摘要
目的对比同一个体两眼分别植入非球面和球面人工晶状体(IOL)后高阶像差的差异。设计前瞻性、病例对照研究。研究对象33例(66眼)双眼老年性白内障患者。方法患者接受超声乳化白内障吸除术后,两眼分别植入球面(Canon Staar KS-3)和非球面(Canon Staar KS-3Ai)IOL。按照IOL设计的差异分成两组,球面组和非球面组,手术后3个月观察患者的视力、最佳矫正视力、IOL位置、屈光状态、高阶像差、瞳孔大小等指标。比较两组高阶像差的差异。主要指标视力、最佳矫正视力,IOL的居中性、屈光状态、瞳孔直径、3阶像差、4阶像差、4阶球差(Z40)、5阶像差及总高阶像差的均方根(RMS)。结果在瞳孔直径6mm时,非球面IOL组的4阶像差(0.193±0.098)μm、4阶球差(0.037±0.099)μm、总像差RMS(0.498±0.072)μm均低于球面IOL组(0.403±0.155)μm、(0.381±0.142)μm、(0.737±0.164)μm,而在瞳孔直径6mm时的3阶和5阶像差RMS,瞳孔直径5mm时总像差RMS两组间比较差异无统计学意义(P均>0.05)。低对比度条件下,10例(30%)非球面组患者视物较球面组患者清晰。瞳孔6mm时,非球面组和球面组平均近视漂移分别是(-0.29±0.09)D和(-0.87±0.16)D,差异有统计学意义(P=0.033)。结论植入非球面IOL后,虽然可以明显降低4阶球差,但是两组间在术后视力和最佳矫正视力方面并没有统计学差异,高阶像差的差异主要表现夜间近视漂移的减少和瞳孔直径5mm以上时的低对比度视力的提高。
Objective To compare intraindividual higher-order aberrations （HOA） after implantation of aspherical and spherical intraocular lenses （IOL）. Design Prospective, case-controlled study. Participants 33 patients （66 eyes） were between 50 and 76 years of ages. The patients with bilateral senile cataracts were operated with phaeoemulsifieation and IOL implantation, All the patients had no other ocular pathologies and no previous ophthalmic surgery. Patients with keratometrie astigmatism higher than -2.0 diopters （D） were excluded from the study. Methods Wavefront aberration measurements of 33 patients （66 eyes） after implantation of a spherical IOL （Canon Staar KS-3） in one eye and an aspherical IOL （Cannon Staar KS-3Ai） in the contralateral eye were analyzed. The eyes were randomly assigned to groups of the spherical IOL or the aspherieal IOL. Third-order, 4th-order, 5th-order, total HOA root-mean-squares （RMS）, and 4th-order spherical aberrations （Z4^0） were compared 3 months after surgery. Main Outcome Measures Visual acuity （VA） , the best corrected visual acuity （BCVA）, the centrality of IOL, refraction data, diameter of pupil size, 3rd-order, 4th-order, 5th-order and total HOA RMS, and 4th-order spherical aberration （Z4^0） RMS were measured. Results Fourth-nrder aberration RMS（0.193±0.098μm）, Z4^0 RMS（0.037±0.099μm）, total HOA RMS（0.498±0.072μm） in the aspherical IOL group were lower than those with the spherical IOL （0.403±0.1551μm,0.381±0.142μm,0.737±0. 164μm, respectively） at 6mm pupil diameter. For 3rd-and 5th-order RMS at 6mm pupil diameter, total HOA RMS （at 5mm pupil diameter）, no significant difference was found in both 1OLs. Under mesopic conditions, ten patients （30%） with an aspheric IOL had better contrast sensitivity. The average myopic shift were （-0.29±0.09）D and （-0.87±0.16）D in the aspherical and spherical IOL groups at 6mm pupil diameter（P 〈0.05）. Conclusions The clinical results confirmed the theoretical preclinical calculations that the spherical aberration of the alter cataract surgery can be eliminated by modifying the anterior surface of the IOL. The Canon Staar KS-3Ai lens compensates for the positive spherical aberration in the cataract eyes. In comparison to a spherical IOL, the aspherical IOL can reduce Z4^0 and 4th-order RMS significantly at 6 mm pupil diameter. But there were no statistical differences between groups for the VA and BCVA. Aspherie IOL rcsuhs less myopic shift in refraction with mydriasis and gain better night vision for the patients with larger pupils （at 5mm pupil diameter or more）.
出处
《眼科》
CAS
2007年第2期96-99,共4页
Ophthalmology in China
