ -0.10 to -0.01）, respectively. There were no significant difference of the best spectacle-corrected visual acuity （ BSCVA）, total coma and total trefoil between these two groups（P 〉0. 05）. The WMD and 95% CI were 0. 12（ -0. 06 to - 0. 29） ;0. 02 （ -0.01 to0.04） and 0.00 （ -0.04 to 0.05）, respectively. Conclusions Aspherical IOL can reduce spherical aberration. The changes of coma and the changes of the aberration induced by the cornea incision need further exploration.