基于角膜球面像差的个体化非球面IOL植入效果和可行性研究

发布时间：2018-04-09 12:33

本文选题：非球面人工晶状体　切入点：球面像差　出处：《南方医科大学》2012年硕士论文

【摘要】：目的通过前瞻性研究,探索基于角膜球面像差的个体化非球面IOL植入的效果和可行性。方法在实施白内障超声乳化手术的患者中,术前运用Pentacam眼前节分析系统测定6mm直径范围内的角膜球面像差,以此为基础,在三种球面像差不同的非球面人工晶状体中选择一种,使得术后总球面像差趋向0μm。这三种非球面人工晶状体包括：Akreos Adapt AO (BauschLomb), AcrySof1Q SN60WF (Alcon Laboratories Inc)和Tecnis ZA9003(Advanced Medical Optics [AMO])。术后3月回访时,再次测定6mm直径范围内的角膜像差,并用Zywave像差仪(BauschLomb)测定6mm直径范围内全眼球面像差。通过与非个体化及其他个体化研究的比较评估本实验个体化方案的植入效果。通过对预测值和实测的球面像差之间的差异比较及误差分析评估个体化方案的可行性。利用SPSS13.0对各参数进行统计分析。术前与术后球面像差及高阶像差的比较采用Wilcoxon符号秩检验；采用Spearman秩相关分析全眼球面像差与预测值,全眼球面像差预测误差与术源性角膜球面像差、术前角膜球面像差,术前角膜球面像差与术源性角膜球面像差等的相关性。所有实验数据以x±s表示,P0.05为差异有统计学意义。结果共53人(60眼)纳入实验。6眼(10.0%)植入Akreos Adapt AO,17眼(28.3%)植入AcrySof IQ SN60WF,37眼(61.7%)植入Tecnis ZA9003。所有纳入研究的60眼术前及术后6mm直径范围内角膜球面像差(Z4,0)分别为为0.250±0.111μm和0.250±0.107μm,二者差异无统计学意义。术后全眼球面像差为0.0365±0.0654u m较预测值(0.027±0.0714μm)略大,但差异无统计学意义(P=0.299)。全眼球面像差的预测误差为-0.009±0.092μm,其中小于±0.10μm的有49眼(81.7%),小于±0.05um的有34眼(56.7%)。结论基于角膜球面像差个体化选择非球面人工晶状体可以减小术后全眼像差,并使全眼像差更接近预设值。由于手术对角膜球面像差的影响很小,且术源性角膜球差与预测误差不具相关性,我们认为在有效控制倾斜、偏中心及测量误差的前提下这种个体化的方法具有可行性。
[Abstract]:PurposeTo explore the effect and feasibility of individualized aspherical IOL implantation based on corneal spherical aberration through prospective studies.MethodAmong the patients undergoing cataract phacoemulsification, the corneal spherical aberration in the range of 6mm diameter was measured by Pentacam anterior segment analysis system before operation. Based on this, one of the three aspherical intraocular lenses with different spherical aberrations was selected.The total spherical aberration tends to be 0 渭 m after operation.These three kinds of aspheric intraocular lenses include: 1: Akreos Adapt AO Bausch Lombb, AcrySof1Q SN60WF Alcon Laboratories Inc. and Tecnis ZA9003(Advanced Medical Optics [AMO].The corneal aberrations in the range of 6mm diameter were measured again at 3 months after operation, and the total face aberrations in the range of 6mm diameter were measured by Zywave aberration instrument (Bausch Lomb).To evaluate the implantation effect of this individualized scheme by comparing with non-individualized and other individualized studies.The feasibility of individualized scheme is evaluated by comparing the difference between the predicted value and the measured spherical aberration and analyzing the error.The parameters were statistically analyzed by SPSS13.0.The preoperative and postoperative spherical aberrations and higher-order aberrations were compared by Wilcoxon sign rank test, the Spearman rank correlation analysis was used to analyze the total ocular surface aberration and prediction value, the prediction error between the total ocular surface aberration and the postoperative corneal spherical aberration, the preoperative corneal spherical aberration, and the preoperative corneal spherical aberration.The correlation between preoperative spherical aberration and postoperative spherical aberration.All the experimental data were expressed as x 卤s (P 0.05) and the difference was statistically significant.ResultA total of 53 patients (60 eyes) were included in the experiment. 6 eyes (10.0 eyes) were implanted with Akreos Adapt AOA (17 eyes and 28.3 eyes) AcrySof IQ SN60WFF7 eyes (61.7 eyes) Tecnis ZA9003 were implanted.The corneal spherical aberrations in 60 eyes were 0.250 卤0.111 渭 m and 0.250 卤0.107 渭 m in the 6mm diameter range before and after the study, respectively. There was no significant difference between the two groups.The total ocular face aberration of 0.0365 卤0.0654u m was slightly larger than that of the predicted value of 0.027 卤0.0714 渭 m, but the difference was not statistically significant.The prediction error of total ocular surface aberration was -0.009 卤0.092 渭 m, of which 49 eyes were less than 卤0.10 渭 m and 34 eyes were less than 卤0.05um.ConclusionThe choice of aspherical intraocular lens based on corneal spherical aberration can reduce the postoperative total ocular aberration and make the whole ocular aberration closer to the preset value.Because surgery has little effect on corneal spherical aberration, and there is no correlation between corneal spherical aberration and prediction error, we think that this individualized method is feasible under the premise of effectively controlling tilt, center deviation and measurement error.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

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