IOLMaster和A超联合角膜地形图测量对人工晶体度数影响的对比分析

The comparative study of IOL Master and A ultrasound combined with corneal topography measurement for IOL power

目的：通过对比光学相干生物测量仪（IOL Master）与A超联合角膜地形图测量人工晶体度数的精确性，探讨两种测量方法在临床应用中的差异。方法选取2010年3月至2011年9月中南大学湘雅医院眼科行白内障超声乳化吸取联合人工晶体（IOL）植入术的白内障患者60例（84眼），其中年龄相关性白内障42例（57眼），并发性白内障18例（27眼），分为IOL Master组和A超联合角膜地形图测量组。术前IOL Master组使用IOL Master测量眼轴长度和角膜曲率，采用Haigis、SRK/T等公式计算IOL度数，同时使用A超联合角膜地形图测量眼轴长度和角膜曲率，采用SRK/Ⅱ公式计算IOL度数；术前A超联合角膜地形图测量组使用A超联合角膜地形图测量眼轴长度和角膜曲率，采用SRK/Ⅱ公式计算IOL度数。术后3个月复查两组患者的屈光状态，计算绝对屈光误差（MAE），并对以上结果进行统计学分析。结果⑴IOL Master组，术前IOL Master和A超测得的眼轴长度比较差异无统计学意义（ P ＞0.05），但是在眼轴长度＞26 mm患者中，两种检查方法检测眼轴长度[（28.53±0.57）mm vs （29.42±0.64）mm]比较差异有统计学意义（ P ＜0.05）；IOL Master和角膜地形图测得的角膜曲率[（42.12±0.31）D vs （43.09±0.27）D]比较差异有统计学意义（ P ＜0.01）；IOL Master和A超联合角膜地形图测量计算的IOL度数平均值[（17.06±0.48）D vs （16.37±0.56）D]比较差异有统计学意义（ P ＜0.05）。⑵术后3个月IOL Master组和A超联合角膜地形图测量组的MAE[（0.07±1.05）D vs （0.16±0.81）D]比较差异有统计学意义（ P ＜0.05）。结论在正常眼轴白内障患者，IOL Master与A超联合角膜地形图对于眼轴测量及IOL度数测算具有高度一致性，但在高度近视白内障患者，IOL Master对于眼轴测量及IOL度数测算精确性更高。

Objective To investigate the difference of IOL Master and A-ultrasound combined with corneal topography meas-urement in intraocular lens （ IOL） power calculation .Methods A total of 84 eyes of 60 cataract patients received phacoemulsification and intraocular lens implantation surgery were selected in Xiangya Hospital from March 2010 to September 2011.There were 57 eyes of 42 age-related cataract patients and 27 eyes of 18 complicated cataract patients .The patients were divided into IOL Master group and A ultrasound combined with corneal topography measurement group .Before surgery , in IOL Master group , axial length （ AL） and corneal curvature were measured with IOL Master , IOL power was calculated according to the Haigis , SRK/T formula and so on.At the same time the axial length （ AL） and corneal curvature were measured with A ultrasound combined with corneal topography respectively and IOL power was calculated by SRK/Ⅱ formula.In A ultrasound combined with corneal topography measurement group , axial length （ AL） and corneal curvature were measured with A ultrasound combined with corneal topography respectively , IOL power was calculat-ed according to the SRK/Ⅱformula.3 months postoperatively , all the patients were conducted refractive outcome and calculating mean absolute refractive error（MAE）.Finally the data were analysed.Results ⑴In IOL Master group, before operation there was no sig-nificant difference in mean axial length between IOL Master and A-ultrasound measurement （ P ＆gt;0.05 ） , while in the patients with AL＆gt;26 mm the axial length was （28.53 ±0.57）mm and （29.42 ±0.64）mm using IOL Master and A-ultrasound measurement respec-tively （ P ＆lt;0.05）.The mean corneal curvature was （42.12 ±0.31）D and （43.09 ±0.27）D using IOL Master and corneal topogra-phy measurement respectively （ P ＆lt;0.01）.The mean IOL power were （17.06 ±0.48）D and （16.37 ±0.56）D in IOL Master group＆amp;nbsp;and A ultrasound combined with corneal topography measurement group respectively （ P ＆lt;0.05 ） .⑵3 months postoperatively , the MAE was （0.07 ±1.05）D and （0.16 ±0.81）D in IOL Master group and A-ultrasound combined with corneal topography measure-ment group（ P ＆lt;0.05） respectively.Conclusions In cataract patients with normal axial length , IOL Master and A-ultrasound com-bined with corneal topography have high consistency for axial length measurement and IOL power calculation .But in cataract patients with high myopia , IOL Master is more accurate for axial length measurement and IOL power calculation compared to A -ultrasound com-bined with corneal topography .