应用OPD-Scan Ⅲ像差仪观察不同非球面单焦点人工晶体眼内高阶像差的特点
发布时间：2018-09-11 06:06
【摘要】：研究目的应用OPD-ScanⅢ(Nidek,Gamagori,Japan)波前像差仪检测白内障患者术中植入不同非球面单焦点人工晶状体(monofocal intraocular lens,Mo IOL)后眼内高阶像差的变化,同时同正常透明晶状体眼内高阶像差进行比较,尝试找出白内障患者人工晶状体(intraocular lens,IOL)植入术后出现眩光、视物模糊等视觉质量下降的原因,同时为白内障患者IOL的个性化选择及IOL设计提供参考依据。研究方法选取2016年06月至2016年12月于我院眼科住院的单纯老年性白内障患者65例(65眼),其中女36例(36眼),男29例(29眼),年龄58~80岁(平均71.0±2.25)。本次研究采用前瞻性随机对照研究方法,随机分为两组,使各组核硬度及年龄相匹配。A组:植入非球面折叠一片式Mo IOL(RAYNER 920H Aspheric)。B组:植入非球面折叠三片式Mo IOL(HOYA PY-60AD)。两组植入的IOL度数均在19.0~24.0D范围内。对照组C组选择同期于本院眼科住院患者家属及大连医科大学学生志愿者,共30例(30眼),随机抽取一只眼检查结果纳入研究范围,其中女15例(15眼),男15例(15眼),年龄12岁~30岁(平均19±1.83)。A、B两组均行白内障超声乳化联合IOL植入术。IOL均采用SRK-Ⅱ公式计算度数,为了使患者术后获得良好的远视力同时满足一定的近视需求,术后预留度数为-0.50D。术后3月使用OPD-ScanⅢ波前像差仪测量记录A、B、C三组在3mm、5mm直径瞳孔下眼内的总高阶像差(total higher-order aberrations,t-HOA)、总三叶草(total trefoil,TT)、总彗差(total coma,TC)均方根值(Root mean square,RMS)及第四阶球差(Z40)值。应用SPSS17.0统计软件包分析,对三组定量资料的比较采用独立样本方差分析,以P0.05为差异具有统计学意义。主观视觉感受采用问卷调查方式采集。研究结果1、3mm直径瞳孔时,A、B两组IOL眼内总高阶像差(HOA)、总彗差(TC)、总三叶草(TT)RMS差异无统计学意义(P0.05),第四阶球差(Z40)B组大于A组,差异有统计学意义(P0.05);C组与A、B组相比,A、B组眼内总高阶像差(HOA)、总彗差(TC)、总三叶草(TT)RMS均较C组增加,且差异具有统计学意义(P0.05),眼内第四阶球差(Z40)C组与A组、B组均无统计学差异(P0.05)。2、5mm直径瞳孔时,B组IOL眼内总高阶像差(HOA)、总彗差(TC)及第四阶球差(Z40)均高于A组,且差异具有统计学意义(P0.05),总三叶草(TT)RMS两组差异无统计学意义(P0.05);A、B组与C组相比,A、B组眼内总高阶像差(HOA)、总三叶草(TT)、总彗差(TC)RMS均较C组明显增加,且差异具有统计学意义(P0.05);眼内第四阶球差(Z40),C组大于A组且具有统计学意义(P0.05),B组与C组无统计学差异(P0.05)。结论1、RAYNER 920H Aspheric人工晶体眼与HOYA PY-60AD人工晶体眼术后三月最佳矫正视力(BCVA)无显著性差异,两种IOL均可以明显提高白内障患者术后视力;2、临床工作中对于术前角膜慧差偏大的患者及瞳孔正常或偏小患者优先考虑植入RAYNER 920H非球面IOL;3、B组(HOYA)IOL负球差的设计基本接近正常青年透明晶状体,考虑对于术前瞳孔较大的白内障患者(如工作性质为夜间工作者、青光眼发作患者等)则更倾向于选择该类型IOL,因为在大瞳孔下其平衡角膜正球差更具优势;4、在同一水平视力下(≥0.8),人工晶体眼内高阶像差的RMS(除球差)明显高于透明晶状体,这种情况在大瞳孔下更为突出,其可能是导致白内障患者术后视觉质量不尽人意的原因之一,表明IOL在设计上需要进一步优化与完善。
[Abstract]:Objective To detect the high-order aberrations of cataract patients after implantation of different aspheric monofocal intraocular lenses (MOIOL) with OPD-Scan III (Nidek, Gamagori, Japan) wavefront aberration meter, and compare it with the high-order aberrations of normal transparent lens, trying to find out the artificial cataract patients. Methods From June 2016 to December 2016, 65 patients (65 eyes) with simple senile cataract were selected and hospitalized in ophthalmology department of our hospital. Thirty-six eyes (29 eyes) were male, aged 58-80 years (mean 71.0 (+ 2.25). The study was randomly divided into two groups to match the nuclear hardness and age. Group A: implanted aspheric folded one-piece Mo IOL (RAYNER 920H Aspheric). Group B: implanted aspheric folded three-piece Mo IOL (HOYA PY-60AD). Two groups were implanted. The IOL scores were all in the range of 19.0-24.0 D. In the control group, 30 patients (30 eyes) were selected from the family members of ophthalmic inpatients and students volunteers of Dalian Medical University in the same period. The results of one eye examination were randomly selected and included in the study, including 15 women (15 eyes) and 15 men (15 eyes), aged 12-30 years (average 19 (+ 1.83)). IOL was calculated by SRK-II formula. The reserved degree was - 0.50D. The total high-order aberrations of A, B, C groups were measured and recorded by OPD-Scan III wavefront aberration meter at 3 mm, 5 mm diameter of pupil at 3 months after operation. Higher-order aberrations (t-HOA), total trefoil (TT), total coma (TC), root mean square (RMS) and