白内障超声乳化手术前后角膜高阶像差的改变

Changes of corneal HOAs before and after Phacoemulsification

目的:比较透明角膜切口白内障超声乳化(Phacoemulsification)联合人工晶状体(IOL)植入术前后角膜高阶像差的改变,为个性化选择IOL提供依据。方法:前瞻性非随机临床研究,收集年龄相关性白内障患者142例(200眼),均接受10∶30方位、2.75 mm透明角膜切口Phacoemulsification+IOL植入术。采用Topcon KR-1W视觉质量分析仪测量术前及术后3个月角膜高阶像差,比较手术前后4 mm及6 mm瞳孔直径下角膜的总高阶像差(tHOA)、球差(SA)、慧差(coma)及三叶草像差(trefoil)的变化。结果:4 mm瞳孔直径下,术前角膜tHOA和trefiol分别为(0.17±0.07)μm和(0.10±0.06)μm,术后3个月为(0.27±0.09)μm和(0.21±0.09)μm;6 mm瞳孔直径下,术前角膜tHOA和trefiol分别为(0.48±0.14)μm和(0.20±0.11)μm,术后3个月为(0.73±0.21)μm和(0.49±0.20)μm,手术前后角膜tHOA和trefiol值比较,差异有统计学意义(P<0.01)。4 mm瞳孔直径下,术前角膜SA和coma分别为(0.05±0.03)μm和(0.10±0.06)μm,术后3个月为(0.05±0.03)μm和(0.11±0.06)μm;6 mm瞳孔直径下,术前角膜SA和coma分别为(0.25±0.07)μm和(0.26±0.13)μm,术后3个月为(0.26±0.07)μm(0.27±0.14)μm,手术前后角膜SA和coma值比较,差异无统计学意义(P>0.05)。结论:2.75 mm透明角膜切口超声乳化术后角膜SA及coma值无明显变化,可为个性化选择非球面IOL提供依据。

Objective:To compare the changes of corneal high order aberration(HOAs)before and after surgery of the Phacoemulsification and intraocular lenses(IOL)implantation,provide a basis for personalized selection of IOL.Methods:A prospective non-random controlled clinical study was conducted on 142 age-related cataract patients(200 eyes).The phacoemulsification and IOL implantation under 2.75mm and 10∶30 orientation clear corneal incision(CCI)was adopted.Preoperatively and 3 months postoperatively,Topcon KR-1W was used to measure the HOAs.The changes of total high order aberration(tHOA),spherical aberration(SA),coma and trefoil were compared from the corneal anterior surface under 4 mm and 6 mm pupil diameters(PD)before and after surgery.Results:Corneal tHOA and trefiol were(0.17±0.07)μm and(0.10±0.06)μm postoperatively at 4mm PD,after 3 months of surgery,they were(0.27±0.09)μm and(0.21±0.09)μm,respectively.Corneal tHOA and trefiol were(0.48±0.14)μm and(0.20±0.11)μm postoperatively at 6 mm PD,after 3 months of surgery,they were(0.73±0.21)μm and(0.49±0.20)μm,respectively.There were statistically significant difference in corneal tHOA and trefiol values before and after surgery(P<0.01).Corneal SA and coma were(0.05±0.03)μm and(0.10±0.06)μm postoperatively at 4 mm PD,after 3 months of surgery,they were(0.05±0.03)μm and(0.11±0.06)μm,respectively.Corneal SA and coma were(0.25±0.07)μm and(0.26±0.13)μm postoperatively at 4 mm PD,after 3 months of surgery,they were(0.26±0.07)μm and(0.27±0.14)μm,respectively.There were no statistically significant difference in corneal SA and coma before and after surgery(P>0.05).Conclusion:There are no statistically significant difference in corneal SA and coma between pre-operation and post-operation with a 2.75 mm CCI phacoemulsification.It can provide a basis for personalized selection of aspheric IOLs.