非球面与球面人工晶状体植入术对高度近视并发白内障患者视觉质量的影响

A comparison between aspheric and spherical intraocular lenses on the optical quality of high myopia patients with complicated cataract IOL implantation

目的比较球面与非球面人工晶状体对高度近视并发白内障患者视觉质量的影响。方法回顾性病例对照研究。采用随机数字表法，将实施超声乳化白内障手术的高度近视并发性白内障患者46例（46眼）随机分为两组。非球面组23例（23眼），行白内障超声乳化联合非球面人工晶状体植入术；球面组23例（23眼），行白内障超声乳化联合球面人工晶状体植入术。观察患者术后3个月的最佳矫正视力（BCVA）、对比敏感度（CS）及波前像差均方根（RMS）值。结果非球面组BCVA为4．5±0．12，球面组BCVA为4．3±0．15，两组差异无统计学意义（t=1．521，P〉0．05）。非球面组在夜视（3．0c／d、6．0c／d）及夜视加周边眩光（1．5c／d、3．0c／d、6．0c／d）条件下，对比敏感度值明显优于球面组．差别有统计学意义（P〈0．05）。在瞳孔直径5．0mm状态下，非球面组的球差、第四阶像差、第五阶像差、第六阶像差及总体高阶像差均明显低于球面组，差异有统计学意义（p〈0．05）。结论非球面人工晶状体可以减少高度近视并发性白内障患者术后的高阶相差尤其是球差，提高对比敏感度，具有比球面人工晶状体更佳的视觉质量。

Objective To compare the effect of an aspheric versus spherical intraocular lens （IOL） on the optical quality of high myopia patients with complicated cataract IOL implantation. Methods In a retrospective study, 46 patients （46 eyes） were randomly selected to undergo phaeoemulsification and implanted with either aspheric IOLs （test group, 23 eyes） or spherical IOLs （control group, 23 eyes）. BCVA,contrast sensitivity and total higher order wavefront aberrations were assessed 3 months after cataract surgery. Results The difference in BCVA between the two groups was not significant. In an examination of contrast sensitivity under nighttime and nighttime with periglare conditions, patients implanted with aspheric IOLs performed significantly better than patients with spherical IOLs （P〈0.05）. For a 5.0 mm optical zone, there was a significant reduction in spherical aberrations, RMS4, RMS5, RMS6 and RMSh in eyes implanted with aspheric IOLs （P〈 0.05）. Conclusion This study shows that the optical quality of high myopia and cataractous eyes implanted with aspheric IOLs is significantly better than that with spherical IOLs.