Quatrix人工晶状体植入术后的疗效观察

Early visual results and mechanism of pseudo-accommodation of the Quatrix aspheric intraocular lens

目的观察年龄相关性白内障患者Quatrix人工晶状体（IOL）植入术后的临床疗效、IOL眼调节幅度及IOL眼高阶像差随调节的变化。方法回顾性系列病例研究。收集2011年1月至6月于天津市眼科医院就诊的67例年龄相关性白内障患者的临床资料，其中行单纯性白内障术后植入Quatrix非球面IOL的患者32只眼（试验组），AR40e IOL植入患者35只眼（对照组）。两组患者年龄、性别、眼轴长度等方面差异均无统计学意义（P〉0．05）。术前和术后1周、1个月和3个月，分别比较两组患者的裸眼远视力（UCVA）、最佳矫正远视力（BCVA）、裸眼近视力、最佳矫正近视力及最佳远矫近视力等情况。所有IOL眼在生理瞳孔状态下，使用iTrace视觉功能分析仪分别测量4．0mm瞳孔时，调节松弛和主观最大调节幅度刺激下，全眼和眼内高阶像差值并进行比较。采用SPSSl3．0统计学软件对数据进行独立样本t检验；对瞳孔、年龄等影响伪调节力的因素，分别行Pearson相关分析。结果全部患者术后3个月UCVA均≥0．39logMAR；随访期间BCVA均≥0．09logMAR。术后3个月，对照组UCVA为（0．30±0．12）logMAR，BCVA为（0．05±0．10）IogMAR，试验组分别为（0．28±0．11）logMAR和（0．07±0．11）logMAR，差异均无统计学意义（t=-0．558，0．371；P=0．579，0．712）。对照组的未矫正近视力为（0．92±0．35）logMAR，最佳矫正近视力为（0．15±0．11）logMAR，试验组分别为（0．52±0．18）logMAR和（0．05±0．08）logMAR，两组差异均有统计学意义（t=3．710，1．572；P：0．022，0．036）。术后3个月试验组平均主观调节幅度为（1．41±0．57）D，大于对照组的（1．18±0．70）D，差异有统计学意义（t=2．064，P=0．027）。在视远调节松弛状态下，对照组患者平均眼内球差为（0．036±0．012）μm，试验组为（0．018±0．009）μm，两组差异有统计学意义（t=-1．997，P=0．041）。在视近调节刺激下，试验组患者眼内球差RMS值向负值方向发展，出现由正变负，由小变大的趋势，且差异有统计学意义（t=3．774，P〈0．01）。对照组患者眼内球差未出现明显变化。对照组和试验组的眼内彗差在4．0mm瞳孔直径下，均表现出随调节出现的由大变小的变化规律。在调节刺激下，试验组眼内彗差RMS值的变化有统计学意义（t=2．346，P=0．037）；而对照组变化差异无统计学意义（t=4．529，P=0．128）。结论早期观察结果显示Quatrix IOL植入临床应用安全有效，患者在具有较好远视力的同时具备一定的视近能力；在调节过程中，Quatrix IOL眼高阶像差成分发生了明显的变化。

Objective To assess the clinical and visual outcomes of the implantation of the Quatrix intraoeular lens （IOL） and investigate the mechanism of pseudo-accommodation of these lens. Methods Opatients （67eyes）received cataract surgery were offered the Quatrix IOL （32 eyes） and AR40e IOL （35 eyes）. The patients＇ refractive status, uncorrected and best corrected distance visual aeuities were assessed preoperatively, 1 week, 1 month and 3 months after surgery. Using the Ray-tracing method, the root mean square （RMS） values of the higher order aberrations for each subject with pupil diameters of 4. 0 mm under accommodative stimuli were calculated. Result The mean uncorrected distance visual acuity improved significantly from 0. 70 to 0. 22 logMAR by the end of 3 months pos-toperative for the Quatrix group. The mean uncorrected near acuity was statistically significantly higher in the Quatrix group than in the AR40e group at the 6 months post-operative examination. The internal spherical aberration increased and changed from a positive to a negative value with inereasing accommodation at 4. 0 mm of pupil diameter under accommodative stimuli for the Quatrix group. The total and internal high order aberrations had no significant difference after surgery in the control group. Conclusion Results show that the Quatix IOL is safe, effective, and stable. It provided some degree of pseudo-accommodation. Flexure changes to the optics of the Quatrix IOL during accommodation could explain some of the pseudo-accommodation of this IOL.