fourth-order spherical aberrations (Z40) were analyzed by SPSS17.0 statistical software package. Independent sample variance analysis was used to compare the three groups of quantitative data, and the difference was statistically significant with P 0.05. Results There was no significant difference in total higher order aberration (HOA), total coma (TC), total clover (TT) RMS between groups A and B (P 0.05), and the fourth order spherical aberration (Z40) in group B was higher than that in group A (P 0.05). Coma (TC), total clover (TT) RMS were significantly higher than those in group C (P 0.05). There was no significant difference between group C and group A in intraocular fourth order spherical aberration (Z40). The total higher order aberration (HOA), total coma (TC) and fourth order spherical aberration (Z40) in group B were higher than those in group A (P 0.05). Total trefoil (TT) RMS had no significant difference between the two groups (P 0.05); compared with group C, total higher order aberration (HOA), total trefoil (TT), total coma (TC) RMS in group A and group B were significantly higher than those in group C (P 0.05); intraocular fourth order spherical aberration (Z40) in group C was greater than that in group A (P 0.05), and there was no significant difference between group B and group C (P 0.05). Conclusion 1. There is no significant difference in BCVA between RAYNER 920H Aspheric IOL and HOYA PY-60AD IOL at 3 months after surgery. Both IOL can significantly improve the postoperative visual acuity of cataract patients. 2. The preoperative patients with large corneal coma and those with normal or small pupils should be given priority in clinical work. Considering the implantation of RAYNER 920H aspheric IOL; 3. The design of IOL negative spherical aberration in group B (HOYA) was similar to that of normal young transparent lens. For cataract patients with large pupil (such as nocturnal workers, glaucoma attack patients, etc.), this type of IOL was more likely to be chosen because of its more balanced corneal spherical aberration under large pupil. 4. At the same level of vision (> 0.8), the RMS (except spherical aberration) of intraocular lens is significantly higher than that of transparent lens, which is more prominent under the large pupil. This may be one of the reasons for the unsatisfactory visual quality of cataract patients after surgery, indicating that IOL design needs to be further optimized and improved.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6
本文编号：2235809
[Abstract]:Objective To detect the high-order aberrations of cataract patients after implantation of different aspheric monofocal intraocular lenses (MOIOL) with OPD-Scan III (Nidek, Gamagori, Japan) wavefront aberration meter, and compare it with the high-order aberrations of normal transparent lens, trying to find out the artificial cataract patients. Methods From June 2016 to December 2016, 65 patients (65 eyes) with simple senile cataract were selected and hospitalized in ophthalmology department of our hospital. Thirty-six eyes (29 eyes) were male, aged 58-80 years (mean 71.0 (+ 2.25). The study was randomly divided into two groups to match the nuclear hardness and age. Group A: implanted aspheric folded one-piece Mo IOL (RAYNER 920H Aspheric). Group B: implanted aspheric folded three-piece Mo IOL (HOYA PY-60AD). Two