单焦点散光矫正型人工晶状体植入眼远期视觉质量观察

Long-term observation of visual quality after monofocal Toric intraocular lens implantation

目的观察单焦点散光矫正型人工晶状体植入眼的远期主观和客观视觉质量。方法将合并角膜规则散光≥0.75 D的白内障患者75例(75眼),根据植入的人工晶状体不同分为WF组(非球面IOL组)和Toric组(散光矫正非球面IOL组),WF组植入AcrySof IQ SN60WF IOL,Toric组植入AcrySof IQ Toric SN6AT IOL,对比并观察2组术后1 a的主观及客观视觉质量。结果术后1 a主观调查问卷Toric组视觉质量优于WF组;裸眼视力:WF组为0.65±0.19,Toric组为0.76±0.14;全眼散光:WF组为1.75±0.77,Toric组为0.33±0.21。调制传递函数截止频率(modulation transfer function cut off frequency,MTF cut off):WF组为(21.972±10.578)c·deg-1,Toric组为(26.733±7.632)c·deg-1;100%对比度下视力(100%VA):WF组为0.722±0.369,Toric组为0.892±0.233,2组比较差异均有统计学意义(均为P<0.05)。瞳孔直径3.0 mm时,各组间球差、彗差、三叶草、次级散光、全眼总低阶像差、全眼总高阶像差、全眼总像差比较,差异均无统计学意义(均为P>0.05)。Pearson相关分析结果显示:全眼散光与裸眼视力、MTF cut off、100%VA均呈负相关;全眼客观散射指数与iTrace视觉功能分析仪测量的散光(iTrace散光)、球差、全眼总低阶像差、全眼总像差均呈正相关;MTF平均高度(MTF average height,MTF AH)与裸眼视力呈正相关,与iTrace散光、球差、彗差、三叶草、次级散光、全眼总低阶像差、全眼总高阶像差、全眼总像差均呈负相关;斯泰尔比值(SR)与裸眼视力呈正相关,与iTrace散光、球差、全眼总低阶像差、全眼总像差均呈负相关;iTrace散光与球差、彗差、三叶草、次级散光、全眼总低阶像差、全眼总高阶像差、全眼总像差均呈正相关(P<0.05)。Toric组患者末次随访时IOL轴位旋转为3.9°±2.1°。结论在合并角膜规则散光的白内障患者的远期临床观察中,植入单焦点散光矫正型IOL能获得更好的主观及客观视觉质量。

Objective To observe the long-term subjective and objective visual quality of monofocal toric intraocular lens(IOL) implantation.Methods According to the types of IOL,75 age-related cataract patients(75 eyes) with more than 0.75 diopter(D) of preexisting corneal astigmatism were divided into two groups:WF group(aspherical IOL group) and Toric group(astigmatism-corrected aspherical IOL group).The patients in WF group received the AcrySof IQ SN60 WF IOLs,while those in the Toric group were given the AcrySof IQ Toric SN6 AT IOLs.There was no statistically significant differences in preoperative age,sex composition ratio,preoperative UCVA,preoperative corneal astigmatism and target refraction between the two groups(all P>0.05).The subjective and objective visual quality was observed one year after the surgery.Results Questionnaire results showed that the patients in the Toric group felt better than those in the WF group,of whom uncorrected visual acuity(UCVA) was 0.65±0.19 in WF group and 0.76±0.14 in Toric group;total astigmatism was 1.75±0.77 in WF group and 0.33±0.21 in Toric group.MTF cut off value was(21.972±10.578)c·deg-1 in WF group and(26.733±7.632)c·deg-1 in Toric group.Visual acuity at 100% contrast(100%VA) was 0.722±0.369 in WF group and 0.892±0.233 in Toric group.All differences above were statistically significant(all P<0.05).When the pupil diameter is 3.0 mm,the spherical aberration,coma aberration,trefoil aberration,secondary astigmatism,total low order aberration,total high order aberration,total aberration were no statistically differences between two groups.Pearson correlation analysis showed that total astigmatism was negatively correlated with UCVA,MTF cut off and 100%VA;OSI was positively correlated with iTrace astigmatism,spherical aberration,total lower order aberration and total ocular aberration;MTF average height was positively correlated with UCVA,and negatively correlated with iTrace astigmatism,spherical aberration,coma aberration,trefoil aberration,secondary astigmatism,total lower order aberration,high order aberration,and total aberration;Strehl ratio was positively correlated with UCVA,and negatively correlated with iTrace astigmatism,spherical aberration,total lower order aberration and total aberration;iTrace astigmatism was positively correlated with spherical aberration,comet aberration,trefoil aberration,secondary astigmatism,total lower order aberration,high order aberration,and total aberration(all P<0.05).The mean rotation of IOLs in Toric group was(3.9±2.1)degrees.Conclusion In the treatment of cataract patients with corneal astigmatism,monofocal and multifocal Toric intraocular lens implantation can acquire good subjective and objective visual quality in long term observation.