不同原理仪器引导的球差个性化人工晶状体植入可行性及视觉质量观察

Observation of visual quality and the feasibility of using two different principle instruments to guide intraocular lens implantation for personalized spherical aberration

目的比较iTrace像差仪和Pentacam系统分别引导的个性化非球面人工晶状体（IOL）植人后的视觉质量，探讨分别利用这2种仪器引导IOL植入使术后全眼球差为＋0．1μm的可行性。方法前瞻性病例研究。分别应用Pentacam系统及iTrace像差仪对行白内障超声乳化联合非球面IOL植入术的年龄相关性白内障患者55例（58眼）术前1d测量6mm瞳孔直径下的角膜球差（Z4^0），分为iTrace组（31眼）和Pentacam组（27眼）。据测量结果分别为患者植入Tecnis IOL、AcrySof IQ IOL、ADAPT-AOIOL，使患者术后全眼球差的预测值在0．05-0．15μm范围内。术后3个月观察患者的裸眼视力（UCVA）、最佳矫正视力（BCVA）、6mm瞳孔直径下的调制传递函数（MTF）、全眼及内眼C4^0。对相关数据采用配对t检验和成组t检验进行分析。结果①术后2组患者的UCVA、BCVA比较．差异均无统计学意义（t=0．83、0．37，P〉0．05）。②所有患者术前预测的6mm瞳孔直径的全眼球差值与＋0．1μm比较差异均无统计学意义（t-1．70、0．64，P〉0．05）；术后6mm瞳孔直径时2组实际全眼球差与＋0．1μm比较，iTrace组差异无统计学意义（t=0．58．P〉0．05），Pentacam组差异有统计学意义（t=2．33，P〈0．05）。③2组患者术前全眼球差预测值与术后全眼球差实际值比较，差异均无统计学意义（t=-1．55、-2．04，P〉0．05）；2组患者术后实际内眼球差与IOL本身的球差值比较，差异均无统计学意义（t=-1．55、0．73，P〉0．05）。2组患者术后全眼球差实际值比较差异无统计学意义（t=1．52，P〉0．05）。④2组患者术后6mm瞳孔时在5、10、15、20、25、30c／d6种空间频率下，高阶像差的MTF值比较差异无统计学意义（t=0．88、0．47、0．34、0．02、-0．57、-0．23，P〉0．05）；球差的MTF值比较差异亦无统计学意义（t=-0．37、-0．46、-0．43、-0．39、-0．68、-1．08，P〉0．05）。结论iTraee与Pentacam分别引导的非球面IOL植入术后均能获得较满意的目标球差，iTraee组预测值更趋近于实际值：2种仪器分别引导的非球面IOL植入均能获得良好的术后视觉质量。

Objective To compare visual quality after using an iTrace Aberrometer or Pentacam system to guide personalized aspheric intraocular lenses （IOLs） implantations; to discuss the feasibility of using the 2 instruments to guide IOL implantation or whole eye spherical aberrations About ＋0.1 μm. Methods This was a prospective clinical study. One day before phacoemulsification and aspherie IOL implantation surgery, a Pentacam or iTraee aberrometer was used to measure corneal spherical aberrations （Z4^0） under a 6 mm pupil diameter of patients with age-related cataract. Fifty-five patients （58 eyes were divided into an iTraee group （31 eyes） and a Pentacam group （27 eyes）. Tecnis IOLs, AcrySof IQ IOLs or ADAPT-AO IOLs were implanted in these patients based on the measurement results so that the patient＇s predictive value of the whole eye spherical aberration was in the range of 0.05-0.15 μm after surgery. After 3 months, uncorrected visual acuity（UCVA）, best corrected visual acuity （BCVA）, modulation transfer function （MTF） for less than a 6 mm pupil diameter, spherical aberrations of the whole and inside eye were measured. The relevant data were analyzed using a paired t test and independent samples t test. Results ① After surgery, the UCVA and BCVA were compared for the 2 groups. The differences were not statistically significant （UCVA： t=0.83, P〉0.05; BCVA： t=0.37, P〉0.05）. ②All predicted preoperative whole eye spherical aberrations under a 6 mm pupil diameter were compared to ＋0.1 μm for the 2 groups. The differences were not statistically significant （iTrace group： t=- 1.70, P〉0.05; Pentacam group： t=0.64, P〉0.05）. After surgery, the actual spherical aberrations of the 2 groups under a 6 mm pupil diameter were compared to ＋0.1 μm. The difference for the iTrace group was not statistically significant （t=0.58, P〉0.05）, but there was a statistically significant difference for the Pentacam group （t=2.33, P〈0.05）.③The difference in the predicted values of the preoperative spherical aberrations of the whole eye and the actual values after surgery were not statistically significant （iTrace group： t=-1.55, P〉0.05; Pentacam group： t=-2.04, P〉0.05）. The actual spherical aberrations of the inside eye after surgery vs. spherical aberrations of IOLs and the differences were not statistically significant （iTrace group： t=1.55, P〉0.05; Pentacam group t=0.73, P〉0.05）. The difference between the 2 groups＇actual values of the spherical aberrations of the whole eye was not statistically significant （t=1.52, P〉O.05）.④After surgery, under a 6 mm pupil diameter at 5, 10, 15, 20, 25 and 30 cycles per degree （c/d） spatial frequencies, the differences in the values of the MTFs of higher-order aberration between the 2 groups were not statistically significant （t=0.88, 0.47, 0.34, 0.02, -0.57, -0.23, P〉0.05） and the differences in the values of the MTFs of spherical aberration for the 2 groups were not statistically significant （t=-0.37, -0.46, -0.43, -0.39, -0.68, -1.08, P〉0.05）. Conclusion The 2 groups that underwent 2 different instrument-guided aspheric IOL implantations can achieve satisfactory targets for spherical aberrations. The iTrace group＇s predictive value is closer to the actual value than the Pentacam group＇s. Aspheric IOL implantation surgery guided with either instrument can achieve good postoperative visual quality.