微切口人工晶状体植入术后的视功能评估
发布时间：2018-08-07 20:49
【摘要】：目的 观察并比较传统3.0mm小切口白内障超声乳化(Small-incision cataract surgery, SICS)手术与2.0mm同轴微切口白内障超声乳化(microincision cataract surgery, MICS)术后植入微切口预装式蓝光滤过非球面人工晶状体(intraocular lens, IOL)的手术源性散光(surgically induced astigmatism, SIA)及囊袋内稳定性。使用OQAS光学质量分析系统(Optical Quality Analysis System, OQAS)对植入不同材质和折射率IOL的IOL眼视觉质量进行评估。在IOL眼模型基础上,比较不同阿贝数、屈光指数及不同入射光波段对人工晶状体(intraocular lens, IOL)色差的影响；比较不同IOL术后引起的焦点移位距离,即相应产生的色差性屈光度。 方法 回顾性系列病例研究及计算机数值模拟实验研究。回顾性分析天津市眼科医院白内障中心2012年10月至2013年1月行白内障超声乳化吸除联合IOL植入术后1w及lmo的IOL眼48眼。其中MICS组：26眼植入微切口预装式一片式C形襻疏水性蓝光滤过丙烯酸酯非球面IOL (iSertl, HOYA)。SICS组：22眼植入小切口预装式三片式C形襻疏水性蓝光滤过丙烯酸酯非球面IOL (PY60AD, HOYA)。使用Pentacam三维眼前节测量系统采集Scheimpflug图像,及散瞳后前房深度,角膜散光大小及轴向。使用Image-pro plus6.0图像分析IOL倾斜度和偏心值,裂隙灯数码照相机照相评估IOL囊袋内旋转情况。 进一步回顾性分析我院植入AR40e、Acrysof SA60AT和IRayner620H IOL各15眼。术后至少1个月行裂隙灯、视力和屈光状态等常规检查,并对IOL眼视觉质量进行OQAS测量。分析比较IOL眼客观散射指数(Objective Scatter Index, OSI), MTF截止频率(MTF Cut off),斯特尔比率(Strehl ratio, SR), Profile width at50%(50%PSF), Profile width at10%(10%PSF)和不同对比度视力(Visual Acuity, VA)。 利用Liou-Brennan眼模型和ZEMAX光学设计软件(ZEMAX Optical Design Program)建立IOL眼模型,模拟植入+22D传统球面IOL (AR40e,美国AMO公司),分别记录3mm瞳孔直径下、离焦为零时IOL不同的阿贝数、屈光指数及入射光波段下调制传递函数(Modulation transfer function, MTF)值及其变化曲线,分析阿贝数、屈光指数及入射光波段对IOL眼色差的影响。在IOL模型眼中模拟植/入+20D的Z9003IOL(美国AMO公司)和SN60WF IOL(美国Alcon),记录3mm瞳孔直径下、离焦为零时复合光源下产生的焦点移位距离,计算产生的色差性屈光度。 结果 传统3.Omm小切口白内障超声乳化手术与2.Omm同轴微切口白内障超声乳化手术,2组间术后1w SIA差异的比较有统计学意义(P0.05),而术后1mo SIA差异的比较无统计学意义(P0.05)。2组术后1w与术后1mo前房深度的比较均有统计学意义(P0.05)。2组间前房深度比较有统计学意义(P0.05)。IOL偏心与倾斜在水平和垂直方向上的数值及差异均无统计学意义(P0.05),2组间术后1mo与术后1w比较旋转度数的差异无统计学意义(P0.05)。 植入AR40e、Acrysof SA60AT和Rayner620H IOL术后至少1个月的人工晶体眼OQAS测量比较,所有IOLI眼的OSI总平均值为2.07±1.58,AR40e、SA60AT与620H三组患者平均OSI分别为1.68±1.09、1.88±1.02和2.11±1.15,组间差异有统计学意义(F=1.632,P=0.032)。三组患者平均SR、50%PSF和10%PSF比较,AR40e优于其他两组,差异有统计学意义(P分别为0.042,0.037和0.022)。在不同对比度视力下,三组患者9%对比度VA差异有统计学意义(P=0.043)。 在IOL眼模型中：(1)3mm瞳孔直径,其他参量相同, IOL阿贝数越大,555nm单色光与470-650nm复色光下MTF值之间的差异逐渐越小；IOL眼在555nm单色光下的MTF值变化很小,但在470-650nm复色光下MTF值随着阿贝数的增大而增大,且每两者间差异明显；(2)3mm瞳孔直径,其他参量相同,随着IOL屈光指数增大,555nm单色光与470-650nm复色光下MTF值之间的差异逐渐增大,IOL眼在555nm单色光下的MTF值逐渐增大,在470-650nm复色光下的MTF值随着屈光指数的增大而增大,但是随着屈光指数的不断增大MTF值的增加量逐渐减小；(3)3mm瞳孔直径时,在所有条件相同的情况下,入射光波段为510-650nm和470～650nm时,Liou-Brennan模型眼的MTF曲线几乎完全重合,前者的MTF值高于后者但差异很小；(4)3mm瞳孔直径时,复合光源下Z9003IOL产生1.66D的色差性屈光不正；而SN60WF IOL产生2.5D的色差性屈光不正。 结论 微切口预装式蓝光滤过非球面IOL具有良好的囊袋内稳定性,2.0mm同轴微切口术式有利于术后早期视力恢复。OQAS系统分析发现植入不同材质和折射率的IOL对于术后IOL眼视觉质量影响较大,相比而言疏水性折射率较低的IOL眼具有更好的视觉质量。在IOL眼模型中分析发现IOL阿贝数越大、屈光指数越小,色差就越小,进而IOL眼视觉质量的影响就越小；蓝光滤过型IOL与非蓝光滤过型IOL对人眼的色差影响相当,植入高屈光指数低阿贝系数的IOL术后会产生更大的色差性屈光不正而降低人眼的视觉质量。
[Abstract]:objective
Observation and comparison of traditional 3.0mm small incision phacoemulsification (Small-incision cataract surgery, SICS) and 2.0mm coaxial microincision cataract phacoemulsification (microincision cataract surgery, MICS) implanted microincision preloaded blue filter aspheric artificial crystalline body (intraocular lens) Cally induced astigmatism, SIA) and internal capsule stability. Using the OQAS optical mass analysis system (Optical Quality Analysis System, OQAS) to evaluate the visual quality of the lenses implanted with different materials and refractive index IOL. The influence of color aberration of ntraocular lens (IOL) and the distance of focus shift caused by different IOL were compared.
