非球面人工晶状体个性化植入的研究

Customized implantation of aspheric IOLs

目的研究依据白内障患者手术前角膜球差个性化选择非球面人工晶状体的可行性及视觉效果。方法前瞻性对照研究。所有入选的年龄相关性白内障患者均在术前用i Trace检查测量角膜球差。将患者随机分为两组:第一组为实验组,根据角膜球差情况选择非球面人工晶状体,角膜球差>0.25μm时植入Hoya FY-60AD(设计球差值为-0.18μm),当角膜球差≤0.25μm时植入Rayner 920H(设计球差值为0);第二组为对照组,该组所有患者均植入Rayner 920H(设计球差值为0)。术后1个月后测量记录患者的视力、像差及对比敏感度结果。结果实验组中全眼球差预测值与术后测量值成正相关(R^2=0.646,P<0.001),两者差异无统计学意义(t=-1.062,P=0.297)。实验组与对照组的视力、术前术后角膜球差差异无统计学意义,术后内眼球差与术后全眼球差在实验组要少于对照组,差异具有统计学意义(P<0.05)。实验组在暗视无眩光3cpd、6cpd空间频率,暗视有眩光6cpd、12cpd空间频率对比敏感度均高于对照组(P<0.05)。结论非球面人工晶状体个性化植入具有其可行性,而且能提高患者的暗环境对比敏感度,改善视觉质量。

Objective To determine the feasibility of customized aspheric IOLs selection based on preoperative corneal spherical aberration and to investigate the visual quality of customized aspheric IOL implantation. Methods Patients with age-related cataract underwent i Trace corneal spherical aberration（ SA） measurement before surgery. In group 1patients,IOL was selected according to corneal SA： Hoya FY-60AD（ aberration：-0. 18μm） was implanted if corneal SA 〉0. 25 μm,and Rayner 920H（ aberration-free aspheric IOL） was implanted if corneal SA 〈0. 25 μm. In group 2,all patients were implanted with aberration-free aspheric IOL Rayner 920 H. Uncorrected visual acuity（ UCVA）,best-corrected visual acuity（ BCVA）,wavefront aberration and contrast sensitivity under mesopic and photopic conditions at one month after surgery were compared. Results Predicted total postoperative SA in group 1 patients was correlated with actual total postoperative SA（ r^2= 0. 646,P〈0. 001）. UCVA,BCVA,corneal SA were similar for the two groups of patients.Internal and total SA were less in group 1（ P〈0. 05）. Contrast sensitivity under mesopic and scotopic conditions was significantly better in group 1 patients（ P〈0. 05）. Conclusions Customized selection of aspheric IOL based on corneal SA was feasible and implantation of aspheric IOL showed better visual quality in night condition.