前囊抛光对白内障术后视觉质量的影响

Effect of anterior capsule polishing on the visual quality after cataract surgery

目的:评价前囊抛光对白内障超声乳化术后视觉质量的影响。方法:前瞻性随机对照研究。纳入2021-11/2022-06于应急总医院眼科行白内障超声乳化联合人工晶状体(IOL)植入术的年龄相关性白内障患者65例73眼,随机分为抛光组(30例35眼,术中行前后囊联合抛光)和对照组(35例38眼,术中仅行后囊抛光)。观察术后1wk,1、3、6mo最佳矫正视力,术后3、6mo测量前囊口面积,并使用Pentacam三维眼前节系统评估后囊膜混浊程度(P评分)、IOL倾斜度和偏心量,使用OPD-ScanⅢ光程差分析系统评估波前像差、点扩散函数(PSF)的斯特列尔比(SR)和调制传递函数(MTF)。结果:术后1wk,1、3、6mo,抛光组患者最佳矫正视力均优于对照组(P<0.05)。术后3、6mo,两组患者前囊口面积、后囊膜混浊程度(P评分)、IOL偏心量、PSF的SR值和MTF均无差异(P>0.05)。术后3mo,两组患者IOL倾斜度、波前像差均无差异(P>0.05),但术后6mo,抛光组IOL倾斜度小于对照组[(1.65±0.60)°vs(2.34±0.43)°,P<0.001)],波前像差也小于对照组(0.03±0.01μm vs 0.06±0.03μm,P<0.001)。结论:白内障超声乳化吸除术中行360°抛光前后囊膜能提高术后最佳矫正视力,且术后IOL倾斜度更低、波前像差更小,视觉质量更好。

AIM:To evaluate the effect of anterior capsule polishing on visual quality after phacoemulsification.METHODS:Prospective randomized control study.A total of 65 patients(73 eyes)with age-related cataract who underwent phacoemulsification combined with intraocular lens(IOL)implantation in the Emergency General Hospital between November 2021 and June 2022 were included.These patients were randomly assigned to two groups,with one group(anterior polishing group)underwent anterior and posterior capsule polishing(30 cases,35 eyes),while the other(control group)receive routine posterior capsule polishing(35 cases,38 eyes).Best corrected visual acuity was observed at 1wk,1,3 and 6mo after operation.Area of anterior capsule orifice was measured at 3 and 6mo after operation.Meanwhile,posterior capsular opacification(P score),IOL tilt and decentration were recorded by Pentacam Scheimpflug system.In addition,wavefront aberration,Strehl ratio(SR)of point spread function(PSF)and modulation transfer function(MTF)were evaluated by OPD-ScanⅢ.RESULTS:At 1wk,1,3 and 6mo after operation,best corrected visual acuity in anterior polishing group is significantly better than that of control group(P<0.05).There were no significant differences in area of anterior capsule opening,P score,IOL decentration,SR of PSF and MTF between two groups at 3 and 6mo after operation(P>0.05).At 3mo follow-up,no significant differences in IOL tilt and wavefront aberration were measured between two groups either(P>0.05).However,IOL tilt[(1.65±0.60)°vs.(2.34±0.43)°,P<0.001]and wavefront aberration(0.03±0.01μm vs.0.06±0.03μm,P<0.001)in anterior polishing group were significant lower compared to control group at 6mo after operation.CONCLUSION:360°polishing of anterior and posterior capsule during phacoemulsification can improve best corrected visual quality,with reduced IOL tilt,lower wavefront aberration and better visual quality.