角膜球面像差引导下个体化IOL植入术后视觉质量

Evaluation of the optical quality of corneal spherical aberration-guided customized intraocular lens implants

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1d应用i-Trace视觉功能分析仪测量患者6．0mm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：-0．15-0．05μm（12眼）；B组：-0．05—0．05μm（24眼）；C组：0．05～0．15μm（25眼）；D组：0．15-0．5μm（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，组问差异有统计学意义（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、30c／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6．0c／d，高频12．0、18c／d空间频率，明视眩光状态下的高频12．0、18．0c／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6．0c／d，高频12．0、18．0c／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。

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 intraoeular 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： 0.15-0.5μ~m （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/m^2, 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.