单纯老年性白内障人群角膜球面像差分析

Analysis of the corneal spherical aberration in people with senile cataract

目的 探讨单纯老年性白内障人群中角膜球面像差的分布情况.方法 回顾性系列病例研究.收集60岁以上单纯老年性白内障患者临床资料,共504例（922只眼）,按年龄（1组：60 ～＜70岁,153例;2组：70～ ＜80岁251例;3组：80～≤90岁100例）分组.使用Pentacam眼前节诊断分析仪于白内障手术前测量角膜参数角膜平均屈光力（Km）值及后表面平均屈光力（Km）值,Zernike分析计算以角膜顶点为中心6 mm直径范围内的前、后表面及总角膜球面像差值.采用单因素方差分析对各角膜参数在不同年龄分组问进行比较,使用配对f检验进行双眼间比较.结果 全部患者平均年龄（73.5±6.8）岁,角膜Km值（44.50±1.39）D,后表面Km值（-6.44±0.25）D,三组之间差异无统计学意义（F值分别为0.738和0.373,P＞0.05）,年龄与角膜Km值及后表面Km值间无相关性（r值分别为-0.033和0.037,P＞0.05）.角膜前表面球面像差l组（0.361 ±0.122） μm,2组（0.401±0.139） μm,3组（0.440±0.145） μm;后表面球面像差分别为（-0.122±0.035）μm,（-0.105 ±0.040）μm,（-0.090±0.043）μm;总角膜球面像差分别为（0.360 ±0.142） μm,（0.421±0.158）.μm,（0.476 ±0.170） μm.角膜前、后表面及总角膜球差在三组间差异均有统计学意义（F值分别为10.561、20.937及17.257,P＜0.01）.前、后表面及总角膜球面像差与年龄间的相关系数r值分别为0.203、0.288及0.258;P ＜0.01;前、后表面及总角膜球面像差在双眼间差异无统计学意义（t值分别为1.624、1.401及1.556;P＞ 0.05）且呈正相关（r值分别为0.524、0.833及0.540,P＜0.01）.结论 60岁以上单纯老年性白内障人群的角膜球面像差平均值较普通人群大,并且前表面及总角膜球差随年龄增加而增大,后表面负性球差随年龄增加而减小,各角膜球面像差参数在双眼间存在高度相关性.

Objective To investigate the distribution of the spherical aberration in people with senile cataract, in the interest of the customized selection of the intraocular lens in cataract surgeries and the future design of the intraoeular lens. Methods Retrospective study. Analysis of 922 eyes from 504 patients over 60-years-old was made. Patients were subdivided into 3 age groups （ 153 patients of 60 - 〈 70 years-old in group 1,251 patients of 70 - 〈 80 years-old in group 2, 100 patients of 80 -≤〈90 years-old in group 3）. Pentacam anterior segment analyzer （ OCULUS, Germany） was used to measure the average corneal and posterior surface K-readings. The Zernike coefficients of corneal spherical aberration was calculated. The difference of corneal parameters among each age group was compared. Results The average age of all patients was （73.5 ± 6.8 ） years-old. The average corneal K-reading was （44. 50 ± 1.39 ）D and the average K-reading of corneal posterior surface was （ - 6.44 ± 0. 25 ） D. There was no difference among 3 age groups （ F = 0. 738 and 0. 373 retrospectively, P 〉 0. 05 ）. The corneal and posterior surface average K-readings had no correlation with the age. The average spherical aberration of anterior corneal surface was （0. 361 ± 0. 122）um in group 1, （0. 401 ±0. 139）um in group 2 and （0. 440 ± 0. 145 ）um in group 3 respectively. The spherical aberration of posterior corneal surface was （ -0. 122 ± 0. 035 ）um, （ -0. 105 ± 0. 040 ）um and （ - 0. 090 ± 0. 043 ） um respectively. The total corneal spherical aberration was （ 0. 360 ± 0. 142 ） um, （0. 421 ± 0. 158 ）um and （0. 476 ± 0. 170 ） um respectively. Significant differences were observed among 3 age groups （ F = 10. 561, 20. 937 and 17. 257 retrospectively, P 〈0. 01 ）. The spherical aberrations of the corneal anterior, posterior surface and total cornea had positive correlation with the age （ r = 0. 203, 0. 288 and 0. 258 respectively, P 〈 0. 01 ）. The corneal spherical aberrations had no differences between right and left eyes, and had significant positive correlation between both sides. Conclusions The people with senile cataract over 60-year-old had higher corneal spherical aberrations than other age. The corneal spherical aberrations increased with the age and had significant correlation inter-ocularly.