本文選題：低度散光 + 多焦點(diǎn)人工晶狀體　； 參考：《天津醫(yī)科大學(xué)》2016年博士論文

【摘要】：目的1.通過對i Trace和KR-1W兩種視覺質(zhì)量分析儀實(shí)際測得的高階像差(HOA)值進(jìn)行比較,對比二者的一致性和差異性,明確兩種視覺質(zhì)量分析儀的工作原理及其在屈光白內(nèi)障手術(shù)中的實(shí)際應(yīng)用價(jià)值。從而為白內(nèi)障患者提供集全面、科學(xué)、精準(zhǔn)、便捷于一身的術(shù)前排查和術(shù)后隨訪的視覺質(zhì)量分析儀,提高患者依從性,保障臨床研究的科學(xué)性。2.通過不同組角膜低度散光的白內(nèi)障患者,行白內(nèi)障超聲乳化聯(lián)合多焦點(diǎn)人工晶狀體(Re STOR)植入術(shù)后視覺參數(shù)的比較,證實(shí)低度散光對多焦點(diǎn)人工晶狀體眼視覺效果的影響;3.通過比較角膜順規(guī)散光0.75~1.0D或逆規(guī)散光0.5~0.75D的患者,行白內(nèi)障超聲乳化聯(lián)合散光矯正型多焦點(diǎn)人工晶狀體(ART2)植入與單純多焦點(diǎn)人工晶狀體(Re STOR)植入,術(shù)后視覺效果的差異,證實(shí)ART2矯正角膜低度散光的可預(yù)測性、有效性、穩(wěn)定性和安全性。方法1.按照納入標(biāo)準(zhǔn)招募健康志愿者行i Trace和KR-1W檢查,記錄實(shí)測的4mm瞳孔直徑下HOA,利用SPSS 19.0統(tǒng)計(jì)軟件對數(shù)據(jù)進(jìn)行方差齊性檢驗(yàn)和配對t檢驗(yàn);采用MEDCALC統(tǒng)計(jì)軟件對數(shù)據(jù)進(jìn)行Bland-Altman分析。比較二者差異性和一致性。2.按照病例選擇標(biāo)準(zhǔn),納入行白內(nèi)障超聲乳化聯(lián)合Re STOR植入術(shù)的單純年齡相關(guān)性白內(nèi)障患者63例(80眼)。根據(jù)術(shù)前角膜散光情況分為兩組,順規(guī)散光≤0.75D或逆規(guī)散光≤0.5D者為A組(35眼);順規(guī)散光0.75D~1.0D或逆規(guī)散光0.5D~0.75D者為B組(45眼)。記錄術(shù)后3月殘余散光(UA)、等效球鏡(SE)、裸眼全程視力(UVA)和遠(yuǎn)視力矯正的全程視力(CVA),以及4mm瞳孔下的平均調(diào)制傳遞函數(shù)(a MTF)、斯特利爾比值(SR),以及脫鏡情況、滿意度。統(tǒng)計(jì)分析找到全程視力、視覺質(zhì)量、術(shù)后脫鏡率和患者滿意度的主要影響因素。3.根據(jù)病例選擇標(biāo)準(zhǔn)納入白內(nèi)障超聲乳化聯(lián)合ART2植入的患者17人17眼。再根據(jù)年齡和術(shù)前角膜散光(順規(guī)0.75~1.0D,逆0.5~0.75D)兩級(jí)分層隨機(jī)抽取同科同期同一術(shù)者行白內(nèi)障超聲乳化聯(lián)合Re STOR植入的患者17人17眼。比較兩組術(shù)后殘余散光、UVA、CVA;i Trace測量a MTF、SR、ART2 IOL軸位測量;以及患者脫鏡率和滿意度。結(jié)果1.一致性比較:KR-1W和i Trace所測角膜HOA的差值平均為-0.01,95%醫(yī)學(xué)參考值范圍為(-0.10~0.08μm)。其中KR-1W比i Trace測量值大的有13眼,占40.6%;比i Trace測量值小的有19眼,占59.4%。兩儀器所測全眼HOA的差值平均為-0.05,95%醫(yī)學(xué)參考值范圍為(-0.16~0.05μm)。其中KR-1W比i Trace測量值大的有7眼,占21.9%;比i Trace測量值小的有25眼,占78.1%。全眼HOA的差值的絕對值最大為0.199μm。二者所測眼內(nèi)HOA差值平均為-0.06,95%醫(yī)學(xué)參考值范圍為(-0.18~0.05μm)。其中KR-1W比i Trace測量值大的有5眼,占15.6%;比i Trace測量值小的有27眼,占84.4%。差異性比較:兩儀器測量角膜HOA的RMS值分別為0.128±0.031μm和0.137±0.046μm,差異較無統(tǒng)計(jì)意義(t=-1.174,P0.05)。兩儀器測量眼內(nèi)HOA(t=-6.339,P0.001)和全眼HOA(t=-5.461,P0.001)結(jié)果比較,差異有統(tǒng)計(jì)學(xué)意義,且i Trace的測量結(jié)果略高于KR-1W。2.兩組術(shù)后3月殘余散光分別為-0.32±0.24D和-0.90±0.28D,等效球鏡分別為-0.43±0.62D和-0.51±0.72D,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。B組UVA和CVA均較A組低,術(shù)后3月A組UVA≥0.8者共計(jì)25眼,占71.4%,100%的患者對術(shù)后視覺效果表示非常滿意;B組術(shù)后UVA≥0.8者共計(jì)15眼,占33.3%,77.8%的患者對術(shù)后視覺效果表示非常滿意,兩組間比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。脫鏡率A組100%,B組86.67%,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。B組a MTF、SR均較A組低,a MTF差異有統(tǒng)計(jì)學(xué)意義(P0.05)。線性回歸分析結(jié)果顯示,術(shù)后UDVA的唯一影響因素是術(shù)前角膜散光(P0.05),UIVA和UNVA、a MTF、SR的唯一影響因素是殘余散光(P0.05);術(shù)后殘余散光、脫鏡率的唯一影響因素是術(shù)前角膜散光(P0.05);術(shù)后滿意度的主要影響因素是術(shù)前期望值、術(shù)后裸眼遠(yuǎn)視力和脫鏡率(P0.05)。3.ART2組術(shù)后3個(gè)月殘余散光與預(yù)測值差異無統(tǒng)計(jì)學(xué)意義(P0.05)。ART2組術(shù)后3個(gè)月IOL旋轉(zhuǎn)度平均為3.12±0.70°,均無需二次手術(shù)調(diào)整軸位。ART2植入術(shù)后半年內(nèi)旋轉(zhuǎn)不足1.5°,且主要發(fā)生在術(shù)后1個(gè)月內(nèi)。ART2組與Re STOR組,術(shù)后殘余散光分別為-0.18±0.07D和-0.91±0.25D,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。ART2組術(shù)后3月UVA分別為UDVA0.01±0.05Log MAR、UIVA0.05±0.07Log MAR、UNVA0.02±0.07Log MAR,Re STOR組UDVA0.08±0.06Log MAR、UIVA 0.15±0.12Log MAR和UNVA0.09±0.08Log MAR,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。ART2組CVA16眼≥0.8,占94.12%,患者對術(shù)后視覺效果表示非常滿意;B組14眼≥0.8,占82.35%,兩組CNVA差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組i Trace視覺質(zhì)量參數(shù)比較,可見ART2組術(shù)后a MTF和SR均略高于Re STOR組,但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后3月,ART2組脫鏡率達(dá)到100%,Re STOR組脫鏡率為82.35%,兩組比較差異無統(tǒng)計(jì)學(xué)意義(P0.05),但未脫鏡者對眼鏡依賴程度均不足1/2天。結(jié)論1.KR-1W和i Trace工作原理不同但各具優(yōu)勢,測量HOA的結(jié)果具有一致性,且角膜HOA的結(jié)果一致性最佳。i Trace更適合用于白內(nèi)障患者術(shù)前、術(shù)后眼部波前像差的測量。i Trace用于白內(nèi)障術(shù)后隨訪檢查,能提供準(zhǔn)確全面的數(shù)據(jù),利于提高患者依從性。2.Re STOR植入術(shù)后患者能獲得良好的裸眼全程視力和視覺質(zhì)量,術(shù)后脫鏡率和滿意度較高。影響Re STOR眼術(shù)后全程視力、視覺質(zhì)量、脫鏡率和患者滿意度的主要因素是殘余散光。3.ART2矯正角膜低度散光具有良好的可預(yù)測性、有效性、穩(wěn)定性和安全性。4.術(shù)前角膜散光順規(guī)0.75~1.0D和逆規(guī)0.5~0.75D的患者,更適合植入ART2獲得更佳的全程視覺效果。