groups were implanted. The IOL scores were all in the range of 19.0-24.0 D. In the control group, 30 patients (30 eyes) were selected from the family members of ophthalmic inpatients and students volunteers of Dalian Medical University in the same period. The results of one eye examination were randomly selected and included in the study, including 15 women (15 eyes) and 15 men (15 eyes), aged 12-30 years (average 19 (+ 1.83)). IOL was calculated by SRK-II formula. The reserved degree was - 0.50D. The total high-order aberrations of A, B, C groups were measured and recorded by OPD-Scan III wavefront aberration meter at 3 mm, 5 mm diameter of pupil at 3 months after operation. Higher-order aberrations (t-HOA), total trefoil (TT), total coma (TC), root mean square (RMS) and fourth-order spherical aberrations (Z40) were analyzed by SPSS17.0 statistical software package. Independent sample variance analysis was used to compare the three groups of quantitative data, and the difference was statistically significant with P 0.05. Results There was no significant difference in total higher order aberration (HOA), total coma (TC), total clover (TT) RMS between groups A and B (P 0.05), and the fourth order spherical aberration (Z40) in group B was higher than that in group A (P 0.05). Coma (TC), total clover (TT) RMS were significantly higher than those in group C (P 0.05). There was no significant difference between group C and group A in intraocular fourth order spherical aberration (Z40). The total higher order aberration (HOA), total coma (TC) and fourth order spherical aberration (Z40) in group B were higher than those in group A (P 0.05). Total trefoil (TT) RMS had no significant difference between the two groups (P 0.05); compared with group C, total higher order aberration (HOA), total trefoil (TT), total coma (TC) RMS in group A and group B were significantly higher than those in group C (P 0.05); intraocular fourth order spherical aberration (Z40) in group C was greater than that in group A (P 0.05), and there was no significant difference between group B and group C (P 0.05). Conclusion 1. There is no significant difference in BCVA between RAYNER 920H Aspheric IOL and HOYA PY-60AD IOL at 3 months after surgery. Both IOL can significantly improve the postoperative visual acuity of cataract patients. 2. The preoperative patients with large corneal coma and those with normal or small pupils should be given priority in clinical work. Considering the implantation of RAYNER 920H aspheric IOL; 3. The design of IOL negative spherical aberration in group B (HOYA) was similar to that of normal young transparent lens. For cataract patients with large pupil (such as nocturnal workers, glaucoma attack patients, etc.), this type of IOL was more likely to be chosen because of its more balanced corneal spherical aberration under large pupil. 4. At the same level of vision (> 0.8), the RMS (except spherical aberration) of intraocular lens is significantly higher than that of transparent lens, which is more prominent under the large pupil. This may be one of the reasons for the unsatisfactory visual quality of cataract patients after surgery, indicating that IOL design needs to be further optimized and improved.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6
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