應(yīng)用OPD-Scan Ⅲ像差儀觀察不同非球面單焦點(diǎn)人工晶體眼內(nèi)高階像差的特點(diǎn)
發(fā)布時(shí)間：2018-09-11 06:06
【摘要】：研究目的應(yīng)用OPD-ScanⅢ(Nidek,Gamagori,Japan)波前像差儀檢測(cè)白內(nèi)障患者術(shù)中植入不同非球面單焦點(diǎn)人工晶狀體(monofocal intraocular lens,Mo IOL)后眼內(nèi)高階像差的變化,同時(shí)同正常透明晶狀體眼內(nèi)高階像差進(jìn)行比較,嘗試找出白內(nèi)障患者人工晶狀體(intraocular lens,IOL)植入術(shù)后出現(xiàn)眩光、視物模糊等視覺質(zhì)量下降的原因,同時(shí)為白內(nèi)障患者IOL的個(gè)性化選擇及IOL設(shè)計(jì)提供參考依據(jù)。研究方法選取2016年06月至2016年12月于我院眼科住院的單純老年性白內(nèi)障患者65例(65眼),其中女36例(36眼),男29例(29眼),年齡58~80歲(平均71.0±2.25)。本次研究采用前瞻性隨機(jī)對(duì)照研究方法,隨機(jī)分為兩組,使各組核硬度及年齡相匹配。A組:植入非球面折疊一片式Mo IOL(RAYNER 920H Aspheric)。B組:植入非球面折疊三片式Mo IOL(HOYA PY-60AD)。兩組植入的IOL度數(shù)均在19.0~24.0D范圍內(nèi)。對(duì)照組C組選擇同期于本院眼科住院患者家屬及大連醫(yī)科大學(xué)學(xué)生志愿者,共30例(30眼),隨機(jī)抽取一只眼檢查結(jié)果納入研究范圍,其中女15例(15眼),男15例(15眼),年齡12歲~30歲(平均19±1.83)。A、B兩組均行白內(nèi)障超聲乳化聯(lián)合IOL植入術(shù)。IOL均采用SRK-Ⅱ公式計(jì)算度數(shù),為了使患者術(shù)后獲得良好的遠(yuǎn)視力同時(shí)滿足一定的近視需求,術(shù)后預(yù)留度數(shù)為-0.50D。術(shù)后3月使用OPD-ScanⅢ波前像差儀測(cè)量記錄A、B、C三組在3mm、5mm直徑瞳孔下眼內(nèi)的總高階像差(total higher-order aberrations,t-HOA)、總?cè)~草(total trefoil,TT)、總彗差(total coma,TC)均方根值(Root mean square,RMS)及第四階球差(Z40)值。應(yīng)用SPSS17.0統(tǒng)計(jì)軟件包分析,對(duì)三組定量資料的比較采用獨(dú)立樣本方差分析,以P0.05為差異具有統(tǒng)計(jì)學(xué)意義。主觀視覺感受采用問卷調(diào)查方式采集。研究結(jié)果1、3mm直徑瞳孔時(shí),A、B兩組IOL眼內(nèi)總高階像差(HOA)、總彗差(TC)、總?cè)~草(TT)RMS差異無統(tǒng)計(jì)學(xué)意義(P0.05),第四階球差(Z40)B組大于A組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);C組與A、B組相比,A、B組眼內(nèi)總高階像差(HOA)、總彗差(TC)、總?cè)~草(TT)RMS均較C組增加,且差異具有統(tǒng)計(jì)學(xué)意義(P0.05),眼內(nèi)第四階球差(Z40)C組與A組、B組均無統(tǒng)計(jì)學(xué)差異(P0.05)。2、5mm直徑瞳孔時(shí),B組IOL眼內(nèi)總高階像差(HOA)、總彗差(TC)及第四階球差(Z40)均高于A組,且差異具有統(tǒng)計(jì)學(xué)意義(P0.05),總?cè)~草(TT)RMS兩組差異無統(tǒng)計(jì)學(xué)意義(P0.05);A、B組與C組相比,A、B組眼內(nèi)總高階像差(HOA)、總?cè)~草(TT)、總彗差(TC)RMS均較C組明顯增加,且差異具有統(tǒng)計(jì)學(xué)意義(P0.05);眼內(nèi)第四階球差(Z40),C組大于A組且具有統(tǒng)計(jì)學(xué)意義(P0.05),B組與C組無統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論1、RAYNER 920H Aspheric人工晶體眼與HOYA PY-60AD人工晶體眼術(shù)后三月最佳矯正視力(BCVA)無顯著性差異,兩種IOL均可以明顯提高白內(nèi)障患者術(shù)后視力;2、臨床工作中對(duì)于術(shù)前角膜慧差偏大的患者及瞳孔正常或偏小患者優(yōu)先考慮植入RAYNER 920H非球面IOL;3、B組(HOYA)IOL負(fù)球差的設(shè)計(jì)基本接近正常青年透明晶狀體,考慮對(duì)于術(shù)前瞳孔較大的白內(nèi)障患者(如工作性質(zhì)為夜間工作者、青光眼發(fā)作患者等)則更傾向于選擇該類型IOL,因?yàn)樵诖笸紫缕淦胶饨悄ふ虿罡邇?yōu)勢(shì);4、在同一水平視力下(≥0.8),人工晶體眼內(nèi)高階像差的RMS(除球差)明顯高于透明晶狀體,這種情況在大瞳孔下更為突出,其可能是導(dǎo)致白內(nèi)障患者術(shù)后視覺質(zhì)量不盡人意的原因之一,表明IOL在設(shè)計(jì)上需要進(jìn)一步優(yōu)化與完善。
[Abstract]:Objective To detect the high-order aberrations of cataract patients after implantation of different aspheric monofocal intraocular lenses (MOIOL) with OPD-Scan III (Nidek, Gamagori, Japan) wavefront aberration meter, and compare it with the high-order aberrations of normal transparent lens, trying to find out the artificial cataract patients. Methods From June 2016 to December 2016, 65 patients (65 eyes) with simple senile cataract were selected and hospitalized in ophthalmology department of our hospital. Thirty-six eyes (29 eyes) were male, aged 58-80 years (mean 71.0 (+ 2.25). The study was randomly divided into two groups to match the nuclear hardness and age. Group A: implanted aspheric folded one-piece Mo IOL (RAYNER 920H Aspheric). Group B: implanted aspheric folded three-piece Mo IOL (HOYA PY-60AD). Two groups were implanted. The IOL scores were all in the range of 19.0-24.0 D. In the control group, 30 patients (30 eyes) were selected from the family members of ophthalmic inpatients and students volunteers of Dalian Medical University in the same period. The results of one eye examination were randomly selected and included in the study, including 