不同类型人工晶状体植入术后视觉质量的比较

Comparison of visual quality after the implantation of different types of intraocular lens

目的比较年龄相关性白内障手术植入不同类型人工晶状体（IOL）后的临床效果。方法回顾性系列病例研究。回顾性分析2014年4月至12月101例（148眼）年龄相关性白内障的临床资料，其中行白内障术后植入传统球面IOL者44眼，植入零球面像差IOL者56眼，植入负球面像差IOL者48眼。以上3个组年龄、术前裸眼视力、眼轴长度等方面差异均无统计学意义（P〉0．05），角膜散光均〈0．75D。术前和术后1周、1个月和3个月，分别比较3个组的裸眼远视力（UCVA）、最佳矫正远视力（BCVA）、裸眼近视力、最佳矫正近视力、全眼的球面像差等情况。以视觉功能分析仪分别测量4．0mm瞳孔时全眼的球面像差并进行比较。结果术后3个月3组裸眼远近视力、最佳矫正远近视力差异均无统计学意义。术后3个月全眼的球面像差差异有统计学意义。按在角膜球面像差值分段比较全眼的球面像差时，在角膜球面像差〈0．15μm和〉0．45μm时，3组全眼的球面像差无统计学差异，在角膜球面像差为0．15～0．45μm时差异有统计学意义。结论早期观察结果显示负球面相差IOL植入术患者视觉质量优于传统球面IOL和非球面IOL植入术者。

Objective To compare the efficacy of different types of intraocular lens （IOL） implantation for age-related cataract. Methods A retrospective case series. Clinical data of 148 eyes of 162 cases of age-related cataract, were collected from April to December in 2014 at our hospital and all subjects were divided into three groups： simple cataract surgery combined with the traditional spherical IOL implantation in 44 eyes, zero spherical aberration AO IOL implantation in 56 eyes and negative spherical aberration ZCB IOL implantation in 48 eyes. The differences in patients age, preoperative uncorrected distance visual acuity and axial length among three groups were not statistically significant （ P 〉 0.05 ）. The corneal astigmatism of all patients were less than 0.75 D. Uncorrected distance visual acuity （ UCVA）, best corrected distance visual acuity （BCVA）, uncorrected near visual acuity （UNVA） and best corrected near vision （BCNA） were assessed preoperatively, 1 week, 1 month and 3 months after the surgery. And the ocular spherical aberration of the patients in 3 groups were assessed 3 months after the surgery. The total ocular spherical aberration of all subjects were measured by using the Ray tracing methed with pupil diameters of 4.0 mm. Results After three months, there were not statistically significant differences in UCVA, BCVA, UNVA and BCNA among three groups. After three months there was statistically significant difference among groups in total ocular spherical aberration. According to the data of corneal spherical aberration, the total ocular spherical aberration of patients in each group was divided into 3 grades. It is founded that the total ocular spherical aberration had no statistically significant defferences among groups when the corneal spherical aberration grade was less than 0.15μm or greater than 0. 45 μm. However,there was statistically significant difference when corneal spherical aberration grade was from 0.15 m to 0. 45 μm. Conclusion Our earlier observation shows that negative spherical aberration IOL implantation is superior to traditional spherical IOL and aspheric IOL.