[Abstract]:Objective 1. to compare the high order aberration (HOA) values measured by two visual quality analyzer of I and KR-1W, to compare the consistency and difference between the two, and to clarify the working principle of the two visual quality analyzer and its practical application in the refractive cataract surgery. The visual quality analyzer, which is convenient for preoperative and postoperative follow-up, improves patient compliance and guarantees the scientific.2. of clinical research through a comparison of visual parameters after cataract phacoemulsification combined with multifocal intraocular lens (Re STOR) implantation by different groups of corneal low astigmatism, and confirms that low degree astigmatism is confirmed. The effect of the visual effect of multifocal intraocular lens (phakic); 3. by comparing the patients with corneal smooth astigmatism 0.75~1.0D or the reverse astigmatism 0.5~0.75D, cataract phacoemulsification combined with astigmatic intraocular lens (ART2) implantation and simple multifocal intraocular lens (Re STOR) implantation, the difference of postoperative visual effect, confirmed the correction of ART2 correction Predictability, effectiveness, stability and safety of low corneal astigmatism. Methods 1. I Trace and KR-1W examinations were recruited according to the inclusion criteria, the measured 4mm pupil diameter HOA was recorded, and SPSS 19 statistical software was used to carry out variance homogeneity test and paired t test on the data, and MEDCALC statistics software was used to make Bland-A. Ltman analysis. Compared the two differences and consistency.2. according to the case selection criteria, 63 cases (80 eyes) of simple age-related cataract patients with cataract phacoemulsification combined with Re STOR implantation were divided into two groups according to the preoperative corneal astigmatism. The CIS astigmatism less than 0.75D or the reverse astigmatism less than 0.5D were in group A (35 eyes); CIS astigmatism 0.75D~1 .0D or reverse astigmatism 0.5D~0.75D was in group B (45 eyes). The residual astigmatism (UA), equivalent sphere (SE), whole course visual acuity (UVA) and distant vision corrected visual acuity (CVA) after operation, and the average modulation transfer function (a MTF) under the pupil of the pupil (a MTF), the ratio (SR) of the pupil of 4mm, and the degree of degree of satisfaction. The total visual acuity was found by statistical analysis. 17 people and 17 eyes of patients with cataract phacoemulsification combined with ART2 implantation according to the case selection criteria.3. were selected according to the criteria of case selection, and the cataract phacoemulsification combined with R in the same group was selected according to age and preoperative corneal astigmatism (CIS 0.75~1.0D, reverse 0.5~0.75D) two level stratification 17 patients and 17 eyes were implanted with e STOR. The residual astigmatism, UVA, CVA, a MTF, SR, ART2 IOL axis measurement of the two groups were measured, and the rate of removal and satisfaction of the patients were compared. There were 13 eyes in 13, 40.6%, 19 eyes smaller than I Trace, and the average difference between HOA in 59.4%. two instruments was -0.05,95% medical reference value range (-0.16~0.05 mu m). 