区域折射型多焦点人工晶状体植入术后视觉质量误差分析

Error analysis of visual quality in segmented refractive multifocal intraocular lenses implanted eyes

目的:分析区域折射型多焦点人工晶状体植入术后客观视觉质量检查误差。方法:选取2019-01/2020-06在中山大学中山眼科中心海南眼科医院行白内障超声乳化摘除术的白内障患者116例180眼进行回顾性分析。根据植入人工晶状体类型,将患者分为两组,单焦组(61例96眼)植入Aspira-aA,多焦组(55例84眼)植入LS-313 MF30。术后3mo检查患者裸眼远视力(UCDVA)、最佳矫正远视力(BCDVA)、裸眼中视力(UCIVA)和裸眼近视力(UCNVA),采用Itrace视觉质量分析仪进行客观视觉质量检查,分析指标包括:全眼高阶像差(HOAt)、眼内高阶像差(HOAi)、角膜高阶像差(HOAc)、球差、彗差、三叶草差、斯特列尔比(SR)、调制传递函数平均高度(MTF AvgHeight)和晶状体失调指数(DLI)。结果:术后3mo,两组UCDVA及BCDVA比较无差异(t=-0.789、-0.815,均P>0.05);多焦组的UCIVA和UCNVA明显优于单焦组,比较均有差异(t=1.971、3.215,均P<0.05)。术后3mo,两组HOAc和球差的比较均无差异(t=1.126、-0.995,均P>0.05)。多焦组的HOAt、HOAi、彗差和三叶草差明显高于单焦组,比较均有差异(t=-2.518、-2.926、-2.859、-3.128,均P<0.05)。多焦组的SR、MTF AvgHeight和DLI明显低于单焦组,比较均有差异(t=2.8537、2.014、3.292,均P<0.05)。视网膜E字视标图、MTF和点扩散函数(PSF)曲线均显示,多焦组术后眼内和全眼像差显著增加,视网膜点阵(RSD)图显示,附加+3D球镜后,彗差和三叶草差明显增加。结论:区域折射型多焦点人工晶状体可以为患者提供优越的远中近视力,Itrace视觉质量分析仪对区域折射型多焦点人工晶状体植入术后像差测量分析可能存在误差,人工晶状体的设计本身可能会导致术后像差的增加和客观视觉质量的降低。

AIM:To analyze the errors of objective visual quality after the implantation of segmented refractive multifocal intraocular lenses in patients with age-related cataract.METHODS:In this retrospective study including 180 eyes of 116 patients with senile cataract,implantation of either Aspira-aA IOL or LS-313 MF30 IOL was performed in Hainan Eye Hospital,Zhongshan Ophthalmic Center,Sun Yat-sen University.According to the implanted IOL,the patients were divided into the SIOL(Aspira-aA)group(61 patients,96 eyes)and the MIOL(LS-313 MF30)group(55 patients,84 eyes).Three months postoperatively,uncorrected distance visual acuity(UCDVA),best corrected distance visual acuity(BCDVA),uncorrected intermediate visual acuity(UCIVA)and uncorrected near visual acuity(UCNVA)were assessed.Total higher-order aberrations(HOAt),internal higher-order aberrations(HOAi),corneal higher-order aberrations(HOAc),spherical aberration(SA),coma aberration(CA),trefoil aberration(TA),Strehl ratio(SR),average height of modulation transfer function(MTF AvgHeight)and dysfunctional lens index(DLI)were measured by iTrace visual quality analyzer(scanning diameter 3mm)three months postoperatively.RESULTS:Three months postoperatively,there was no statistically significant difference between the two groups in UCDVA and BCDVA(t=-0.789,-0.815;all P>0.05).UCIVA and UCNVA in the MIOL group were better than those in the SIOL group,with statistically significant difference(t=1.971,3.215;all P<0.05).No statistically significant differences were observed in HOAc and spherical aberration between the two groups(t=1.126,-0.995;all P>0.05).HOAt,HOAi,coma aberration and trefoil aberration were larger in the MIOL group than those in the SIOL group(t=-2.518,-2.926,-2.859,-3.128;all P<0.05).Strehl ratio,MTF AvgHeight and DLI in the MIOL group were lower than those in the SIOL group,with statistically significant difference(t=2.8537,2.014,3.292;all P<0.05).The results of retinal letter,MTF AvgHeight and SR showed that HOAt and HOAi increased significantly in the MIOL group.The retinal spot diagram showed that coma aberration and trefoil aberration increased significantly with the addition of+3D spherical diopter.CONCLUSION:Segmented refractive multifocal intraocular lens can provide excellent uncorrected distance,intermediate and near visual acuity.There may be errors in aberration measurement by iTrace visual quality analyzer after segmented refractive multifocal intraocular lenses implantation.The design of intraocular lens may lead to the postoperative increase in aberration and a decrease in objective visual quality.