相对个性化植入非球面人工晶状体的可行性及视觉质量的研究

发布时间：2018-04-12 06:26

  本文选题：超声乳化白内障吸除术 + 白内障　； 参考：《天津医科大学》2010年硕士论文

【摘要】： 目的：探讨根据患者术前角膜球差植入合适的非球面人工晶状体fintraocular lens,IOL)使其术后全眼球差为零这一方法的可行性。并评价术前角膜球差大于等于0.33μm与小于0.33μm的年龄相关性白内障患者在植入Tecnis ZA9003非球面人工晶状体(intraocular lens,IOL)术后视觉质量。 方法：前瞻性系列病例研究。对46例(57眼)年龄相关性白内障患者术前1d利用iTrace视觉功能分析仪测量6.0mm直径下角膜球差(Z40),为使患者术后总球差接近于零,对角膜球差小于0.1μm者植入Sofport Advanced Optic(AO)IOL(10眼),0.1μm到0.235μm者植入AcrySof IQ IOL(20眼),大于0.235μm者植入Tecnis ZA9003 IOL(27眼)。患者均行3.2 mm透明角膜切口的超声乳化白内障吸除联合非球面IOL植入术,术后3个月观察患者的裸眼视力、最佳矫正视力(best corrected visual acuity,BCVA).6.0mm瞳孔直径时的全眼及内眼(主要是IOL)球差。采用t检验和方差分析对获得的数据进行统计学分析。 对48例(60眼)年龄相关性白内障患者术前1d利用iTrace视觉功能分析仪测量6.0mm直径的角膜球差,将角膜球差大于等于0.33μm设为观察组,小于0.33μm者为对照组,所有患者均行3.2 mm透明角膜切口的超声乳化白内障吸除联合Tecnis ZA9003非球面IOL植入术,术后3个月观察患者的裸眼视力、最佳矫正视力、对比敏感度及3.0mm和6.0mm瞳孔直径下的全眼像差及5、10、15、20、25、30周/度(cycles per degree,cpd)空间频率下的调制传递函数。采用配对t检验对获得的数据进行统计学分析。 结果：术后所有患者6.0mm瞳孔直径时的全眼球差为0.015±0.056μm(Sofport:0.081±0.013μm；AcrySofIQ:0.006±0.038μm；Tecnis:0.007±0.070μm)；所有患者术后全眼球差的预测值与实际值的差异无统计学意义：t=1.983,P= 0.052(Sofport:t=1.957,P=0.082；AcrySofIQ:t=0.030,P=0.976；Tecnis:t =2.031,P=0.053):所有患者全眼球差的预测值与实际值的差值为：0.014±0.044μm(Sofport:0.006±0.012gm；AcrySofIQ:-0.000±0.037μm；Tecnis: 0.027±0.052μm,F=2.626,P=0.082)。术后三组患者的裸眼视力、BCVA差异均无统计学意义(F=0.901,2.416,P=0.412,0.099)。 术前6.0mm直径的角膜球差,观察组(0.362±0.075μm)大于对照组(0.231±0.056μm),差异有统计学意义(t=7.694,P=0.000)。术后3个月,6.0mm瞳孔时的全眼球差观察组(0.088±0.046um)大于对照组(-0.038±0.062μm),差异有统计学意义(t=8.939,P=0.000)。两组患者的裸眼视力及最佳矫正视力差异均无统计学意义(P0.05)。观察组的对比敏感度值优于对照组,在暗视(3cpd)及暗视加眩光(1.5、6cpd)下两组差异均有统计学意义(P0.05)。观察组在3.Omm和6.0mm瞳孔直径下各频段的调制传递函数值均高于对照组(P0.05)。 结论：本研究根据患者术前的角膜球差植入合适的非球面IOL,术后均能够获得较满意的目标球差,为相对个性化植入非球面IOL这一方法的可行性提供临床依据。非球面IOL植入术后预留少量的正球差可能会提高患者的视觉质量。
[Abstract]:Objective: to investigate the feasibility of preoperative corneal spherical aberration implantation (fintraocular lens lensus IOL) to zero the postoperative total eyeball difference.The visual quality of patients with age-related cataract whose corneal spherical aberration was greater than 0.33 渭 m or less than 0.33 渭 m was evaluated after implantation of Tecnis ZA9003 aspherical intraocular lens (Tecnis ZA9003 intraocular lens).Methods: a series of prospective case studies.In order to make the total spherical aberration of cornea near zero after operation, 46 cases (57 eyes) of age-related cataract were measured with iTrace visual function analyzer to measure the corneal spherical aberration under the diameter of 6.0mm 1 day before operation.AcrySof IQ IOL(20 eyes were implanted in Sofport Advanced Optic(AO)IOL(10 eyes with corneal spherical aberration less than 0.1 渭 m to 0.235 渭 m, and Tecnis ZA9003 IOL(27 eyes were implanted with more than 0.235 渭 m.All patients were treated with phacoemulsification and aspherical IOL implantation with 3.2mm transparent corneal incision. The uncorrected visual acuity was observed 3 months after operation. The best corrected visual acuity of BCVA was 6.0mm in diameter of pupil, and the spherical aberration of the whole eye and the inner eye (mainly IOL) was observed.T-test and ANOVA were used to analyze the data.The corneal spherical aberration of 6.0mm diameter was measured by iTrace visual function analyzer 1 day before operation in 48 patients with age-related cataract. The corneal spherical aberration greater than or equal to 0.33 渭 m was set as the observation group and the control group was less than 0.33 渭 m.All patients were treated with phacoemulsification and Tecnis ZA9003 aspherical IOL implantation with 3.2mm transparent corneal incision. The uncorrected visual acuity and the best corrected visual acuity were observed 3 months after operation.Contrast sensitivity, the whole eye aberration at the pupil diameter of 3.0mm and 6.0mm and the modulation transfer function at the spatial frequency of 510101520 / C 2530 cycles per cycles.The data obtained were statistically analyzed by paired t test.缁撴灉:鏈�鍚庢墸�

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