15 women (15 eyes) and 15 men (15 eyes), aged 12-30 years (average 19 (+ 1.83)). IOL was calculated by SRK-II formula. The reserved degree was - 0.50D. The total high-order aberrations of A, B, C groups were measured and recorded by OPD-Scan III wavefront aberration meter at 3 mm, 5 mm diameter of pupil at 3 months after operation. Higher-order aberrations (t-HOA), total trefoil (TT), total coma (TC), root mean square (RMS) and fourth-order spherical aberrations (Z40) were analyzed by SPSS17.0 statistical software package. Independent sample variance analysis was used to compare the three groups of quantitative data, and the difference was statistically significant with P 0.05. Results There was no significant difference in total higher order aberration (HOA), total coma (TC), total clover (TT) RMS between groups A and B (P 0.05), and the fourth order spherical aberration (Z40) in group B was higher than that in group A (P 0.05). Coma (TC), total clover (TT) RMS were significantly higher than those in group C (P 0.05). There was no significant difference between group C and group A in intraocular fourth order spherical aberration (Z40). The total higher order aberration (HOA), total coma (TC) and fourth order spherical aberration (Z40) in group B were higher than those in group A (P 0.05). Total trefoil (TT) RMS had no significant difference between the two groups (P 0.05); compared with group C, total higher order aberration (HOA), total trefoil (TT), total coma (TC) RMS in group A and group B were significantly higher than those in group C (P 0.05); intraocular fourth order spherical aberration (Z40) in group C was greater than that in group A (P 0.05), and there was no significant difference between group B and group C (P 0.05). Conclusion 1. There is no significant difference in BCVA between RAYNER 920H Aspheric IOL and HOYA PY-60AD IOL at 3 months after surgery. Both IOL can significantly improve the postoperative visual acuity of cataract patients. 2. The preoperative patients with large corneal coma and those with normal or small pupils should be given priority in clinical work. Considering the implantation of RAYNER 920H aspheric IOL; 3. The design of IOL negative spherical aberration in group B (HOYA) was similar to that of normal young transparent lens. For cataract patients with large pupil (such as nocturnal workers, glaucoma attack patients, etc.), this type of IOL was more likely to be chosen because of its more balanced corneal spherical aberration under large pupil. 4. At the same level of vision (> 0.8), the RMS (except spherical aberration) of intraocular lens is significantly higher than that of transparent lens, which is more prominent under the large pupil. This may be one of the reasons for the unsatisfactory visual quality of cataract patients after surgery, indicating that IOL design needs to be further optimized and improved.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R779.6
本文編號(hào)：2235809
[Abstract]:Objective To detect the high-order aberrations of cataract patients after implantation of different aspheric monofocal intraocular lenses (MOIOL) with OPD-Scan III (Nidek, Gamagori, Japan) wavefront aberration meter, and compare it with the high-order aberrations of normal transparent lens, trying to find out the artificial cataract patients. Methods From June 2016 to December 2016, 65 patients (65 eyes) with simple senile cataract were selected and hospitalized in ophthalmology department of our hospital. Thirty-six eyes (29 eyes) were male, aged 58-80 years (mean 71.0 (+ 2.25). The study