Method
Retrospective series case study and computer numerical simulation experiment. Retrospective analysis of 48 eyes of 1W and LMO IOL eyes in the cataract center of Tianjin Ophthalmological Hospital from October 2012 to January 2013 after phacoemulsification combined with IOL implantation. In group MICS, 26 eyes were preloaded with one-piece C loop hydrophobic blue filter Acrylate aspherical IOL (iSertl, HOYA).SICS group: 22 eyes were implanted with small incision preloaded type three C loop hydrophobic blue filter acrylate aspherical IOL (PY60AD, HOYA). Scheimpflug images were collected with Pentacam three-dimensional anterior chamber measurement system, and the depth of anterior chamber after mydriasis, corneal astigmatism size and axis. Image-pro Plus6.0 was used. Image analysis IOL tilt and eccentricity, slit lamp digital camera photography to assess rotation in IOL bag.
Further retrospective analysis of 15 eyes of AR40e, Acrysof SA60AT and IRayner620H IOL in our hospital. Routine examination of slit lights, visual acuity and refractive state at least 1 months after operation, and OQAS measurement of visual quality of IOL eyes. Analysis and comparison of the objective scattering index of IOL eyes (Objective Scatter Index, OSI) and Stehr's cut-off frequency. Strehl ratio (SR), Profile width at 50% (50% PSF), Profile width at 10% (10% PSF) and Visual Acuity (VA).
Using the Liou-Brennan eye model and the ZEMAX optical design software (ZEMAX Optical Design Program), the IOL eye model is established, and the traditional spherical IOL (AR40e, American AMO company) is simulated, and the number of Abbe, the number of refractive index and the modulation transfer function under the incident light band are recorded respectively under the diameter of the pupil of the 3mm pupil. Unction, MTF) value and its variation curve, analyze the effect of Abbe number, refractive index and incident light band on IOL eye color difference. In the IOL model, the simulated plant / +20D Z9003IOL (American AMO company) and SN60WF IOL (US Alcon) record the focus shift distance under the 3mm pupil diameter and the zero time when the defocus is zero, and calculate the color generated. Differential diopter.
Result
Traditional 3.Omm small incision cataract phacoemulsification and 2.Omm coaxial micro incision cataract phacoemulsification, the comparison of 1W SIA differences between the 2 groups was statistically significant (P0.05), but there was no significant difference in 1Mo SIA after operation (P0.05) the comparison of 1W with 1Mo anterior chamber depth after operation in group.2 was statistically significant (P0.05) between groups before operation There was no statistically significant difference in the depth of the room (P0.05).IOL eccentricity and tilt in the horizontal and vertical directions (P0.05). There was no significant difference in the rotation degree of 1Mo between the 2 groups after the operation (P0.05).
