光程差分析系统和三维眼前节分析诊断系统综合分析屈光性白内障手术术后视觉质量的风险因素

Comprehensive Analysis of Risk Factors of Visual Quality after Refractive Cataract Surgery with Optical Path Difference Analysis System and Three-Dimensional Anterior Segment Analysis and Diagnosis System

目的:探讨光程差分析系统(OPD-ScanⅢ)和三维眼前节分析诊断系统(Pentacam)综合分析屈光性白内障手术术后视觉质量的风险因素。方法:纳入中山爱尔眼科医院2020年4月至2022年4月200例白内障患者进行前瞻性研究。所有患者均接受屈光性白内障手术治疗,于术前、术后1个月、术后3个月,测量所有患者视力恢复情况;通过OPD-ScanⅢ检查测量所有患者全眼总高阶像差;通过Pentacam检查患者角膜曲率、全角膜高阶像差。于术后3个月,采用视功能与生存质量调查问卷(NEI-VFQ-25)评估患者视觉质量。结果:术后1个月、术后3个月时患者裸眼视力、矫正视力均较术前提高,且术后3个月高于术后1个月,差异有统计学意义(P<0.05);经过屈光性白内障手术,患者总高阶像差、全角膜高阶像差较术前升高,Km较术前下降,差异有统计学意义(P<0.05);经多元线性回归分析,结果显示,总高阶像差高、全角膜高阶像差高是影响屈光性白内障手术术后视觉质量的风险因素。结论:总高阶像差高、全角膜高阶像差高是影响屈光性白内障手术术后视觉质量的风险因素,可于术前通过OPD-ScanⅢ和Pentacam精确评估患者高阶像差,减少高阶像差升高幅度,提高术后视觉质量。

Objective:To explore the risk factors of visual quality after refractive cataract surgery with optical path difference analysis system(OPD-Scan III)and three-dimensional anterior segment analysis and diagnosis system(Pentacam).Methods:A prospective study was conducted on 200 cataract patients in Zhongshan Aier Eye Hospital from April 2020 to April 2022.All patients received refractive cataract surgery,and their vision recovery was measured before,1 month after and 3 months after surgery.The total higher-order aberrations of the whole eyes of all patients were measured by OPD-ScanⅢ.Pentacam was used to check the corneal curvature and high order aberrations of the whole cornea.Three months after surgery,the visual quality of patients was assessed by the visual function and quality of life questionnaire(NEI-VFQ-25).Results:The uncorrected visual acuity and corrected visual acuity of the patients at 1 month and 3 months after operation were higher than those before operation,and 3 months after operation was higher than 1 month after operation,with a statistical significant difference(P<0.05).After refractive cataract surgery,the total higher-order aberrations and total corneal higher-order aberrations of the patients were higher than those before surgery,and the Km was lower than that before surgery,with a statistical significant difference(P<0.05).Through multiple linear regression analysis,the results showed that high total higher-order aberrations and high whole-corneal higher-order aberrations were risk factors affecting visual quality after refractive cataract surgery.Conclusion:High total higher-order aberrations and high whole-corneal higher-order aberrations are the risk factors that affect the visual quality after refractive cataract surgery.The higher-order aberrations of patients can be accurately evaluated by OPD-Scan III and Pentacam before surgery to reduce the increase of higher-order aberrations and improve the visual quality after surgery.