低度散光对多焦点人工晶状体眼视觉质量的影响

发布时间：2018-05-30 23:24

本文选题：低度散光 + 多焦点人工晶状体　；参考：《天津医科大学》2016年博士论文

【摘要】：目的1.通过对i Trace和KR-1W两种视觉质量分析仪实际测得的高阶像差(HOA)值进行比较,对比二者的一致性和差异性,明确两种视觉质量分析仪的工作原理及其在屈光白内障手术中的实际应用价值。从而为白内障患者提供集全面、科学、精准、便捷于一身的术前排查和术后随访的视觉质量分析仪,提高患者依从性,保障临床研究的科学性。2.通过不同组角膜低度散光的白内障患者,行白内障超声乳化联合多焦点人工晶状体(Re STOR)植入术后视觉参数的比较,证实低度散光对多焦点人工晶状体眼视觉效果的影响;3.通过比较角膜顺规散光0.75~1.0D或逆规散光0.5~0.75D的患者,行白内障超声乳化联合散光矫正型多焦点人工晶状体(ART2)植入与单纯多焦点人工晶状体(Re STOR)植入,术后视觉效果的差异,证实ART2矫正角膜低度散光的可预测性、有效性、稳定性和安全性。方法1.按照纳入标准招募健康志愿者行i Trace和KR-1W检查,记录实测的4mm瞳孔直径下HOA,利用SPSS 19.0统计软件对数据进行方差齐性检验和配对t检验;采用MEDCALC统计软件对数据进行Bland-Altman分析。比较二者差异性和一致性。2.按照病例选择标准,纳入行白内障超声乳化联合Re STOR植入术的单纯年龄相关性白内障患者63例(80眼)。根据术前角膜散光情况分为两组,顺规散光≤0.75D或逆规散光≤0.5D者为A组(35眼);顺规散光0.75D~1.0D或逆规散光0.5D~0.75D者为B组(45眼)。记录术后3月残余散光(UA)、等效球镜(SE)、裸眼全程视力(UVA)和远视力矫正的全程视力(CVA),以及4mm瞳孔下的平均调制传递函数(a MTF)、斯特利尔比值(SR),以及脱镜情况、满意度。统计分析找到全程视力、视觉质量、术后脱镜率和患者满意度的主要影响因素。3.根据病例选择标准纳入白内障超声乳化联合ART2植入的患者17人17眼。再根据年龄和术前角膜散光(顺规0.75~1.0D,逆0.5~0.75D)两级分层随机抽取同科同期同一术者行白内障超声乳化联合Re STOR植入的患者17人17眼。比较两组术后残余散光、UVA、CVA;i Trace测量a MTF、SR、ART2 IOL轴位测量;以及患者脱镜率和满意度。结果1.一致性比较:KR-1W和i Trace所测角膜HOA的差值平均为-0.01,95%医学参考值范围为(-0.10~0.08μm)。其中KR-1W比i Trace测量值大的有13眼,占40.6%;比i Trace测量值小的有19眼,占59.4%。两仪器所测全眼HOA的差值平均为-0.05,95%医学参考值范围为(-0.16~0.05μm)。其中KR-1W比i Trace测量值大的有7眼,占21.9%;比i Trace测量值小的有25眼,占78.1%。全眼HOA的差值的绝对值最大为0.199μm。二者所测眼内HOA差值平均为-0.06,95%医学参考值范围为(-0.18~0.05μm)。其中KR-1W比i Trace测量值大的有5眼,占15.6%;比i Trace测量值小的有27眼,占84.4%。差异性比较:两仪器测量角膜HOA的RMS值分别为0.128±0.031μm和0.137±0.046μm,差异较无统计意义(t=-1.174,P0.05)。两仪器测量眼内HOA(t=-6.339,P0.001)和全眼HOA(t=-5.461,P0.001)结果比较,差异有统计学意义,且i Trace的测量结果略高于KR-1W。2.两组术后3月残余散光分别为-0.32±0.24D和-0.90±0.28D,等效球镜分别为-0.43±0.62D和-0.51±0.72D,差异均有统计学意义(P0.05)。B组UVA和CVA均较A组低,术后3月A组UVA≥0.8者共计25眼,占71.4%,100%的患者对术后视觉效果表示非常满意;B组术后UVA≥0.8者共计15眼,占33.3%,77.8%的患者对术后视觉效果表示非常满意,两组间比较差异均有统计学意义(P0.05)。脱镜率A组100%,B组86.67%,差异有统计学意义(P0.05)。B组a MTF、SR均较A组低,a MTF差异有统计学意义(P0.05)。线性回归分析结果显示,术后UDVA的唯一影响因素是术前角膜散光(P0.05),UIVA和UNVA、a MTF、SR的唯一影响因素是残余散光(P0.05);术后残余散光、脱镜率的唯一影响因素是术前角膜散光(P0.05);术后满意度的主要影响因素是术前期望值、术后裸眼远视力和脱镜率(P0.05)。3.ART2组术后3个月残余散光与预测值差异无统计学意义(P0.05)。ART2组术后3个月IOL旋转度平均为3.12±0.70°,均无需二次手术调整轴位。ART2植入术后半年内旋转不足1.5°,且主要发生在术后1个月内。ART2组与Re STOR组,术后残余散光分别为-0.18±0.07D和-0.91±0.25D,差异有统计学意义(P0.05)。ART2组术后3月UVA分别为UDVA0.01±0.05Log MAR、UIVA0.05±0.07Log MAR、UNVA0.02±0.07Log MAR,Re STOR组UDVA0.08±0.06Log MAR、UIVA 0.15±0.12Log MAR和UNVA0.09±0.08Log MAR,差异均有统计学意义(P0.05)。ART2组CVA16眼≥0.8,占94.12%,患者对术后视觉效果表示非常满意;B组14眼≥0.8,占82.35%,两组CNVA差异具有统计学意义(P0.05)。两组i Trace视觉质量参数比较,可见ART2组术后a MTF和SR均略高于Re STOR组,但差异无统计学意义(P0.05)。术后3月,ART2组脱镜率达到100%,Re STOR组脱镜率为82.35%,两组比较差异无统计学意义(P0.05),但未脱镜者对眼镜依赖程度均不足1/2天。结论1.KR-1W和i Trace工作原理不同但各具优势,测量HOA的结果具有一致性,且角膜HOA的结果一致性最佳。i Trace更适合用于白内障患者术前、术后眼部波前像差的测量。i Trace用于白内障术后随访检查,能提供准确全面的数据,利于提高患者依从性。2.Re STOR植入术后患者能获得良好的裸眼全程视力和视觉质量,术后脱镜率和满意度较高。影响Re STOR眼术后全程视力、视觉质量、脱镜率和患者满意度的主要因素是残余散光。3.ART2矫正角膜低度散光具有良好的可预测性、有效性、稳定性和安全性。4.术前角膜散光顺规0.75~1.0D和逆规0.5~0.75D的患者,更适合植入ART2获得更佳的全程视觉效果。
[Abstract]:Objective 1. to compare the high order aberration (HOA) values measured by two visual quality analyzer of I and KR-1W, to compare the consistency and difference between the two, and to clarify the working principle of the two visual quality analyzer and its practical application in the refractive cataract surgery. The visual quality analyzer, which is convenient for preoperative and postoperative follow-up, improves patient compliance and guarantees the scientific.2. of clinical research through a comparison