白内障合并2型糖尿病患者高阶像差及其相关性的研究

Higher-Order Aberrations and Their Correlation in Cataract Patients with Diabetes Mellitus

目的分析白内障合并糖尿病患者全角膜高阶像差的特点及其与年龄、眼轴、Q值、前房深度的相关性。方法回顾性分析2021年1月至2021年12月我医院拟行白内障超声乳化吸除术及一期人工晶体植入术患者252例(253眼)。采用Spearman分析各项高阶像差与年龄、眼轴、Q值、前房深度、糖尿血红蛋白之间的相关性,多组间分析采用Kruskal-Wallis检验。结果①年龄与Z3(-1)、Z4(0)无相关性(r=-0.022,0.040,P=0.725,0.530),与角膜Z3(3)、Z3(1)存在正相关性(r=0.156,0.149,P=0.013,0.018),与Z3(-3)存在负相关性(r=-0.227,P=0.000)。②眼轴与Z3(-3)、Z3(1)、Z4(0)无相关性(r=-0.109,0.106,0.034,P=0.083,0.095,0.586),与Z3(3)存在极弱的负相关性(r=-0.171,P=0.006),与Z3(-1)存在正相关性(r=0.191,P=0.002)。③Q值与Z3(-3)不存在相关性(r=0.041,P=0.513),与Z3(3)存在负相关性(r=-0.119,P=0.060),与Z3(1)、Z3(-1)、Z4(0)存在正相关性(r=0.204,0.235,0.730;P=0.001,0.000,0.000)。④中央前房深度与Z3(3)不存在相关性(r=0.057,P=0.364),与Z3(-3)、Z3(1)、Z4(0)之间存在负相关性(r=-0.177,-0.268,-0.392;P=0.005,0.000,0.000),Z3(-1)存在正相关性(r=0.174,P=0.006)。⑤糖化血红蛋白(HbA1c)与Z3(3)、Z3(1)、Z3(-1)、Z3(-3)、Z4(0)均无相关性(r=-0.009,-0.010,-0.095,0.029,-0.020;P=0.882,0.871,0.132,0.646,0.750)。结论白内障合并糖尿病患者全角膜高阶像差以球差及垂直彗差为主,全角膜高阶像差与多种因素有关系,球差与年龄、眼轴、HbA1c无相关性,球差与Q值存在强相关性,球差与中央前房深度存在弱的负相关性。术前应该根据患者的眼部及全身情况,合理选择非球面人工晶状体及多焦点人工晶状体或连续视程人工晶状体。

Objective To study characteristics of high-order aberrations of the whole cornea in patients with cataract and diabetes mellitus and correlations of other age,eye axis,Q value and anterior chamber depth. Methods From January 2021 to December 2021,252 patients(253 eyes)who underwent phacoemulsification and one-stage intraocular lens implantation with Hospital were collected.Correlations between various higher-order aberrations and age,axial length,Q value,anterior chamber depth,and glycohemoglobin were analyzed by Spearman.The Kruskal-Wallis test was used for analysis between multiple groups.Resulets①Age had no correlation with Z3(-1)and Z4(0)(r=-0.022,0.040,P=0.725,0.530),but had a positive correlation with corneal Z3(3)and Z3(1)(r=0.156,0.149,P=0.013,0.018),there was a negative correlation with Z3(-3)(r=-0.227,P=0.000).②There was a positive correlation between age and corneal Z3(3)and Z3(1)(r=0.156,0.149,P=0.013,0.018).There was a negative correlation between age and Z3(-3)(r=-0.227,P=0.000).②There was no correlation between eye axis and Z3(-3),Z3(1),Z4(0)(r=-0.109,0.106,0.034,P=0.083,0.095,0.586).There was a very weak negative correlation between eye axis and Z3(3)(r=-0.171,P=0.006).There was a positive correlation between eye axis and Z3(-1)(r=0.191,P=0.002).③There was no correlation between Q value and Z3(-3)(r=0.041,P=0.513).There was a negative correlation between Q value and Z3(3)(r=-0.119,P=0.060).There was a negative correlation between Q value and Z3(3)(r=-0.119,P=0.060).There was a positive correlation between Q value and Z3(1),Z3(-1),Z4(0)(r=0.204,0.235,0.730,P=0.001,0.000,0.000).There was no correlation between central anterior chamber depth and Z3(3)(r=0.057,P=0.364).There was a negative correlation between the depth of the central anterior chamber and Z3(-3),Z3(1),Z4(0)(r=-0.177,-0.268,-0.392,P=0.005,0.000,0.000).④There was a positive correlation between central anterior chamber depth and Z3(-1)(r=0.174,P=0.006).⑤There was no correlation between Glycated hemoglobin HbA1c and Z3(3),Z3(1),Z3(-1),Z3(-3),Z4(0)(r=-0.009,-0.010,-0.095,0.029,-0.020,P=0.882,0.871,0.132,0.646,0.750).Conclusion The higher-order aberrations of whole cornea in patients with cataract and diabetes could be mainly spherical aberration and vertical coma.Higher-order aberrations of the whole cornea could be related to various factors.There would be no correlation between spherical aberration and age,eye axis,glycated lineage protein.There would be a strong correlation between spherical aberration and Q value.There would be a weak negative correlation between spherical aberration and central anterior chamber depth.Based on the patient's eye and general condition before surgery,aspheric intraocular lens and multifocal intraocular lens or continuous vision intraocular lens would be reasonably selected.