飞秒激光辅助白内障手术与传统超声乳化手术在不同眼轴长白内障患者中对眼高阶相差的对比研究

Comparative study of high-order aberrations between femtosecond laser-assisted cataract surgery and traditional phacoemulsification in cataract patients with different axial length

目的研究飞秒激光辅助白内障手术与传统超声乳化手术在不同眼轴长白内障患者中对眼高阶相差影响的差异。方法白内障手术患者按眼轴长不同分为22 mm≤AL<24 mm组、24 mm≤AL<26 mm组及AL≥26 mm组,各组内均100例(100只眼),组内患眼再随机均分为飞秒激光组及传统超声乳化组,每组各50例(50只眼)。所有患眼术前及术后3个月均行眼高阶相差检测并分析结果。结果眼轴≥22~<24 mm组,飞秒激光辅助下白内障手术患眼手术后全眼及眼内的三种高阶相差(眼总高阶相差、3阶像差及4阶像差)均比术前明显减少,差异均有统计学意义(P<0.05),但角膜的三种高阶相差改变差异无统计学意义;用传统超声乳化手术组,全眼及眼内的三种高阶相差均比术前明显减少,角膜的三种相差均有比术前不同程度的增加,差异均有统计学意义(P<0.05)。眼轴≥24~<26 mm组中,无论是飞秒激光组还是传统超声乳化组,在眼总高阶相差及3阶像差这两项指标上,全眼及眼内相差均比术前有所减少,差异有统计学意义,飞秒激光组及超声乳化组手术前后角膜相差变化无统计学意义;在4阶像差的各项数据比较中,所有差异的比较均无统计学意义。眼轴≥26 mm组中,传统超声乳化组患眼全眼及眼内三种高阶相差均比术前明显减少,差异有统计学意义,角膜相差的改变虽然有比术前增加趋势,但统计学数据显示差异不明显。飞秒激光手术组中仅眼内的眼总高阶相差和3阶像差改变有统计学意义,其他值的改变无统计学意义。三种眼轴长组中所有相差指标在飞秒激光组和传统超声乳化组比较差异均无统计学意义。结论无论是飞秒激光辅助还是传统超声乳化白内障手术都能有效减少眼内高阶相差,而且两种手术方式对眼高阶相差的改变差异不明显。对于正常眼轴白内障患眼,飞秒激光辅助手术切口制作能减少角膜相差的产生。

Objective To compare the high-order aberrations of femtosecond laser-assisted cataract surgery versus traditional phacoemulsification in cataract patients with different axial length.Methods Patients undergoing cataract surgery were divided into three groups based on their axial length(AL): 22 mm≤AL<24 mm group, 24 mm≤AL<26 mm group and AL≥26 mm group. There were 100 cases in each group. Patients in each group were randomly selected to receive femtosecond laser-assisted cataract surgery or the traditional phacoemulsification surgery, thus each subgroup consisted 50 patients. All patients were examined for high-order aberrations before and 3 months after the surgery and the results were analyzed.Results In the 22 mm≤AL<24 mm group, patients who underwent femtosecond laser-assisted cataract surgery showed less three high-order aberrations(whole, third-order and fourth order aberrations) after the surgery, the difference was statistically significant(P<0.05), but the difference in the three high-order aberrations of the cornea was not statistically significant. In the traditional phacoemulsification surgery group, the three high-order aberrations were also significantly reduced after the surgery, and the three high-order aberrations of the cornea were increased after the surgery. The difference was statistically significant(P<0.05). In the 24 mm≤AL<26 mm group, the total and third order aberrations were reduced after the surgery for both the laser and traditional group. The difference was statistically significant. There was no statistically significant difference in corneal aberrations in both the laser and traditional group. As to the fourth order aberration, there was no statistically significant difference for all comparisons. In the AL≥26 mm group, patients who underwent traditional phacoemulsification had significantly lower three high-order aberrations than those before the operation, and the difference was statistically significant. Although there was an increasing trend in corneal aberrations after the surgery, the difference was not statistically significant. For patients who underwent laser-assisted surgery, only changes in the total and third order aberrations were statistically significant. There was no significant difference in all aberrations between the femtosecond laser group and the traditional phacoemulsification group for patients in different AL groups.Conclusions The cataract caused by opacity of the lens is the main source of high-order aberrations in cataract patients. Both femtosecond laser-assisted and traditional phacoemulsification surgery can effectively reduce the high-order aberrations in the eye. The difference in the change of the high-order aberrations between the two surgical methods is not obvious. For cataract patients with normal AL, femtosecond laser-assisted surgical incision can reduce corneal aberrations.