of visual parameters after cataract phacoemulsification combined with multifocal intraocular lens (Re STOR) implantation by different groups of corneal low astigmatism, and confirms that low degree astigmatism is confirmed. The effect of the visual effect of multifocal intraocular lens (phakic); 3. by comparing the patients with corneal smooth astigmatism 0.75~1.0D or the reverse astigmatism 0.5~0.75D, cataract phacoemulsification combined with astigmatic intraocular lens (ART2) implantation and simple multifocal intraocular lens (Re STOR) implantation, the difference of postoperative visual effect, confirmed the correction of ART2 correction Predictability, effectiveness, stability and safety of low corneal astigmatism. Methods 1. I Trace and KR-1W examinations were recruited according to the inclusion criteria, the measured 4mm pupil diameter HOA was recorded, and SPSS 19 statistical software was used to carry out variance homogeneity test and paired t test on the data, and MEDCALC statistics software was used to make Bland-A. Ltman analysis. Compared the two differences and consistency.2. according to the case selection criteria, 63 cases (80 eyes) of simple age-related cataract patients with cataract phacoemulsification combined with Re STOR implantation were divided into two groups according to the preoperative corneal astigmatism. The CIS astigmatism less than 0.75D or the reverse astigmatism less than 0.5D were in group A (35 eyes); CIS astigmatism 0.75D~1 .0D or reverse astigmatism 0.5D~0.75D was in group B (45 eyes). The residual astigmatism (UA), equivalent sphere (SE), whole course visual acuity (UVA) and distant vision corrected visual acuity (CVA) after operation, and the average modulation transfer function (a MTF) under the pupil of the pupil (a MTF), the ratio (SR) of the pupil of 4mm, and the degree of degree of satisfaction. The total visual acuity was found by statistical analysis. 17 people and 17 eyes of patients with cataract phacoemulsification combined with ART2 implantation according to the case selection criteria.3. were selected according to the criteria of case selection, and the cataract phacoemulsification combined with R in the same group was selected according to age and preoperative corneal astigmatism (CIS 0.75~1.0D, reverse 0.5~0.75D) two level stratification 17 patients and 17 eyes were implanted with e STOR. The residual astigmatism, UVA, CVA, a MTF, SR, ART2 IOL axis measurement of the two groups were measured, and the rate of removal and satisfaction of the patients were compared. There were 13 eyes in 13, 40.6%, 19 eyes smaller than I Trace, and the average difference between HOA in 59.4%. two instruments was -0.05,95% medical reference value range (-0.16~0.05 mu m). 7 eyes, 21.9% of KR-1W than I Trace, were 25 eyes smaller than I Trace measurements, and the absolute value of the difference was the largest of 0.199. The average HOA value measured in the eyes of M. two was (-0.18~0.05) reference value (-0.18~0.05 mu m). Among them, KR-1W was larger than I Trace, accounting for 15.6%; 27 eyes were smaller than I Trace, accounting for 84.4%. difference comparison: two instruments measured 0.128 + 0.031 Mu and 0.137 + 0.046 micron respectively, and the difference was less statistically significant T=-1.174, P0.05. Two instrument measurements of intraocular HOA (t=-6.339, P0.001) and full eye HOA (t=-5.461, P0.001) were