视觉质量分析仪KR-1W指导非球面IOL个性化植入的可行性评估

Feasibility assessment of visual quality analyzer KR-1W guiding personalized aspheric IOL implantation

目的：探讨依据视觉质量分析仪KR-1W测量患者超声乳化白内障吸除术前角膜球差,指导相对个性化的植入非球面人工晶状体（intraocular lens,IOL）,使其术后全眼球差接近于0.1μm的可行性。方法：前瞻性病例系列研究。对73例100眼年龄相关性白内障患者行超声乳化白内障吸除联合非球面IOL植入术,术前1d利用视觉功能分析仪KR-1W测量6.0mm瞳孔直径的角膜球面像差,为使患者术后总球差接近于0.1μm,分别对术前角膜球差小于0.15μm患者植入Sofport Advanced Optic IOL（AO组,9例16眼）,0.25-0.3μm者植入AcrySof IQ IOL（IQ组,45例57眼）,大于0.35μm者植入Tecnis ZA9003 IOL（Tecnis组,19例27眼）。患者均行2.75mm透明角膜切口的超声乳化白内障吸除联合非球面IOL植入术,术后3mo观察患者的裸眼视力、最佳矫正视力、6.0mm瞳孔直径时的全眼及内眼（主要是IOL）球差。采用t检验和方差分析对获得的数据进行统计学分析。结果：术后所有患者6.0mm瞳孔直径时的全眼球差为0.084±0.032μm;Tecnis组：0.091±0.021μm;AO组：0.0814±0.013μm;IQ组：0.093±0.042μm。所有患者术后全眼球差的预测值与实际值的差异无统计学意义（t=1.932,P=0.061）;所有患者全眼球差的预测值与实际值的差值为0.013±0.041μm,差异无统计学意义（F=2.537,P=0.091）。术后3组患者的裸眼视力、最佳矫正视力比较,差异均无统计学意义（F=0.897,P=0.421;F=1.423,P=0.097）。结论：根据视觉质量分析仪KR-1W给定的角膜球差植入合适的非球面IOL,术后均能够获得较满意的目标球差,提示视觉质量分析仪KR-1W可为个性化植入非球面IOL提供临床依据。

AIM： To discuss the feasibility of using the visual quality analyzer KR- 1W to guide the relatively personalized aspheric intraocular lens（ IOL） implants to make the whole eye spherical aberration close to 0. 1μ m.METHODS： In this prospective case series study,the corneal spherical aberration with 6mm aperture of 73patients（ 100 eyes） was measured with KR- 1W Visual Function Analyzer 1d before surgery. For the sake of the whole postoperative spherical aberration were close to0. 1μ m, 9 cases（ 16 eyes） with corneal spherical aberration 〈 0. 15μ m were implanted Sofport Advanced Optic IOL,named AO group; 45 cases（ 57 eyes） with corneal spherical aberration 0. 25 ~ 0. 3μ m were implanted AcrySof IQ IOL,named IQ group; 19 cases（ 27 eyes） with corneal spherical aberration 〉 0. 35μ m were implanted Tecnis ZA9003 IOL,named Tecnis group. Aspherical IOL was implanted after phacoemulsification through a cornea2. 75 mm incision without suture. Uncorrected visual acuity,beat corrected visual acuity,spherical aberration of the whole eye and jnternal optics（ mainly IOL） at 6mm pupil diameter were examined at 3mo postoperatively.The relevant data were analyzed using t- test and variance analysis.RESULTS： The whole ocular spherical aberration at6 mm pupil diameter in all postoperative were 0. 084 ±0. 032μ m; in Tecnis group,the data were 0.091 ± 0.021μ m; in AO group,the data were 0. 0814- 0. 013μ m; IQ groupwere 0. 093 ± 0. 042μ m. There was no significantly different between the predicted value and actual value of ocular spherical aberration at 6 mm pupil diameter in all postoperative（ t = 1. 932,P = 0. 061） and in the three groups. The difference value in the predicted values of the preoperative spherical aberrations of the whole eye and the actual values after surgery was 0. 013 ± 0. 041μ m; there was no statistically significant difference（ F = 2. 537,P =0. 091）. Respectively compared the uncorrected visual acuity and besta corrected visual acuity among three groups of postoperative,no significant difference were found（ F = 0. 897,P = 0. 421; F = 1. 423,P = 0. 097）.CONCLUSION： Personality selection of aspheric IOL based on preoperative corneal spherical aberration of patients is feasible and produces satisfactory target postoperative total spherical aberration.