Acri.Smart 36A非球面人工晶状体临床应用研究

目的探讨Acri.Smart36A非球面人工晶状体对人工晶状体眼视觉质量和波前像差的影响。方法选择老年性白内障患者24例30眼,随机分为2组,植入非球面设计的Acri.Smart36A人工晶状体(Acri.Smart36A组)15眼和植入球面设计的Acri.Smart46S人工晶状体15眼(Acri.Smart46S组),比较两组术后3个月最佳矫正视力、对比敏感度(眩光和无眩光条件下,6.3°、4.0°、2.5°、1.6°、1.0°空间频率下)、像差(尤其眼内球差)的差异。结果术后3个月,Acri.Smart36A组最佳矫正视力为0.87±0.16,Acri.Smart46S组为0.85±0.18,差异无统计学意义(P>0.05)。术后Acri.Smart36A组患者对比敏感度除眩光条件下1.0°及无眩光条件下1.6°空间频率之外其余各空间频率均较Acri.Smart46S组好(均为P<0.05)。术后Acri.Smart36A组总球差为(-0.060±0.355)μm,眼内球差为(-0.283±0.177)μm;Acri.Smart46S组总球差为(0.145±0.137)μm,眼内球差为(0.072±0.159)μm,差异均有统计学意义(均为P<0.05)。结论相较球面人工晶状体,Acri.Smart36A非球面人工晶状体能减少眼内球差,提高对比敏感度、眩光敏感度,提高视觉质量。     

非球面人工晶状体植入术后视觉质量的临床观察

目的 观察白内障超声乳化非球面人工晶状体植入术后视觉质量方面的临床效果.方法 选择65例(70只眼)年龄相关性白内障患者.随机分成两组,每组35只眼.在超声乳化术后,实验组植入非球面人工晶状体,对照组植入传统球面人工晶状体.并分别于术后1周、1月、3月检测两组裸眼远、近视力,最佳矫正远视力,最佳矫正远视力后的近视力,对比敏感度,波前相差,立体视觉.视功能与生存质量(VF/QOL)问卷调查等.结果 在术后1周、1月,两组裸眼远、近视力,最佳矫正远视力、最佳矫正远视力后的近视力比较无明显差异(P>0.05);术后3月两组裸眼远视力、最佳矫正远视力比较有明显差异(P<0.05);实验组裸眼近视力,最佳矫正远视力后的近视力明显优于对照组,差异有统计学意义(P<0.05);术后1月、3月,实验组在昼及昼眩光,夜及夜眩光的各频段对比敏感度(1.5cpd,3.0cpd,6.0cpa,12cpd,18cod)均明显优于对照组,差异有统计学意义(P<0.05);术后1月、3月,两组在瞳孔直径≥6mm时的三阶彗差、四阶球差、五阶次级彗差、高阶像差的均方根(RMS值)比较,实验组均低于对照组,两组差异具有统计学意义(P<0.05);术后1月、3月,两组在最佳矫正视力下的远、近立体视觉的比较.差异无统计学意义(P>0.05);术后3月,VF/QOL问卷调查显示两组近视力视觉相关活动、视力有关的感觉适应的比较.差异有统计学意义(P<0.05).结论 白内障超声乳化植入非球面人工晶状体与植入传统的球面人工晶状体相比,能够有效减少术后的高阶像差尤其是球差,提高对比敏感度,改善术后的视觉质量.     

