手术导航系统在多焦点人工晶状体植入手术中的初步应用

Application of surgery guidance system on aspheric diffractive multifocal intraocular lenses implantation: a preliminary clinical observation

目的观察在白内障超声乳化吸除术联合多焦点人工晶状体植入手术中应用Lenstar LS900手术导航系统对患眼手术前后屈光状态变化的影响,初步评价Lenstar LS900手术导航系统的临床应用价值。设计回顾性病例系列。研究对象2012年8月就诊于北京同仁医院并行白内障超声乳化吸除术的单纯白内障患者36例(45眼)。方法根据手术中是否应用导航系统分为导航组17例(22眼)和对照组19例(23眼)。导航组患眼术前分别采用Lenstar LS900光学低相干反射生物测量仪及IOL Master进行眼轴长度、前房深度、角膜曲率、散光度等参数的测量;术后1、3个月采用Lenstar LS900光学低相干反射生物测量仪对上述参数进行复查。对照组患眼术前、术后3个月均采用IOL Master进行上述参数的测量。比较导航组患者术前两种测量仪器测量的一致性;比较两组患眼术前、术后3个月的屈光参数差值的变化情况。主要指标患眼术前术后的眼轴长度、前房深度、角膜曲率、散光度。结果导航组术前Lenstar LS900和IOL Master测量数据中,眼轴、角膜曲率、散光度的测量值比较差异均无统计学意义(P均>0.05),而前房深度两种仪器的测量数值分别为(2.82±0.46)mm和(3.14±0.52)mm(P=0.036)。导航组术前、术后1、3个月眼轴分别为(25.48±3.26)mm、(25.38±3.01)mm、(25.40±3.01)mm(P=1.000);前房深度分别为(3.14±0.53)mm、(3.56±0.76)mm、(3.62±0.81)mm(P=0.000);散光度分别为(0.97±0.37)D、(0.72±0.32)D、(0.62±0.27)D(P=0.003)。导航组术前和术后3个月散光度差值为(-0.35±0.27)D,对照组术前、术后3个月散光度差值为(0.20±0.49)D(P=0.000)。结论在白内障超声乳化吸除术+人工晶状体植入手术中应用Lenstar LS900手术导航系统可减少手术源性散光的形成,并可减少患者原有的部分散光度,值得在白内障手术中推广应用。

Objective To compare the refraction effects of the implantation of the aspheric diffractive multifocal intraocular lens （IOL） with the Lenstar LS900 surgical guidance system to the traditional oprerations without the guidance system. Design Retrospective case series. Participants 36 patients （45 eyes） with senile cataract that underwent phacoemulsification and aspheric diffractive multifocal IOL implantation in Beijing Tongren Hospital in Aug. 2013 were included. Methods 36 patients （45 eyes） were divided into two groups. Guidance group, include 17 patients （22 eyes）, the sugeries of phacoemulsification and aspheric diffractive muhifocal IOL implantation of whom were performed with the assistance of Lenstar LS900 surgery guidance system, the refraction parameters （axial length, anterior chamber depth, corneal curvature and astigmatism） of whom were measured with Lenstar LS900 and IOL Master independently before the operation, and the same parameters of whom were measured with Lenstar LS900 at 1 and 3 months after the operation. The control group, include 19 patients （23 eyes）, the same parameters of whom were measured with IOL Master preand 3 months post-operation, and the sugeries of whom were performed without the assistance of the surgery guidance system. The parameters measured with Lenstar LS900 were compared to those measured with IOL Master in the guidance group at preoperation. The difference of astigmatism degrees between pre and post-operation were compared between the two groups. Main Outcome Measures Axial length, anterior chamber depth, corneal curvature, and astigmatism. Results The mean axial length, corneal curvature, astigmatism diopter measured with Lenstar Ls900 were not signifigantly different from the measurements with IOL Master （all P〉0.05）, and the mean anterior chamber depth was （2.82±0.46） mm with Lenstar LS900 and （3.14±0.52） mm with IOL Master （P=0.036）. In the guidancegroup, the mean axial length was （25.48±3.26） mm at pre-operation, （25.38±3.01） mm at 1 month post-operation, and （25.40±3.01） mm at 3 months post-operation （P=1.000）; the mean anterior chamber depth was （3.14±0.53） mm at pre-operation, （3.56±0.76） mm at 1month post-operation, and （3.62±0.81） mm at 3 months post-operation （P=0.000）; the mean astigmatism diopter was （0.97±0.37） D at pre--opelation, （0.72±0.32） D at 1 month post-operation, and （0.62±0.27） D at 3 months post-operation （P=0.003）. The difference of astigmatism diopter between pre-and 3 months post-operation was （-0.35±0.27） D in guidance group, and （0.20±0.49）D in control group （P= 0.000）. Conclusion Real-time eye tracking based on Lenstar LS900 surgery guidance system can decrease the postoperative astigmatism diopter, thus increase the repeatability and accuracy of the surgery. It could be widely used in clinical practices.