不同人工晶状体在飞秒激光辅助白内障手术后眼高阶像差的比较

Comparison of the high order aberrations to different intraocular lenses following femtosecond laser assisted cataract surgery

目的:对比不同人工晶状体(IOL)在飞秒激光辅助白内障术后眼高阶像差。方法:选取行飞秒激光辅助白内障超声乳化手术的白内障患者120例(120眼)为研究对象,按照术前角膜球差分别植入单焦点IOL、双焦点IOL、连续视程IOL,预估术后全眼球差在0~+0.10μm以内。随访1个月,散瞳观察术眼IOL位置并应用iTrace视功能分析仪记录瞳孔直径4 mm下的患者手术前后眼相关高阶像差均方根值。结果:所有患者均顺利完成手术,术后1个月IOL位置居中,无并发症发生。(1)三组患者术后全眼、眼内高阶像差均明显低于术前,差异有统计学意义(t=5.383、5.626,P<0.05),角膜高阶像差手术前后差异无统计学意义(t=2.146,P>0.05)。(2)三组术后角膜高阶像差比较,差异无统计学意义(F=1.278,P>0.05),全眼及眼内高阶像差比较,差异有统计学意义(F=3.195、3.771,P<0.05)。进一步对比眼内高阶像差,双焦点IOL组和连续视程IOL组术后眼内高阶像差、慧差均低于单焦点IOL组,差异有统计学意义(P<0.05),三叶草像差及次级散光像差,差异无明显统计学意义(P>0.05),双焦点IOL组和连续视程IOL组之间的眼内高阶像差、慧差、三叶草像差及次级散光像差,差异无统计学意义(P>0.05)。结论:IOL的生物学特性影响术后眼内高阶相差,双焦点IOL和连续视程IOL相比单焦点IOL更能减少术后眼内高阶像差,尤其是慧差。术前对其进行相应的评估对于术后视觉质量的把控有益。

Objective To compare the higher-order aberrations of different intraocular lenses(IOL) after femtosecond laser-assisted cataract surgery.Method 120 eyes of 120 cataract patients received femtosecond laser assisted phacoemulsification were enrolled.They were assigned into three groups based on the type of intraocular lens(IOL) used: monofocal IOL, multifocal IOL, extended range of vision IOL.It is estimated that the total eye deviation after surgery is Within 0-+0.10 μm.Following up for 1 month, the IOL position of the operative eye was observed with mydriasis and the root mean square value of the related higher-order aberrations of the eyes of patients with pupil diameter of 4 mm before and after the operation was recorded with iTrace visual function analyzer.Results All patients successfully completed the operation, and the IOL position was in the middle one month after the operation, without complications.(1)The total and the internal high-order aberrations after surgery were significantly lower than those before surgery(t=5.383、5.626,P<0.05), while the cornea high-order aberrations showed no significance(t=2.146,P>0.05).(2)There was no statistically significant difference in higher-order corneal aberration among the three groups after surgery(F=1.278,P>0.05),there was statistically significant difference between the whole eye and intraocular higher-order aberrations(F=3.195、3.771, P<0.05).Further analysis of internal high-order aberrations and coma in the multifocal IOL group and Symfony IOL group were significantly lower than those in monofocal IOL group(P<0.05), and no significant difference of trefoil and secondary astigmatism were founded among different types of IOL groups(P>0.05).There was no statistical differences in the internal high-order aberrations、coma、trefoil and secondary between multifocal IOL group and extended range of vision IOL group(P>0.05).Conclusion The biological characteristics of IOL affect intraocular high order aberrations after surgery.Multifocal IOL and extended range of vision IOL which Compared with monofocal IOL can reduce internal high-order aberrations effectively, especially coma.Appropriate evaluation is more beneficial for postoperative visual quality.