was randomly divided into two groups to match the nuclear hardness and age. Group A: implanted aspheric folded one-piece Mo IOL (RAYNER 920H Aspheric). Group B: implanted aspheric folded three-piece Mo IOL (HOYA PY-60AD). Two groups were implanted. The IOL scores were all in the range of 19.0-24.0 D. In the control group, 30 patients (30 eyes) were selected from the family members of ophthalmic inpatients and students volunteers of Dalian Medical University in the same period. The results of one eye examination were randomly selected and included in the study, including 15 women (15 eyes) and 15 men (15 eyes), aged 12-30 years (average 19 (+ 1.83)). IOL was calculated by SRK-II formula. The reserved degree was - 0.50D. The total high-order aberrations of A, B, C groups were measured and recorded by OPD-Scan III wavefront aberration meter at 3 mm, 5 mm diameter of pupil at 3 months after operation. Higher-order aberrations (t-HOA), total trefoil (TT), total coma (TC), root mean square (RMS) and fourth-order spherical aberrations (Z40) were analyzed by SPSS17.0 statistical software package. Independent sample variance analysis was used to compare the three groups of quantitative data, and the difference was statistically significant with P 0.05. Results There was no significant difference in total higher order aberration (HOA), total coma (TC), total clover (TT) RMS between groups A and B (P 0.05), and the fourth order spherical aberration (Z40) in group B was higher than that in group A (P 0.05). Coma (TC), total clover (TT) RMS were significantly higher than those in group C (P 0.05). There was no significant difference between group C and group A in intraocular fourth order spherical aberration (Z40). The total higher order aberration (HOA), total coma (TC) and fourth order spherical aberration (Z40) in group B were higher than those in group A (P 0.05). Total trefoil (TT) RMS had no significant difference between the two groups (P 0.05); compared with group C, total higher order aberration (HOA), total trefoil (TT), total coma (TC) RMS in group A and group B were significantly higher than those in group C (P 0.05); intraocular fourth order spherical aberration (Z40) in group C was greater than that in group A (P 0.05), and there was no significant difference between group B and group C (P 0.05). Conclusion 1. There is no significant difference in BCVA between RAYNER 920H Aspheric IOL and HOYA PY-60AD IOL at 3 months after surgery. Both IOL can significantly improve the postoperative visual acuity of cataract patients. 2. The preoperative patients with large corneal coma and those with normal or small pupils should be given priority in clinical work. Considering the implantation of RAYNER 920H aspheric IOL; 3. The design of IOL negative spherical aberration in group B (HOYA) was similar to that of normal young transparent lens. For cataract patients with large pupil (such as nocturnal workers, glaucoma attack patients, etc.), this type of IOL was more likely to be chosen because of its more balanced corneal spherical aberration under large pupil. 4. At the same level of vision (> 0.8), the RMS (except spherical aberration) of intraocular lens is significantly higher than that of transparent lens, which is more prominent under the large pupil. This may be one of the reasons for the unsatisfactory visual quality of cataract patients after surgery, indicating that IOL design needs to be further optimized and improved.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R779.6
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