非球面和球面人工晶状体植入术后高阶像差及对比敏感度的对比观察

目的 对比观察白内障超声乳化吸除分别植入非球面和球面人工晶状体术后患眼高阶像差及对比敏感度的差异.设计病例系列研究.研究对象单纯老年性白内障患者(除外其他眼病)76例(88眼),依照患者意愿,按照植入非球面或球面人工晶状体的类型不同分为两组:非球面人工品状体(KS-3Ai)组38例(45眼),球面人工晶状体(KS-3)组38例(43眼).方法 入选患者均行白内障超声乳化吸除术分别植入预装式非球面(Canon Staar KS-3Ai)或预装式球面(Canon staar KS-3)人工晶状体.术后3个月观察两组患者视力、最佳矫正视力、人工晶状体居中情况、屈光状态,波前像差仪检查瞳孔6 mm的高阶像差(包括四阶像差、球差、总高阶像差均方根、四阶彗差),检查患者的对比敏感度、眩光敏感度.主要指标最佳矫正视力,瞳孔6mm的四阶像差、球差、总高阶像差均方根、四阶彗差,对比敏感度、眩光敏感度.结果 瞳孔6 mm时非球面组球差(Z40)[(0.0182±0.2068)μm]低于球面组[(0.3254±0.1518)μm],差异有统计学意义(P=0.000).四阶像差均方根(RMS4)非球面组[(0.2620±0.1685)μm]低于球面组[(0.4633±0.2352)μm],二者差异有统计学意义(P=0.004).高阶像差均方根非球面组[(0.5406±0.2055)μm]低于球面组[(0.8137±0.4442)μm],二者差异有统计学意义(P=0.012).但两组间术后最佳矫正视力、对比敏感度及眩光敏感度差异均无统计学意义.结论 非球面人工晶状体(KS-3Ai)较普通的球面人工晶状体(KS-3)能够明显降低包括球面像差在内的高阶像差,但视力及对比敏感度并未发现明显差别.(眼科,2008,17:89-93)     

非球面和球面人工晶状体植入术后早期视觉质量的对比研究

目的 比较非球面和球面人工晶状体(intr.ocul.rlens,IOL)植入术后患者早期的视觉质量.方法 43例白内障患者接受超声乳化白内障吸出术后,左右眼分别植入球面(.lcon SN60.T)和非球面(.lton SN60WF)IOL,按照植入IOL的差异分为球面组和非球面组.术后3个月观察患者的裸眼视力、最佳矫正视力、屈光状态、IOL位置、高阶像差等指标,并加以比较分析.结果 术后3个月,球面与非球面组裸眼视力、最佳矫正视力分别为0.65±0.12、0.69±0.09;0.89±0.07、0.95±0.12.2组间裸眼视力、最佳矫正视力和屈光状态差异无统计学意义(P>0.05),无一例术中或术后发生并发症;瞳孔直径6 mm时,非球面组术眼的4阶球差明显低于球面组,3阶和5阶像差在2组间没有统计学差异;低对比度条件下18例患者认为非球面IOL眼比球面IOL眼视物清晰.结论 非球面IOL与球面IOL均可明显提高患者术后客观视力,但非球面IOL可以减少术眼的高阶像差尤其是球差,从而提高视觉质量.     

非球面人工晶体植入术后高阶像差对比研究

目的 与球面人工晶体比较观察Canon Staar公司KS-3Ai非球面人工晶体植入术后早期的临床效果。方法 2组病人进行常规的白内障超声乳化联合人工晶体植入术，术后一个月检查像差，裸眼和最佳校正视力。结果 KS-3Ai组术总高阶像（0．90±0．48um）、球差（0．22±0．17）uin和彗差（0．34±0．23）um低于球面人工晶体组（1．2±0．43）um、（0．46±0．20）um、（0．50±0．24um）。BCVA、UCVA和彗差、总高阶像差有相关性。结论 与球面人工晶体比较，KS-3AI非球面人工晶体植入术后球差、彗差和总高阶像差显著降低。非球面人工晶体可以减少白内障术后眼的正性球面像差，同时降低总高阶像差，提示高阶像差在术后视觉质量方面有一定的作用。     

球面与非球面人工晶状体植入的视功能学比较

目的 观察非球面人工晶状体植入视功能学方面的临床效果.方法 55例(60眼)老年性白内障,随机分成两组.试验组植入非球面人工晶状体,对照组植入传统球面人工晶状体,并分别于术后1周、1月、3月检测两组裸眼远、近视力,最佳矫正远视力,最佳矫正远视力后的近视力,对比敏感度,波前像差,立体视觉等.结果 在术后1周、1月,两组裸眼远、近视力,最佳矫正远视力、远视力最佳矫正状态下的近视力比较差异无统计学意义(P>0.05);术后3月,两组裸眼远、近视力,最佳矫正远视力、远视力最佳矫正状态下的近视力比较差异有统计学意义(P<0.05);术后1月、3月,试验组在昼间有无眩光及夜间有无眩光的各频段对比敏感度均明显优于对照组的各频段,差异有统计学意义(P<0.05);术后1月、3月,试验组的四阶球差及高阶像差均低于对照组,差异具有统计学意义(P<0.05);术后1月、3月,两组在最佳矫正视力下的远、近立体视觉的比较,差异无统计学意义(P>0.05).结论 非球面人工晶状体植入能减少球面像差,提高对比敏感度,改善术后的视觉质量.     