7 eyes, 21.9% of KR-1W than I Trace, were 25 eyes smaller than I Trace measurements, and the absolute value of the difference was the largest of 0.199. The average HOA value measured in the eyes of M. two was (-0.18~0.05) reference value (-0.18~0.05 mu m). Among them, KR-1W was larger than I Trace, accounting for 15.6%; 27 eyes were smaller than I Trace, accounting for 84.4%. difference comparison: two instruments measured 0.128 + 0.031 Mu and 0.137 + 0.046 micron respectively, and the difference was less statistically significant T=-1.174, P0.05. Two instrument measurements of intraocular HOA (t=-6.339, P0.001) and full eye HOA (t=-5.461, P0.001) were statistically significant, and the results of I Trace were slightly higher than that of KR-1W.2. two after the operation in the KR-1W.2. two group. The study meaning (P0.05) group.B UVA and CVA were lower than those in the A group. In group A, UVA more than 0.8 in March were 25 eyes, accounting for 71.4%, and 100% of the patients were very satisfied with postoperative visual effects. In B group, UVA more than 0.8 were 15 eyes, 33.3% and 77.8% of the patients were very satisfied with postoperative visual effects, and there were statistically significant differences between the two groups (P0.05). The difference was statistically significant (P0.05) in group B (P0.05) and group B (P0.05), a MTF in group.B, SR was lower than that in A group, and a MTF difference was statistically significant (P0.05). The only influencing factor of the mirror rate was preoperative corneal astigmatism (P0.05). The main factors affecting the postoperative satisfaction were the expected value of preoperation, the postoperative astigmatism and the removal rate (P0.05) in group.3.ART2 after operation, there was no significant difference in the residual astigmatism at 3 months after operation (P0.05) in group.ART2, the average of IOL rotation was 3.12 + 0.70 degrees in the group.ART2 after operation, and no two times were needed. The rotation of axial.ART2 implantation was less than 1.5 degrees within half a year after operation, and mainly occurred in group.ART2 and Re STOR within 1 months after operation. The residual astigmatism after operation was -0.18 0.07D and -0.91 + 0.25D, respectively. The difference was statistically significant (P0.05).ART2 group after operation in March. The Re STOR group was UDVA0.08 + 0.06Log MAR, UIVA 0.15 + 0.12Log MAR and UNVA0.09 + 0.08Log MAR. The difference was statistically significant (P0.05) was more than 0.8, accounting for 94.12%. The patients were very satisfied with the postoperative visual effects; 14 eyes were more than 0.8, accounting for 82.35%. The two groups of visual quality parameters were compared. The results showed that a MTF and SR in group ART2 were slightly higher than those in Re STOR group, but the difference was not statistically significant (P0.05). In March, the removal rate of ART2 in group ART2 was 100%, and in Re STOR group was 82.35%, the difference between the two groups was not statistically significant (P0.05). Each advantage, the results of the measurement of HOA are consistent, and the results of the corneal HOA results are the best.I Trace more suitable for cataract surgery. Postoperative ocular wavefront aberrations are measured by.I Trace for postoperative follow-up examination of cataract surgery, which can provide accurate and comprehensive data for patients with high patient compliance after.2.Re STOR implantation. Good naked eye visual acuity and visual quality, high postsurgical removal rate and satisfactory degree of satisfaction. The main factors affecting the whole visual acuity, visual quality, removal rate and patient satisfaction after Re STOR eye are residual astigmatism with good predictability, effectiveness, stability and safety of corneal astigmatism before.4.. Patients with 0.75~1.0D and 0.5~0.75D are more suitable for implantation of ART2 to achieve better visual effect.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R779.6

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