一片式和三片式Tecnis非球面人工晶状体的偏心和倾斜及其高阶像差的对比研究

Comparative study of the tilt, decentration and higher-order aberrations （HOA） of single-piece and 3-piece tecnis aspheric intraocular lenses

目的 比较白内障摘除术后一片式与三片式非球面人工晶状体（IOL）的偏心量和倾斜度及其对眼内像差的影响.方法 前瞻性临床病例对照研究.根据随机数字表法将49例（72只眼）白内障患者随机分成两组,一组植入Tecnis ZCB00型IOL（美国AMO公司,一片式）,即ZCB00组,另一组植入Tecnis ZA9003型IOL（美国AMO公司,三片式）,即ZA9003组.术后3个月利用Pentacam三维眼前节成像系统测量IOL的偏心和45°、90°、135°及180°方向上的倾斜度;利用iTrace视觉功能分析仪采集眼内像差.两组IOL的偏心量、倾斜度和眼内像差各指标行独立样本t检验,而倾斜度和偏心量对眼内像差的影响采用Pearson相关进行分析.结果 患者年龄在50～80岁之间.术后3个月两组最佳矫正视力（BCVA）≥0.5,其中ZA9003组的BCVA与3.0 mm和5.0 mm瞳孔直径下眼内的Z3（散光）均呈正相关（r=0.504,P=0.003;r=0.637,P=0.000）,而与Z13（四阶散光）均呈负相关（r=-0.476,P=0.005;r=-0.531,P=0.001）.ZCB00组在90°和135°方向上的倾斜分别为（0.50±0.33）°、（0.69±0.41）°均较ZA9003组（0.90±0.78）°、（0.98±0.73）°小,差异具有统计学意义（t=2.899,P=0.005;t=2.120,P=0.038）.5.0 mm瞳孔下,ZCB00的离焦（Z4）、散光（Z5）、三阶彗差（Z8）、四阶散光（Z11）和四阶球差（Z12）均低于ZA9003组,差异具有统计学意义（t=2.372,P=0.021;t=2.801,P=0.007;t=3.269,P=0.002;t=3.230,P=0.002;t=3.468,P=0.001）.ZA9003组90°方向上的倾斜与3.0 mm和5.0 mm瞳孔下的四阶散光（Z13）均呈正相关（r=0.396,P=0.023;r=0.378,P=0.030）;其偏心值与3.0 mm瞳孔下的Z13呈负相关（r=-0.441,P=0.010）.结论 一片式与三片式IOL均有良好囊袋内稳定性,前者更稳定且视觉质量略优;前者偏心和倾斜与眼内像差之间不存在显著相关性,后者偏心和倾斜与不同瞳孔直径下的眼内四阶散光之间存在显著相关性。

Purpose To compare the tilt and decentration between a single-piece and a 3-piece aspheric intraocular lens （IOL）,and the impact of these factors on the HOAs after phacoemulsification and IOL implanted in capsular bag.Methods It is a prospective randomized clinical trial.According to the table of random number,72 eyes of 49 patients were divided into 2 groups.One group received a 1-piece aspheric IOL （Tecnis ZCBO0,AMO） and a 3-piece aspheric IOL （Tecnis ZA9003,AMO） in the other group.The tilt at 45°,90°,135° and180° and decentration of the IOL were obtained using Scheimphlug system （Pentacam,Oculus） and image-analysis 3 months after the surgery.The internal ocular HOA of the IOL were evaluated with iTrace examination.The tilt and decentration of the IOL and the variables of the internal ocular HOAs were compared by independent-samples t test.The effect of tilt and decentration on the HOAs was assessed by Pearson correlation analysis.Results Patients age ranged from 50 to 80 years.The best corrected visual acuity （BCVA） of both group were all not less than 0.5.In 3-piece IOLs group,there was a significant positive correlation between the BCVA and the astigmatism （Z3） （r=0.504,P=0.003;r=0.637,P=0.000） and a significant negative correlation between the BCVA and the fourth-order astigmatism （Z13） （r=-0.476,P=0.005;r=-0.531,P=0.001） at 3.0 mm and 5.0 mm pupil.The mean tilt at 90° （vertical） and 135°of the 3-piece aspheric IOL group [（0.90±0.78）° and （0.98±0.73）°,respectively] were higher than those in 1-piece aspheric IOL group [（0.50±0.33）° and （0.69±0.41）°,respectively],the differences were statistically significant （t=2.899,P=0.005;t=2.120,P=0.038）.At 5.0 mm pupil,the defocus （Z4）,astigmatism （Z5）,third-order coma（Z8）,fourth-order astigmatism （Z11） and fourth-order spherical （Z12） in 3-piece aspheric IOLs group were higher than those in 1-piece aspheric IOL group,the difference were statistically significant （t=2.372,P=0.021;t=2.801,P=0.007;t=3.269,P=0.002;t=3.230,P=0.002;t=3.468,P=0.001）.In 3-piece IOL group,a significant positive correlation was found between the mean tilt and the fourth-order astigmatism （Z13） at 3.0 mm and 5.0 mm pupil （r=0.396,P=0.023;r=0.378,P=0.030）,and a significant negative correlation was also found between the decentration and the fourth-order astigmatism （Z13） with at 3.0 mm pupil （r=-0.441,P =0.010）.Conclusions Both 1-piece and 3-piece IOL designs showed well stability in capsular bag,the former was slightly more stable with better visual quality.There was no significant correlation between the internal ocular HOA and the degrees of IOL tilt and decentration in the 1-piece aspheric IOL group.At different pupil diameters,a significant correlation was found between the decentration and tilt of IOL and fourth-order astigmatism Z （13） in the 3-piece IOL group.