不同球差人工晶状体植入术后视觉质量及最佳矫正球差分析

Analysis of postoperative best corrected visual quality and spherical aberration after different spherical aberration artificial lens implantation

目的 比较负球差、零球差非球面人工晶状体（intraocular lens,IOL）及球面IOL植入术后不同瞳孔直径下高阶像差、调制传递函数值（modulation transfer function,MTF）、斯特尔比率值（Sterol Ratio,SR）及焦深值,并对全眼球差与SR值及焦深值的相关性进行分析,为确定最佳矫正球差提供依据.方法 临床病例对照研究.对2013年1～8月在山东医专附属眼科医院就诊的白内障患者150例（180只眼）,按数字表法随机分组植入IOL：Ⅰ组Tecnis ZCB00、Ⅱ组Rayner 920H、Ⅲ组Acrysof SA60AT,术后3个月散瞳后使用iTrace测量3、5、6 mm下角膜球差C40、全眼各项高阶像差的均方根RMS （Root-Mean-Square）值、MTFtHoA（total higher order aberration）值、SR值,使用Visual Optics Lab-CT软件计算焦深值.三组定量资料采用单因素方差分析,两两比较,采用SNK-q检验,相关性采用Pearson线性回归分析.结果 （1）3 mm瞳孔直径下,三组IOL眼角膜球差C40、全眼彗差、三叶草、总高阶像差RMS值、MTFtHOA值、SR值及焦深值差异无统计学意义（P＞0.05）;全眼球差C40 RMS值差异有统计学意义（F=5.192P=0.012）,Ⅰ组＜Ⅲ组（P =0.000）.（2）5 mm瞳孔直径下,三组角膜球差C40、全眼彗差、三叶草RMS值差异无统计学意义（P＞0.05）;全眼球差C40、总高阶像差RMS值及焦深值差异有统计学意义（P＜0.05）,Ⅰ组＜Ⅱ组＜Ⅲ组（P =0.000）;全眼MT-FtHOA值及SR值差异有统计学意义（P＜0.05）,Ⅰ组＞Ⅱ组＞Ⅲ组（P =0.000）.（3）6 mm瞳孔直径下,全眼球差与焦深值呈正线性相关（r=0.361,P＜0.05）,与SR值呈负线性相关（r=-0.382,P ＜0.05）,两线相交于＋0.1 μm左右.结论 小瞳孔下,不同球差设计IOL植入术后视觉质量差异无统计学意义.大瞳孔直径下,不同球差设计IOL植入术后视觉质量差异有统计学意义,负球差IOL眼MT-FtHOA值及SR值最高,球面IOL眼焦深最大;综合评价视觉质量,当全眼球差位于＋0.1 μm左右时,IOL眼的视觉质量最好.

Objective To compare visual quality including high-order aberration,MTF,SR,DOF （depth of focus） of the eyes implanted with two different aspheric IOL and spheric IOL at diffre ent pupil diameter.And to analyze the relationship between spherical aberration （SA） and SR,DOF at 6mm pupil diameter.To investigate the level of SA that showed the best objective visual quality of pseudophakic eyes.Methods A total of 150 patients （180 eyes） were divided into three groups randomly.Group Ⅰ Tecnis ZCB00 IOL,Group Ⅱ Rayner 920H IOL,Group Ⅲ Acrysof SA60AT IOL.The iTrace was used to measure high-order aberration,MTFtHOA and SR.The Visual Optics Lab-CT software was used to measure DOF.Results When at 3mm pupil diameter,corneal C40,total ocular coma,trefoil,total high-order aberration RMS value,MTFtHOA,SR and DOF had no difference between three groups （P ＞0.05）; total ocular C40 was lower in Group Ⅰ than in Group Ⅲ （P=0.000）.When at 5mm pupil diameter,corneal C40,total ocular coma,trefoil RMS value had no difference between three groups （P ＞0.05）; total ocular C40,high-order aberration,MTFtHOA,SR and DOF were different between three groups （P ＜0.05）.SR was higher with decreasing entire SA （r =-0.382,P ＜0.05）,DOF had positive correlation with entire SA （r =0.361,P ＜0.05）.Conclusions When at small pupil diameter,the visual quality of the eyes implanted with IOLs of different SA has no difference.When at large pupil diameter,the visual quality of the eyes implanted with IOLs of different SA have significant difference.The eyes implanted with negative SA IOL have the highest value of MTFtHOA and SR,while eyes implanted with spherical IOL have the highest value of DOF.It is better to reserve some positive SA （about ＋0.1tm） to obtain the best visual quality.