The total average OSI of all IOLI eyes was 2.07 + 1.58, AR40e, SA60AT and 620H three were 1.68 + 1.02 and 2.11 + 1.15 in all IOLI eyes, compared with the AR40e, Acrysof SA60AT and Rayner620H IOL. The average OSI in all IOLI eyes was 1.68 + 1.02 and 2.11 + 1.15. Compared to SF and 10%PSF, AR40e was superior to the other two groups, and the difference was statistically significant (P was 0.042,0.037 and 0.022 respectively). Under different contrast visual acuity, the difference between 9% and VA in the three groups was statistically significant (P=0.043).
In the IOL eye model, (1) the diameter of the pupil of the 3mm, the other parameters are the same, the greater the IOL Abbe number, the smaller the difference between the 555nm monochromatic light and the MTF value under the 470-650nm complex light; the MTF value of the IOL eye in the 555nm monochromatic light is very small, but the MTF value increases with the increase of Abbe number under the 470-650nm complex light, and the difference is obvious between the two. 2) 3mm pupil diameter, the other parameters are the same, with the IOL refractive index increasing, the difference between the 555nm monochromatic light and the MTF value under the 470-650nm complex light increases gradually. The MTF value of the IOL eye in the 555nm monochromatic light increases gradually, and the MTF value under the 470-650nm complex light increases with the increase of the refractive index, but with the increasing of the refractive index MTF. The increment of the value gradually decreases; (3) when the 3mm pupil diameter is in the same condition, when the incident light band is 510-650nm and 470 to 650nm, the MTF curve of the Liou-Brennan model eye is almost completely overlapped, and the former is higher than the latter but the difference is very small. (4) the chromatic aberration of Z9003IOL produces 1.66D under the composite light source when the 3mm pupil diameter is in diameter. Light is not right; SN60WF IOL produces 2.5D's chromatic aberration.
conclusion
The micro incision preinstalled blue light filter for aspheric IOL has a good internal capsule stability, and the 2.0mm coaxial micro incision is beneficial to the early postoperative visual acuity recovery.OQAS system analysis found that IOL with different material and refractive index has great influence on the visual quality of IOL eye after operation, and the IOL eye with lower hydrophobicity index is better than that of the lower hydrophobicity refractive index. Visual quality. In the IOL eye model, it is found that the larger the IOL Abbe number, the smaller the refractive index, the smaller the color difference, and the smaller the effect of the visual quality of the IOL eye; the blue filter IOL and the non Blu light filter IOL have the same effect on the human eye color difference, and the higher refractive index low Abbe coefficient IOL will produce a greater chromatic aberration after the implantation of the high refractive index low Abbe coefficient. It reduces the visual quality of the human eye.
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R779.6
本文编号：2171302
[Abstract]:objective
Observation and comparison of traditional 3.0mm small incision phacoemulsification (Small-incision cataract surgery, SICS) and 2.0mm coaxial microincision cataract phacoemulsification (microincision cataract surgery, MICS) implanted microincision preloaded blue filter aspheric artificial crystalline body (intraocular lens) Cally induced astigmatism, SIA) and internal capsule stability. Using the OQAS optical mass analysis system (Optical Quality Analysis System, OQAS) to evaluate the visual quality of the lenses implanted with different materials and refractive index IOL. The influence of color aberration of ntraocular lens (IOL) and the distance of focus shift caused by different IOL were compared.
Method
Retrospective series case study and computer numerical simulation experiment. Retrospective analysis of 48 eyes of 1W and LMO IOL eyes in the cataract center of Tianjin Ophthalmological Hospital from October 2012 to January 2013 after phacoemulsification combined with IOL implantation. In group MICS, 26 eyes were preloaded with one-piece C loop hydrophobic blue filter Acrylate aspherical IOL (iSertl, HOYA).SICS group: 22 eyes were implanted with small incision preloaded type three C loop hydrophobic blue filter acrylate aspherical IOL (PY60AD, HOYA). Scheimpflug images were collected with Pentacam three-dimensional anterior chamber measurement system, and the depth of anterior chamber after mydriasis, corneal astigmatism size and axis. Image-pro Plus6.0 was used. Image analysis IOL tilt and eccentricity, slit lamp digital camera photography to assess rotation in IOL bag.
Further retrospective analysis of 15 eyes of AR40e, Acrysof SA60AT and IRayner620H IOL in our hospital. Routine examination of slit lights, visual acuity and refractive state at least 1 months after operation, and OQAS measurement of visual quality of IOL eyes. Analysis and comparison of the objective scattering index of IOL eyes (Objective Scatter Index, OSI) and Stehr's cut-off frequency. Strehl ratio (SR), Profile width at 50% (50% PSF), Profile width at 10% (10% PSF) and Visual Acuity (VA).
