三片式与一片式人工晶状体囊袋旋转稳定性比较及对高阶像差影响

Comparison of rotational stability between three-piece and one-piece intraocular lenses： effect on high-order aberration

目的比较三片式与一片式人工晶状体（intraocularlenses，IOL）不同时间段的囊袋旋转稳定性及研究不同旋转角度下内眼及全眼各高阶像差成分的变化，为散光型IOL的最佳设计提供新思路。方法临床病例对照研究。对2010年11月至2011年7月在天津眼科医院白内障超声乳化植入IOL60例患者随机分为两组，A组30例（30只眼），植人三片式疏水性丙烯酸酯IOLAR40e；B组30例（30只眼），植入一片式疏水性丙烯酸酯IOL ZCBOO。术中手术显微镜照相，术后1天、7天及1月裂隙灯后照法采集照片，用图像分析软件联合MB—ruler软件计算IOL襻的旋转度。用iTrace视觉功能分析仪测量术后7天及1月6mm瞳孔直径内眼及全眼高阶像差成分，再将7天及1月两组IOL眼根据旋转度〈3°和3°分组比较内眼及全眼高阶像差成分。结果术后1月两组UCVAI〉0．6、BCVA≥0．8。术后1天与术中夹角比较，A组（t=-0．435，P-0．667），B组（t=-0．336，P=0．739），差异均无统计学意义（P〉0．05），体位对旋转度无影响。以术后1天为参考值，7天及1月IOL旋转度A组分别为（2．21±1．45）°和（2．43±1．59）°，B组分别为（1．98±1．20）°和（2．14±1．37）°，两组间不同时间段比较，差异均无统计学意义（P〉0．05）。术后7天和1月两组IOL内眼球差及全眼总高阶像差、球差差异均有统计学意义（P〈0．05），而内眼总高阶像差、彗差和三叶草及全眼彗差、三叶草差异均无统计学意义（P〉0．05）。在不同旋转角度下，7天和1月两组内眼和全眼高阶像差成分各自比较，差异均无统计学意义（P〉0．05）。结论三片式与一片式IOL均有良好囊袋旋转稳定性，一片式更为稳定，更适合设计散光型IOL；两种IOL的旋转度对内眼及全眼高阶像差无影响。

Objective To compare rotational stability in the capsular bag between three-piece and one-piece intraocular lenses （IOL） and study the influence of rotation angle （RA） on the high-order aberrations （HOAs） of interior and entire eye in order to determine whether the design is suitable for toric lens. Methods A total of 60 eyes （60 patients） were divided into 2 groups randomly. Group A implanted with AR40e three-piece hydrophobic acrylic foldable IOL. Group B implanted with ZCBOO one-piece hydrophobic acrylic foldable IOL. The uncorrected visual acuity （UCVA） and best corrected visual acuity （BCVA） were detected. The rotational stability was evaluated at the end of surgery using operating microscope photograph and then use digital anterior segment photograph at 1 day, lweek and 1 month after surgery, and then use the Adobe Photoshop software combined with MB-ruler to calculate the rotation angle. The high-order aberrations （HOAs） of interior and en- tire eye at one week, one month postoperative under 6mm pupil diameter were measured with iTrace visual function analyzer and compared between the two groups, and then grouped with rotation angle comparing the HOAs between groups. Results All eyes had UCVA better than 0.6 and BCVA better than 0.8. There were no significantly differences between operative and one day postoperatively in the two groups （P 〉0.05）. The RA in Group A was （2.21±1.45）° and （2.43±1.59）°; Group B was （1.98±1.20）° and （2.14±1.37）° at one week and one month postoperatively, there were no statistically significant differences between the two groups at the two junctures （P 〉0.05）. The total high-order aberration （tHOA）, spherical aberration （SA） of entire eye were statistically significantly lower in group B than in group A at one week and one month postoperatively （P 〈0.05）, and the SA of interior eye was also significantly lower （P 〈0.05）. There were no statistically differences of HOAs between RA〈3° group and RA 3° group in the two groups at one week and one month postoperatively （P 〉0.05）. Conclusions They all demonstrate good rotational stabilities of three-piece and one-piece IOL, especially in one-piece IOL, which the design is suitable for toric IOL; the rotation angles of three-piece and one-piece IOL have no influence on HOAs.