微切口人工晶狀體植入術(shù)后的視功能評(píng)估
發(fā)布時(shí)間：2018-08-07 20:49
【摘要】：目的 觀察并比較傳統(tǒng)3.0mm小切口白內(nèi)障超聲乳化(Small-incision cataract surgery, SICS)手術(shù)與2.0mm同軸微切口白內(nèi)障超聲乳化(microincision cataract surgery, MICS)術(shù)后植入微切口預(yù)裝式藍(lán)光濾過(guò)非球面人工晶狀體(intraocular lens, IOL)的手術(shù)源性散光(surgically induced astigmatism, SIA)及囊袋內(nèi)穩(wěn)定性。使用OQAS光學(xué)質(zhì)量分析系統(tǒng)(Optical Quality Analysis System, OQAS)對(duì)植入不同材質(zhì)和折射率IOL的IOL眼視覺(jué)質(zhì)量進(jìn)行評(píng)估。在IOL眼模型基礎(chǔ)上,比較不同阿貝數(shù)、屈光指數(shù)及不同入射光波段對(duì)人工晶狀體(intraocular lens, IOL)色差的影響；比較不同IOL術(shù)后引起的焦點(diǎn)移位距離,即相應(yīng)產(chǎn)生的色差性屈光度。 方法 回顧性系列病例研究及計(jì)算機(jī)數(shù)值模擬實(shí)驗(yàn)研究�；仡櫺苑治鎏旖蚴醒劭漆t(yī)院白內(nèi)障中心2012年10月至2013年1月行白內(nèi)障超聲乳化吸除聯(lián)合IOL植入術(shù)后1w及l(fā)mo的IOL眼48眼。其中MICS組：26眼植入微切口預(yù)裝式一片式C形襻疏水性藍(lán)光濾過(guò)丙烯酸酯非球面IOL (iSertl, HOYA)。SICS組：22眼植入小切口預(yù)裝式三片式C形襻疏水性藍(lán)光濾過(guò)丙烯酸酯非球面IOL (PY60AD, HOYA)。使用Pentacam三維眼前節(jié)測(cè)量系統(tǒng)采集Scheimpflug圖像,及散瞳后前房深度,角膜散光大小及軸向。使用Image-pro plus6.0圖像分析IOL傾斜度和偏心值,裂隙燈數(shù)碼照相機(jī)照相評(píng)估IOL囊袋內(nèi)旋轉(zhuǎn)情況。 進(jìn)一步回顧性分析我院植入AR40e、Acrysof SA60AT和IRayner620H IOL各15眼。術(shù)后至少1個(gè)月行裂隙燈、視力和屈光狀態(tài)等常規(guī)檢查,并對(duì)IOL眼視覺(jué)質(zhì)量進(jìn)行OQAS測(cè)量。分析比較IOL眼客觀散射指數(shù)(Objective Scatter Index, OSI), MTF截止頻率(MTF Cut off),斯特爾比率(Strehl ratio, SR), Profile width at50%(50%PSF), Profile width at10%(10%PSF)和不同對(duì)比度視力(Visual Acuity, VA)。 利用Liou-Brennan眼模型和ZEMAX光學(xué)設(shè)計(jì)軟件(ZEMAX Optical Design Program)建立IOL眼模型,模擬植入+22D傳統(tǒng)球面IOL (AR40e,美國(guó)AMO公司),分別記錄3mm瞳孔直徑下、離焦為零時(shí)IOL不同的阿貝數(shù)、屈光指數(shù)及入射光波段下調(diào)制傳遞函數(shù)(Modulation transfer function, MTF)值及其變化曲線,分析阿貝數(shù)、屈光指數(shù)及入射光波段對(duì)IOL眼色差的影響。在IOL模型眼中模擬植/入+20D的Z9003IOL(美國(guó)AMO公司)和SN60WF IOL(美國(guó)Alcon),記錄3mm瞳孔直徑下、離焦為零時(shí)復(fù)合光源下產(chǎn)生的焦點(diǎn)移位距離,計(jì)算產(chǎn)生的色差性屈光度。 結(jié)果 傳統(tǒng)3.Omm小切口白內(nèi)障超聲乳化手術(shù)與2.Omm同軸微切口白內(nèi)障超聲乳化手術(shù),2組間術(shù)后1w SIA差異的比較有統(tǒng)計(jì)學(xué)意義(P0.05),而術(shù)后1mo SIA差異的比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2組術(shù)后1w與術(shù)后1mo前房深度的比較均有統(tǒng)計(jì)學(xué)意義(P0.05)。