iTrace引导个体化非球面人工晶状体植入可行性及术后视觉质量研究

Analyze the feasibility and postoperative visual quality of iTrace guiding personalized aspheric intraocular lens implantation

目的探讨使用iTrace视觉功能分析仪测量白内障患者术前角膜球差，根据角膜球差进行合理分组，选择适合的非球面人工晶状体（IOL）植入，使得术后全眼球差位于＋0．1μm左右这一方法的可行性，并使用多种视觉质量评价指标客观评价个性化非球面IOL植入术后患者的视觉质量。方法选取2014年6—11月在山东省鲁南眼科医院白内障患者115例（115只眼），应用数学表法随机分为实验组（63只眼）和对照组（52只眼），术前1天使用iTrace测量术眼6mm瞳孔直径下角膜球差，实验组中角膜球差小于＋0．15μm者植入Rayner 920 HIOL（零球差），角膜球差位于＋0．15μm～＋0．35μm者植入Acrysof SN60WF IOL（球差为-0．20μm），角膜球差大于＋0．35μm者植入Tecnis ZCB00 IOL（球差为-0．27μm），对照组统一植入Rayner 920H IOL，术后3个月散瞳后使用iTrace测量3mm及6mm下全眼各项高阶像差值的均方根值（RMS）、调制传递函数值（MTF）及斯特尔比率值（SR），使用Visual Optics Lab—CT软件计算焦深值。采用f检验及单因素方差分析对所得数据进行统计学分析，P〈0．05认为差异有统计学意义。结果（1）所有患者术后全眼球差的预测值与实际值差异无统计学意义（P〉0．05），所有患者术后全眼球差的绝对误差差异无统计学意义（P〉0．05）。（2）患者术后视觉质量分析：3mm瞳孔直径下，实验组与对照组术后全眼球差C4^0、全眼彗差、三叶草、总高阶像差RMS值、MTFtHOA值（total higher order aberration）、SR值及焦深值差异无统计学意义（P〉0．05）。6mm瞳孔直径下，两组术后全眼彗差、三叶草、焦深值差异无统计学意义（P〉0．05）；全眼球差C4^0、总高阶像差、全眼MTFtHOA值及SR值差异有统计学意义（P〈0．05）。结论使用iTrace测量患者术前角膜球差，根据角膜球差植入合适的非球面IOL使得术后全眼球差位于＋0．1μm左右该方法具有良好的可行性；个性化非球面人工晶状体植入术后患者在大瞳孔直径下具有更佳的客观视觉质量。

Objective To analyze the feasibility of selectively targeting about ＋0.1μm total postoperative spherical aberration by selecting the best fit aspheric intraocular lens （IOL） based on iTrace measured preoperative corneal spherical aberration of patients, and then evaluate visual quality of the patients with personalized aspheric IOL implantation using a variety of visual quality evaluation index objectively. Methods A total of 115 cataract patients （115 eyes） were divided into experimental group （63 eyes） and control group （52 eyes） randomly. The cornea spherical aberration at 6 mm pupil diameter was measure with an iTrace Visual Function Analyzer 1 day before surgery. The target postoperative total spherical aberration was at about ＋0.1μm in the experimental group, thus, for corneal spherical aberration less than ＋0.15μm, the Rayner 920H IOL of zero spherical aberration was selected, for corneal spherical aberration at ＋0.15μm-＋0.35μm, the Acrysof SN60WF IOL of-0.20um spherical aberration was selected, for corneal spherical aberration greater than ＋0.35um, the Tecnis ZCB00 IOL of-0.27um was selected. While, Rayner 920H IOL was implanted into the control group. The value of high-order aberrations （HOAs）, modulation transfer function （MTF） and sterol Ratio （SR） at 3 mm and 6 mm aperture were measure with iTrace 3 months after surgery, the Visual Optics Lab-CT software was used to calculate the depth of focus （DOF）. t-test and ANOVA were used to analyze the data, and P 〈0.05 was significantly different. Results There was no significantly difference between the predicted value and actual value of the postoperative spherical aberration as while as the absolute error for all the patients （P 〉0.05）. Postoperative visual quality analysis： When at 3ram pupil diameter, total ocular spherical aberration C4^0, coma, trefoil, total high-order aberration RMS value, MTFtHOA, SR and DOF had no significantly difference between the two groups （P 〉0.05）. When at 6mm pupil diameter, total ocular coma, trefoil and DOF had no significantly difference between the two groups （P 〉0.05）, while total ocular spherical aberration C4^0, total high-order aberration, MTFtHOA and SR had significantly difference between the two groups （P 〈 0.05）. Conclusions Customized selection of aspheric IOL based on iTrace measured preoperative corneal spherical aberration targeting about ＋0.1μm total postoperative spherical aberration is feasible, and the objective visual quality of the patients with personalized aspheric IOL implantation is better at large pupil diameter.