白内障人工晶状体植入术对角膜高阶像差的影响及术后视觉质量对比观察

发布时间：2018-04-15 04:04

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》2011年硕士论文

【摘要】：目的：探讨利用iTrace像差仪观察白内障超声乳化联合人工晶状体(intraocular lens, IOL)植入术前后角膜高阶像差的变化；根据白内障超声乳化联合植入三组非球面IOL术后不同全眼球差,比较不同全眼球差在不同空间频率下球差影响下的MTF值,分析保留多少球差值可使患者获得更好视觉质量,为非球面IOL的球差设计及人眼的最佳球差值提供理论依据。方法：选取50例(56眼)年龄相关性白内障患者行2.8mm透明角膜切口的超声乳化白内障吸除联合折叠型人工晶体植入术,分别于术前1天,术后7天、1个月及3个月利用iTrace视觉功能分析仪测量角膜高阶像差(包括总的高阶像差、球差、彗差、三叶草以及3-6阶像差),选取瞳孔直径为3.0 mm、6.0mm范围内的高阶像差,将角膜高阶像差按直径范围不同分为两组,对其进行比较。用具有一个重复测量的两因素设计定量资料方差分析方法对两组数据分别进行统计学分析。选取行白内障超声乳化联合IOL植入术的患者107例120眼,根据植入非球面IOL类型分为ZA9003 IOL组35例41眼,PY60AD IOL组39例43眼,ADAPT-AO IOL组33例36眼,术后三个月为患者行裸眼视力,最佳矫正视力(BCVA)检查；应用iTrace视觉功能分析仪检查记录3.0 mm、6.0mm瞳孔直径下的全眼高阶像差成分及球差影响下的调制解调函数(modulation transfer function, MTF)值。结果：术前3.0mm、6.0mm直径的角膜球差分别为(0.027±0.037)μm、(0.287±0.154)μm,术后1w时(0.037±0.059)μm、(0.306±0.131)μm,术后1m时(0.034±0.048)μm、(0.310±0.232)μm,术后3m时(0.032±0.041)μm、(0.291±0.224)μm,手术前后差异无统计学意义(P0.05),其余各项高阶像差及总高阶像差手术前后的变化与球差的变化相似。三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)。在3.0mm瞳孔直径下,三组非球面IOL全眼高阶像差各成分,差异无统计学意义(P0.05)；在6.0mmm瞳孔直径下,三组非球面IOL全眼高阶像差各成分,除球差外,差异均无统计学意义(P0.05)。在3.0mm瞳孔直径下,三组非球面IOL球差影响下的MTF值的比较,差异无统计学意义(P0.05)；在6.0mmm瞳孔直径下,三组非球面IOL球差影响下的MTF值的比较,空间频率为5cpd、10cpd.、15cpd、20cpd时,三组间差异有统计学意义(P0.05),且三组间MTF值大小为:PY-60ADZA9003 ADAPT-AO;在空间频率为25cpd、30cpd时,PY-60AD与其他两组比较差异均有统计学意义(P0.05)；ZA9003与ADAPT-AO两组相比差异无统计学意义(P0.05). 结论：超声乳化白内障吸除术后角膜前表面高阶像差的变化不影响术后患者的视觉质量。为本研究第二部分白内障超声乳化联合植入不同IOL后导致全眼像差变化来自植入的非球面人工晶状体提供理论基础,从而进一步评价不同非球面IOL植入术后的视觉质量。非球面IOL植入术后全眼球差保留约0.1μm时,患者可具有较高视觉质量。
[Abstract]:Objective: to investigate the changes of corneal higher-order aberrations before and after phacoemulsification combined with intraocular lens implantation (IOL) with iTrace aberration instrument, according to the different total aberrations after cataract phacoemulsification combined with aspherical IOL implantation.To compare the MTF values of different total eyeball aberrations under the influence of spherical aberration at different spatial frequencies, to analyze how many ball differences can be retained to make the patients obtain better visual quality, and to provide a theoretical basis for the spherical aberration design of aspheric IOL and the best spherical differential value for human eyes.Methods: 50 patients (56 eyes) with age-related cataract underwent phacoemulsification and foldable intraocular lens implantation with 2.8mm transparent corneal incision.High order aberrations (including total high order aberration, spherical aberration, coma, clover and 3-6 order aberration) were measured by iTrace visual function analyzer 7 days, 1 month and 3 months after operation.The high order aberrations of cornea were divided into two groups according to the diameter range.Two groups of data were statistically analyzed by two factors design quantitative analysis of variance method with a repeated measurement.107 cases (120 eyes) with cataract phacoemulsification combined with IOL implantation were divided into ZA9003 IOL group (35 cases, 41 eyes), ZA9003 IOL group (39 cases, 43 eyes) and ADAPT-AO IOL group (33 cases, 36 eyes).The iTrace visual function analyzer was used to record the high order aberration components of the eyes under the pupil diameter of 3.0 mm to 6.0 mm and the modulation and demodulation function (MTF) under the influence of spherical aberration.Results: the corneal spherical aberration was 0.027 卤0.037) 渭 m before operation, 0.037 卤0.059) 渭 m at 1 week after operation, 0.034 卤0.232 渭 m at 1m, 0.310 卤0.232 渭 m at 1m and 0.291 卤0.224 渭 m at 3m 卤0.041) 渭 m. There was no significant difference before and after operation. The changes of other high order aberrations and high order aberrations were similar to those before and after operation.There was no significant difference in uncorrected visual acuity and best corrected visual acuity between the three groups (P 0.05).Under the pupil diameter of 3.0mm, there was no significant difference in the components of higher order aberration of aspherical IOL in the three groups (P 0.05), but there was no significant difference in all the components of high order aberration of aspherical IOL under the pupil diameter of 6.0mmm with the exception of spherical aberration (P 0.05).Under the influence of 3.0mm pupil diameter, there was no significant difference in MTF value between the three groups under the influence of aspheric IOL spherical aberration, and there was no significant difference between the three groups under the pupil diameter of 6.0mmm. When the space frequency was 5cpd10cpd.n 15cpd20cpd, the MTF value under the influence of aspheric spherical IOL spherical aberration was compared between the three groups under the pupil diameter of 3.0mm.The difference among the three groups was statistically significant (P 0.05), and the MTF value of the three groups was: PY-60ADZA9003 ADAPT-AO.There was no significant difference between PY-60AD and the other two groups when the spatial frequency was 25cpdl 30cpd and there was no significant difference between the three groups (P0.05A9003 and ADAPT-AO).Conclusion: the changes of high-order aberrations on the anterior corneal surface after phacoemulsification do not affect the visual quality of the patients after phacoemulsification.The second part of this study provides a theoretical basis for the change of the aberration of the whole eye caused by phacoemulsification combined with the implantation of different IOL, thus further evaluating the visual quality of different aspheric IOL implants.After Aspheric IOL implantation, the visual quality of the patients was higher when the difference of the whole eyeball was kept about 0. 1 渭 m.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6

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