2組間前房深度比較有統(tǒng)計(jì)學(xué)意義(P0.05)。IOL偏心與傾斜在水平和垂直方向上的數(shù)值及差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),2組間術(shù)后1mo與術(shù)后1w比較旋轉(zhuǎn)度數(shù)的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 植入AR40e、Acrysof SA60AT和Rayner620H IOL術(shù)后至少1個(gè)月的人工晶體眼OQAS測(cè)量比較,所有IOLI眼的OSI總平均值為2.07±1.58,AR40e、SA60AT與620H三組患者平均OSI分別為1.68±1.09、1.88±1.02和2.11±1.15,組間差異有統(tǒng)計(jì)學(xué)意義(F=1.632,P=0.032)。三組患者平均SR、50%PSF和10%PSF比較,AR40e優(yōu)于其他兩組,差異有統(tǒng)計(jì)學(xué)意義(P分別為0.042,0.037和0.022)。在不同對(duì)比度視力下,三組患者9%對(duì)比度VA差異有統(tǒng)計(jì)學(xué)意義(P=0.043)。 在IOL眼模型中：(1)3mm瞳孔直徑,其他參量相同, IOL阿貝數(shù)越大,555nm單色光與470-650nm復(fù)色光下MTF值之間的差異逐漸越��；IOL眼在555nm單色光下的MTF值變化很小,但在470-650nm復(fù)色光下MTF值隨著阿貝數(shù)的增大而增大,且每?jī)烧唛g差異明顯；(2)3mm瞳孔直徑,其他參量相同,隨著IOL屈光指數(shù)增大,555nm單色光與470-650nm復(fù)色光下MTF值之間的差異逐漸增大,IOL眼在555nm單色光下的MTF值逐漸增大,在470-650nm復(fù)色光下的MTF值隨著屈光指數(shù)的增大而增大,但是隨著屈光指數(shù)的不斷增大MTF值的增加量逐漸減��；(3)3mm瞳孔直徑時(shí),在所有條件相同的情況下,入射光波段為510-650nm和470～650nm時(shí),Liou-Brennan模型眼的MTF曲線幾乎完全重合,前者的MTF值高于后者但差異很��；(4)3mm瞳孔直徑時(shí),復(fù)合光源下Z9003IOL產(chǎn)生1.66D的色差性屈光不正；而SN60WF IOL產(chǎn)生2.5D的色差性屈光不正。 結(jié)論 微切口預(yù)裝式藍(lán)光濾過(guò)非球面IOL具有良好的囊袋內(nèi)穩(wěn)定性,2.0mm同軸微切口術(shù)式有利于術(shù)后早期視力恢復(fù)。OQAS系統(tǒng)分析發(fā)現(xiàn)植入不同材質(zhì)和折射率的IOL對(duì)于術(shù)后IOL眼視覺(jué)質(zhì)量影響較大,相比而言疏水性折射率較低的IOL眼具有更好的視覺(jué)質(zhì)量。在IOL眼模型中分析發(fā)現(xiàn)IOL阿貝數(shù)越大、屈光指數(shù)越小,色差就越小,進(jìn)而IOL眼視覺(jué)質(zhì)量的影響就越��；藍(lán)光濾過(guò)型IOL與非藍(lán)光濾過(guò)型IOL對(duì)人眼的色差影響相當(dāng),植入高屈光指數(shù)低阿貝系數(shù)的IOL術(shù)后會(huì)產(chǎn)生更大的色差性屈光不正而降低人眼的視覺(jué)質(zhì)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.
【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】：2014
【分類(lèi)號(hào)】：R779.6
本文編號(hào)：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.
【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】：2014
【分類(lèi)號(hào)】：R779.6
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