高阶像差及散射光对非球面IOL眼视网膜成像质量的影响

Effect of high-order aberrations and scattered light on visual quality in pseudophakic eyes with asphericmonofocal IOLs

背景高阶像差和散射光可能会对白内障超声乳化摘出联合非球面IOL植入眼视网膜成像质量造成影响，但目前采用客观方法评估其影响的研究较少。目的客观分析白内障超声乳化摘出联合非球面IOL植入术后的高阶像差及散射光对视网膜成像质量的影响，并探讨改善白内障术后视觉质量的方法。方法采用系列病例观察研究方法，收集天津市眼科医院2014年2—8月行白内障超声乳化摘出联合非球面IOL植入术3个月的患者53例67眼，利用i-Trace波前像差仪测量术后3个月患者4mm瞳孔下的全眼、角膜及晶状体的总像差、总高阶像差、球差、彗差、三叶草等主要高阶像差的均方根值（RMS），分析全眼像差与角膜像差、晶状体像差的相关性。用视觉质量分析系统OQASⅡ测量非球面IOL植入眼4mm瞳孔下的客观散射指数（OSI）及客观视网膜成像质量指标，包括调制解调函数截止频率（MTFcutoff）、斯特尔比值（SR）及100％、20％、9％对比度下的OQAS值，分析客观视网膜成像质量指标与全眼像差、角膜像差、晶状体像差及OSI的相关性；并分析OSI与全眼像差、角膜像差及晶状体像差的相关性。结果全眼像差与角膜像差、晶状体像差均呈正相关（r=0．255～0．586，均P〈O．05；r=0．582—0．907，均P〈0．01），全眼像差与晶状体像差的相关性更强。客观视网膜成像质量指标与全眼的总像差、总高阶像差及各主要高阶像差均呈负相关（r=-0．247—-0．675，均P〈0．05）；客观视网膜成像质量指标与角膜、晶状体的总像差、总高阶像差及部分主要高阶像差呈负相关（r=-0．245—-0．497，均P〈0．05；r=-0．246—-0．513，均P〈0．05）。客观视网膜成像质量指标与OSI均呈负相关（r=-0．620—-0．781，均P〈0．01）；OSI与全眼、角膜及晶状体的总像差、总高阶像差及部分主要高阶像差均呈正相关（r=0．396—0．727，均P〈O．01；r=0．320—0．522，均P〈0．05；r=0．319—0．598，均P〈0．01）。结论非球面IOL植入眼的高阶像差及散射光可能是术眼客观视网膜成像质量下降的主要影响因素，晶状体高阶像差对全眼高阶像差的影响更大。

Background High order aberrations and scattered light may be the main influencing factors of visual quality after phacoemulsification combined the aspherical IOL implantation. However, the study on objectively assessing the impact of them is little. Objective This study was to assess the impact of high order aberrations and scattered light on visual quality after phacoemulsification combined the aspherical IOL implantation. Methods A series cases-observational study was performed. Sixty-seven eyes of 53 patients who finished phacoemulsification and aspherical IOL implantation for at least 3 months in Tianjin Eye Hospital from February to August 2014 were enrolled. The root mean square （RMS） of total aberrations and high order aberrations was measured under the 4 mm pupil diameter with i-Trace aberrometer,including general high order aberrations, spherical aberrations, coma, and trefoil of entire eye, cornea and internal optics. The correlations between ocular aberrations and corneal or internal optic aberrations were analyzed. Objective scatter index （OSI） and objective visual quality parameters were measured,including MTF cut off frequency （MTF cut off）,strehl ratio （SR） and OQAS values （100% OV,20% OV,9% OV） with OQAS 11 , and the correlations between the objective visual quality parameters and OSI, ocular aberrations, corneal aberrations or internal optic aberrations were analyzed. In addition,the correlations between OSI and ocular, corneal or internal optic aberrations were evaluated. Writen informed censent was obtained from each patient before entering the study. Results Ocular aberrations were significantly positively correlated with corneal or internal optic aberrations （ r = O. 255-0. 586, all at P〈0.05 ; r = 0. 582-0. 907, all at P〈0. 01 ） , and the associations between internal optic and ocular aberrations was stronger than those between corneal and ocular aberrations. The objective visual quality parameters were negatively correlated with ocular, corneal and internal optic aberrations （r=-0. 247- -0. 675, all at P〈0.05 ;r =-0. 245- -0. 497, all at P〈0. 05 ;r = -0. 246- -0.513, all at P〈0. 05 ） as well as with OSI （ r = -0. 620- -0. 781 ,all at P〈0.01 ）. Most of the associations between internal optic aberrations and objective visual quality parameters were stronger than those of corneal aberrations. Furthermore, ocular, corneal and optical aberrations were all positively correlated with OSI （ r = 0. 396 - 0. 727, all at P 〈 0. 01 ; r = 0. 320 - 0. 522, all at P 〈 0.05 ; r = 0. 319 - 0. 598, all at P〈0.01 ）. Conclusions High order aberrations and scattered light seem to interact with objective visual quality in aspherical IOL implanted eyes, and the correlation between internal optic aberrations and ocular aberrations tends to be stronger than that of corneal aberrations.