statistically significant, and the results of I Trace were slightly higher than that of KR-1W.2. two after the operation in the KR-1W.2. two group. The study meaning (P0.05) group.B UVA and CVA were lower than those in the A group. In group A, UVA more than 0.8 in March were 25 eyes, accounting for 71.4%, and 100% of the patients were very satisfied with postoperative visual effects. In B group, UVA more than 0.8 were 15 eyes, 33.3% and 77.8% of the patients were very satisfied with postoperative visual effects, and there were statistically significant differences between the two groups (P0.05). The difference was statistically significant (P0.05) in group B (P0.05) and group B (P0.05), a MTF in group.B, SR was lower than that in A group, and a MTF difference was statistically significant (P0.05). The only influencing factor of the mirror rate was preoperative corneal astigmatism (P0.05). The main factors affecting the postoperative satisfaction were the expected value of preoperation, the postoperative astigmatism and the removal rate (P0.05) in group.3.ART2 after operation, there was no significant difference in the residual astigmatism at 3 months after operation (P0.05) in group.ART2, the average of IOL rotation was 3.12 + 0.70 degrees in the group.ART2 after operation, and no two times were needed. The rotation of axial.ART2 implantation was less than 1.5 degrees within half a year after operation, and mainly occurred in group.ART2 and Re STOR within 1 months after operation. The residual astigmatism after operation was -0.18 0.07D and -0.91 + 0.25D, respectively. The difference was statistically significant (P0.05).ART2 group after operation in March. The Re STOR group was UDVA0.08 + 0.06Log MAR, UIVA 0.15 + 0.12Log MAR and UNVA0.09 + 0.08Log MAR. The difference was statistically significant (P0.05) was more than 0.8, accounting for 94.12%. The patients were very satisfied with the postoperative visual effects; 14 eyes were more than 0.8, accounting for 82.35%. The two groups of visual quality parameters were compared. The results showed that a MTF and SR in group ART2 were slightly higher than those in Re STOR group, but the difference was not statistically significant (P0.05). In March, the removal rate of ART2 in group ART2 was 100%, and in Re STOR group was 82.35%, the difference between the two groups was not statistically significant (P0.05). Each advantage, the results of the measurement of HOA are consistent, and the results of the corneal HOA results are the best.I Trace more suitable for cataract surgery. Postoperative ocular wavefront aberrations are measured by.I Trace for postoperative follow-up examination of cataract surgery, which can provide accurate and comprehensive data for patients with high patient compliance after.2.Re STOR implantation. Good naked eye visual acuity and visual quality, high postsurgical removal rate and satisfactory degree of satisfaction. The main factors affecting the whole visual acuity, visual quality, removal rate and patient satisfaction after Re STOR eye are residual astigmatism with good predictability, effectiveness, stability and safety of corneal astigmatism before.4.. Patients with 0.75~1.0D and 0.5~0.75D are more suitable for implantation of ART2 to achieve better visual effect.
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R779.6

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