基于角膜球差的个体化非球面IOL植入效果和可行性研究

Effectiveness and feasibility of personalized aspheric intraocular lens(IOL) implantation based on preoperative corneal spherical aberration

目的探索基于角膜球差的个体化非球面IOL植入的效果和可行性。方法在实施白内障超声乳化手术的患者中,术前测定6mm直径范围内的角膜球差,以此为基础,选择不同球差的非球面人工晶状体,以使术后总球差趋向0μm。术后3月回访时,测定6mm直径全眼球差及角膜像差,并与术前和预测值比较。通过与非个体化及其他个体化研究的比较评估个体化方案的植入效果;通过对预测值和实测的球面像差之间的差异比较及误差分析评估个体化方案的可行性。结果共53例(60眼)纳入实验。所有纳入研究的60眼术前及术后6mm直径范围内角膜球面像差(Z4,0)分别为(0.250±0.111)μm和(0.250±0.107)μm,二者差异无统计学意义(P=0.768)。术后全眼球差为0.036 5±0.065 4μm较预测值0.027±0.0714μm略大,但差异无统计学意义(P=0.299)。全眼球面像差的预测误差为(-0.009±0.092)μm,其中小于(±0.10)μm的有49眼(81.7%),小于(±0.05)μm的有34眼(56.7%)。结论基于角膜球面像差个体化选择非球面人工晶状体具有可行性;这种方法可以减小术后全眼球面像差,使全眼球面像差更接近预设值。

Objective To determine the effectiveness and feasibility of personalized aspheric intraocular lens（IOL） implantation based on preoperative corneal spherical aberration.Methods Patients for cataract surgery were offered topographical measurement preoperatively.Based on the corneal spherical aberration at 6-mm optical zone,one of three aspheric IOLs was chosen so the arithmetic sum of the corneal spherical aberration and pseudophakic spherical aberration came close to zero.In the follow-up 3 months after surgery,corneal spherical aberration at 6-mm diameter was measured and compared with the preoperative value and predictive value.The effectiveness was assessed by comparing postoperative total ocular spherical aberration with other personalized and nonpersonalized studies.The feasibility was assessed by comparing predictive value and postoperative total spherical aberration.Results Sixty eyes of 53 patients were available for analysis.The preoperative and postoperative corneal spherical aberration at 6-mm diameter were（0.250±0.111） μm and（0.250±0.107） μm respectively.The difference was not statistically significant（P=0.768）.Postoperative total ocular spherical aberration at 6-mm diameter was 0.0365±0.0654 μm,which was bigger than the preoperative.But the difference was not statistically significant（P=0.299）.For the entire population,mean absolute predictive error measured was（-0.009±0.092） μm,among which 49 eyes （81.7%） were with in（±0.10） μm and 34 eyes（56.7%） were within（±0.05） μm.Conclusion The personalized aspheric intraocular lens（IOL） implantation based on preoperative corneal spherical aberration is feasible.This method can reduce postoperative total ocular aberrations,and make the aberration close to the predictive value.