IOL Master 700与A超联合角膜地形图测量对白内障术后屈光误差影响的比较

Comparative study of IOL Master 700 and A-ultrasound combined with corneal topography measurement of refractive error after phacoemulsification

目的:分析A超联合角膜地形图测量白内障患者眼部相关生物参数及术后屈光误差,并与IOL Master 700进行对比,评估其在临床应用中的精确性。方法:前瞻性研究。收集2020-07/2021-07在苏州大学附属第一医院就诊的白内障患者113例122眼,分别应用IOL Master 700、A超及角膜地形图测量眼轴长度(AL)、前房深度(ACD)、晶状体厚度(LT)和角膜曲率(Km),并分析术后3mo屈光误差情况。结果:IOL Master 700和A超联合角膜地形图测量的AL(24.09±1.65、23.81±1.62mm)、ACD(3.11±0.42、2.97±0.43mm)、Km(44.12±1.59、44.06±1.54D)均有差异(P<0.05),LT(4.34±0.46、4.30±0.59mm)无差异(P>0.05)。不同测量方法人工晶状体(IOL)屈光度计算公式术后平均绝对屈光误差(MAE)具有显著差异(P<0.001),其中IOL Master 700测量仪自带的Barrett UniversalⅡ公式MAE与HolladayⅠ、Haigis、SRK/T公式比较均有差异(P<0.01),与A超联合角膜地形图计算公式SRK/T、Barrett UniversalⅡ公式比较亦均有差异(P<0.01),但IOL Master 700测量仪自带的HolladayⅠ、Haigis、SRK/T公式MAE与A超联合角膜地形图计算公式SRK/T公式比较均无差异(P>0.05)。此外,IOL Master 700测量仪自带的Barrett UniversalⅡ公式绝对屈光误差中值(MedAE)最小(0.260D),A超联合角膜地形图计算公式Barrett UniversalⅡ公式MedAE最大(0.765D)。结论:A超联合角膜地形图测量的AL、ACD、Km值均较IOL Master 700偏小,运用SRK/T公式计算IOL屈光度时,二者测算结果相近,而使用Barrett UniversalⅡ公式时A超联合角膜地形图屈光误差较大,易导致远视漂移。

AIM:To evaluate the accuracy of A-ultrasound combined with corneal topography measurement in clinical application by analyzing the ocular-related biometric parameters and refractive error and comparing with those of IOL Master 700 in cataract patients. METHODS: A prospective study. Clinical data were collected from 113 patients(122 eyes) who underwent phacoemulsification in the First Affiliated Hospital of Soochow University from July 2020 to July 2021. The axial length(AL), anterior chamber depth(ACD), lens thickness(LT) and corneal curvature(Km)were measured respectively by IOL Master 700 and A-ultrasound combined with corneal topography measurement and the 3 mo after the surgery of the refractive error was analyzed.RESULTS: There were differences in AL(24.09±1.65, 23.81±1.62 mm), ACD(3.11±0.42, 2.97±0.43 mm) and Km(44.12±1.59, 44.06±1.54 D) measured by IOL Master 700 and A-ultrasound combined with corneal topography(P<0.05), while there was no difference in LT(4.34±0.46, 4.30±0.59 mm)(P>0.05). The postoperative mean absolute refractive error(MAE) of intraocular lens(IOL) diopter calculation formulas with different measurement methods was significantly different(P<0.001). The Barrett Universal II formula MAE of the IOL Master 700 measuring instrument was different from the Holladay I, Haigis and SRK/T formulas(P<0.01), at the same time, compared with the A-ultrasound combined with corneal topography calculation formula SRK/T and Barrett Universal II formula, they were also different(P<0.01). However, there was no difference among the Holladay Ⅰ, Haigis, SRK/T formula MAE which come from the IOL Master 700 measuring instrument and the A-ultrasound combined with corneal topography calculation formula SRK/T formula(P>0.05). In addition, the Barrett Universal II formula of the IOL Master 700 measuring instrument has the smallest median absolute refractive error(MedAE)(0.260 D), and the A-ultrasound combined with corneal topography calculation formula Barrett Universal II formula MedAE is the largest(0.765 D).CONCLUSION: The values of AL, ACD and Km measured by A-ultrasound combined with corneal topography were smaller than those of IOL Master 700. When the SRK/T formula was used to calculate the IOL diopter, the results of the two group were similar. However, when using the Barrett Universal Ⅱ formula, the refractive error of the A-ultrasound combined with corneal topography group was large, resulting in hyperopia drift.