双襻式与四襻式人工晶状体在高度近视眼内稳定性的比较

Comparison of the Stability of Two-Haptic and Four-Haptic Intraocular Lenses in Highly Myopic Eyes

目的:探讨双襻式与四襻式人工晶状体(IOL)植入高度近视眼后在囊袋中倾斜与偏心情况的差异。方法:回顾性病例对照研究。选取2016年10月至2017年6月在复旦大学附属眼耳鼻喉科医院接受超声乳化白内障吸除联合双襻式IOL(Tecnis ZCB00,AMO)或四襻式IOL(MC X11 ASP,HumanOptics)植入术的高度近视患者148例(148眼),其中植入双襻式IOL 54眼为双襻式IOL组,植入四襻式IOL 94眼为四襻式IOL组。于术后6个月进行随访。使用OPD-Scan III视觉质量分析仪记录各眼IOL倾斜、偏心、高阶像差与调制传递函数等数据。比较2种IOL植入组的IOL偏心、倾斜和视觉质量参数的差异。采用独立样本t检验、Mann-WhitneyU检验、χ2检验、Spearman相关性分析进行数据分析。结果:双襻式IOL组与四襻式IOL组年龄、性别、术后最佳矫正视力差异均无统计学意义。在眼轴26~<28 mm亚组与28~<30 mm亚组内,双襻式IOL组IOL的偏心位移均显著大于四襻式IOL组[0.26(0.15,0.33)mmvs.0.18(0.10,0.24)mm,Z=-2.81,P=0.005;(0.42±0.28)mmvs.(0.18±0.07)mm,t=2.96,P=0.01]。双襻式IOL组(r=0.304,P=0.027)与四襻式IOL组(r=0.366,P<0.001)IOL偏心位移均与眼轴长度呈正相关。在7 mm瞳孔直径下,四襻式IOL组的全眼及眼内高阶像差与彗差较双襻式IOL组更小(均P<0.05)。结论:对于高度近视眼,四襻式IOL较双襻式IOL具有更好的长期居中稳定性,且在光线较弱时可能具有更好的视觉质量。

Objective:To compare the stability of two-haptic and four-haptic intraocular lenses(IOL)in high myopic eyes.Methods:In this retrospective case-control study,148 high myopic patients who received uneventful phacoemulsification with the implantation of a two-haptic IOL(Tecnis ZCB00,AMO)or four-haptic IOL(MC X11 ASP,HumanOptics)during October 2016 to June 2017 at the Eye&ENT Hospital of Fudan University were selected.Of these,54 were in the two-haptic IOL group,and 94 in the four-haptic IOL group.Follow-up was planned for six months after surgery,including routine postoperative examinations.An OPD-Scan III aberrometer was used to evaluate the decentration and tilt of the IOL,higher-order aberrations,and modulation transfer function.Comparisons of IOL decentration and tilt,and visual qualities were conducted between the two groups.An independent-sample t-test,Mann-Whitney U-test,χ2 test,and Spearman correlation test were used in statistical analyses.Results:No statistically significant difference in terms of age,gender,or best-corrected visual acuity was seen between the two groups.However,significant differences were seen between the decentration of the two-haptic IOL group and the four-haptic IOL group when they were divided into subgroups of axial lengths between 26 mm and<28 mm,and between 28 mm and<30 mm[0.26(0.15,0.33)mm vs.0.18(0.10,0.24)mm,Z=-2.81,P=0.005;(0.42±0.28)mm vs.(0.18±0.07)mm,t=2.96,P=0.01].Meanwhile,significant correlations were found between decentration and axial length in both the two-haptic IOL group(r=0.304,P=0.027)and four-haptic IOL group(r=0.366,P<0.001).Under conditions of a pupil size of 7 mm,better ocular and intraocular higher-order aberrations and coma were seen in the four-haptic IOL group(all P<0.05).Conclusions:For high myopic eyes,the four-haptic IOL seems to be better than the two-haptic IOL in terms of long-term IOL stability and visual quality,especially in low-light conditions.