Using the Liou-Brennan eye model and the ZEMAX optical design software (ZEMAX Optical Design Program), the IOL eye model is established, and the traditional spherical IOL (AR40e, American AMO company) is simulated, and the number of Abbe, the number of refractive index and the modulation transfer function under the incident light band are recorded respectively under the diameter of the pupil of the 3mm pupil. Unction, MTF) value and its variation curve, analyze the effect of Abbe number, refractive index and incident light band on IOL eye color difference. In the IOL model, the simulated plant / +20D Z9003IOL (American AMO company) and SN60WF IOL (US Alcon) record the focus shift distance under the 3mm pupil diameter and the zero time when the defocus is zero, and calculate the color generated. Differential diopter.
Result
Traditional 3.Omm small incision cataract phacoemulsification and 2.Omm coaxial micro incision cataract phacoemulsification, the comparison of 1W SIA differences between the 2 groups was statistically significant (P0.05), but there was no significant difference in 1Mo SIA after operation (P0.05) the comparison of 1W with 1Mo anterior chamber depth after operation in group.2 was statistically significant (P0.05) between groups before operation There was no statistically significant difference in the depth of the room (P0.05).IOL eccentricity and tilt in the horizontal and vertical directions (P0.05). There was no significant difference in the rotation degree of 1Mo between the 2 groups after the operation (P0.05).
The total average OSI of all IOLI eyes was 2.07 + 1.58, AR40e, SA60AT and 620H three were 1.68 + 1.02 and 2.11 + 1.15 in all IOLI eyes, compared with the AR40e, Acrysof SA60AT and Rayner620H IOL. The average OSI in all IOLI eyes was 1.68 + 1.02 and 2.11 + 1.15. Compared to SF and 10%PSF, AR40e was superior to the other two groups, and the difference was statistically significant (P was 0.042,0.037 and 0.022 respectively). Under different contrast visual acuity, the difference between 9% and VA in the three groups was statistically significant (P=0.043).
In the IOL eye model, (1) the diameter of the pupil of the 3mm, the other parameters are the same, the greater the IOL Abbe number, the smaller the difference between the 555nm monochromatic light and the MTF value under the 470-650nm complex light; the MTF value of the IOL eye in the 555nm monochromatic light is very small, but the MTF value increases with the increase of Abbe number under the 470-650nm complex light, and the difference is obvious between the two. 2) 3mm pupil diameter, the other parameters are the same, with the IOL refractive index increasing, the difference between the 555nm monochromatic light and the MTF value under the 470-650nm complex light increases gradually. The MTF value of the IOL eye in the 555nm monochromatic light increases gradually, and the MTF value under the 470-650nm complex light increases with the increase of the refractive index, but with the increasing of the refractive index MTF. The increment of the value gradually decreases; (3) when the 3mm pupil diameter is in the same condition, when the incident light band is 510-650nm and 470 to 650nm, the MTF curve of the Liou-Brennan model eye is almost completely overlapped, and the former is higher than the latter but the difference is very small. (4) the chromatic aberration of Z9003IOL produces 1.66D under the composite light source when the 3mm pupil diameter is in diameter. Light is not right; SN60WF IOL produces 2.5D's chromatic aberration.
conclusion
The micro incision preinstalled blue light filter for aspheric IOL has a good internal capsule stability, and the 2.0mm coaxial micro incision is beneficial to the early postoperative visual acuity recovery.OQAS system analysis found that IOL with different material and refractive index has great influence on the visual quality of IOL eye after operation, and the IOL eye with lower hydrophobicity index is better than that of the lower hydrophobicity refractive index. Visual quality. In the IOL eye model, it is found that the larger the IOL Abbe number, the smaller the refractive index, the smaller the color difference, and the smaller the effect of the visual quality of the IOL eye; the blue filter IOL and the non Blu light filter IOL have the same effect on the human eye color difference, and the higher refractive index low Abbe coefficient IOL will produce a greater chromatic aberration after the implantation of the high refractive index low Abbe coefficient. It reduces the visual quality of the human eye.
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R779.6
【参考文献】
相关期刊论文 前5条
1 金海鹰;Toric人工晶状体植入术的研究进展[J];国外医学.眼科学分册;2002年06期
2 苏定旺;钟丘;岑志敏;刘水;毕苏欣;;不同类型丙烯酸酯人工晶状体囊袋旋转稳定性的临床比较[J];临床眼科杂志;2010年02期
3 瞿佳,吕帆,毛欣杰,毛崇溶;视觉矫正质量评价研究[J];中华眼科杂志;2003年06期
4 李国星;宋慧洋;王勤美;赵云娥;;蓝光滤过型人工晶状体植入术后的视功能[J];眼视光学杂志;2007年05期
5 严宗辉,胡建荣,黄丽娜;眼高阶像差评价分析[J];中国实用眼科杂志;2003年03期
，本文编号：2171302
本文链接：https://www.wllwen.com/yixuelunwen/yank/2171302.html
最近更新
教材专著