i-Trace全功能视觉分析仪对非球面人工晶状体视功能的评价

目的 研究白内障摘除植入非球面人工晶状体对全眼高阶像差及调制传递函数(modulation transfer function:MTF)的影响.方法 连续选取41例(60只眼)老年性白内障患者,根据病人植入人工晶体的意愿分为对照组(球面人工晶体组)30只眼和试验组(非球面人工晶状体组)30只眼.术后用i-Trace全功能视觉分析仪分析二组全眼、角膜、晶状体高级像差和球面像差及MTF值.结果 术后试验组与对照组裸眼远视力差异无统计学意义,全眼和晶状体的高阶像差及球面像差差异有统计学意义,角膜高阶像差及球面像差差异无统计学意义,二组间高阶像差及球面像差下MTF值差异有统计学意义.结论 白内障手术植入非球面人工晶状体比植入球面人工晶状体可减少全眼的高阶像差和球面像差,提高成像质量,增加病人满意度.     

i-Trace全功能视觉分析仪对非球面人工晶状体视功能的评价

目的 研究白内障摘除植入非球面人工晶状体对全眼高阶像差及调制传递函数(modulation transfer function:MTF)的影响.方法 连续选取41例(60只眼)老年性白内障患者,根据病人植入人工晶体的意愿分为对照组(球面人工晶体组)30只眼和试验组(非球面人工晶状体组)30只眼.术后用i-Trace全功能视觉分析仪分析二组全眼、角膜、晶状体高级像差和球面像差及MTF值.结果 术后试验组与对照组裸眼远视力差异无统计学意义,全眼和晶状体的高阶像差及球面像差差异有统计学意义,角膜高阶像差及球面像差差异无统计学意义,二组间高阶像差及球面像差下MTF值差异有统计学意义.结论 白内障手术植入非球面人工晶状体比植入球面人工晶状体可减少全眼的高阶像差和球面像差,提高成像质量,增加病人满意度.     

零球差非球面人工晶状体在高度近视眼中对比度视力与像差的研究

目的 研究高度近视患者晶状体摘除联合零球差非球面与球面人工晶状体植入术后暗环境对比度视力及波前像差差异.方法 在本前瞻性队列研究中,选择28例(44只眼)高度近视患者,按植入的人工晶状体类型分成2组,试验组23只眼,植入零球差非球面人工晶状体Akreos AO (Bausch&Lomb,Inc),对照组21只眼,植入球面人工晶状体(Rayner SuperflexTM 620H);于手术术后3个月时测量最佳矫正视力,角膜像差,全眼像差及暗环境下对比度视力.结果 (1)试验组与对照组各参数比较;年龄[(52.6±5.7)岁vs.(54.1±5.9)岁,P=0.281)]、眼轴长度[(30.21±2.06) mm vs.(31.03±2.03) mm,P=0.289]、手术前最佳矫正视力(4.68±0.10 vs.4.63±0.12 P=0.248)、人工晶状体度数[ (4.8±2.98)D vs (3.42±3.83)D,P=0.235]、术后等效球镜度数[(-2.53±1.25)D vs(-2.12±0.70)D,P=0.273]手术后最佳矫正视力(4.83±0.15 vs.4.76±0.15 P=0.211)均无统计学意义(P＞0.05).(2)像差比较(6 mm瞳孔直径):术后角膜球差[(0.27±0.18) μm vs (0.28±0.16) μm,P=0.905)]、全眼球差[(0.23±0.14)μm vs (0.32±0.16)μm,P=0.144)]、全眼总高阶像差[ (1.46±0.48)μm vs(1.14±0.50) μm,P=0.277]、彗差[(0.68±0.45) μm vs (0.73±0.48) μm,P =0.782]、三叶草[(0.55±0.15) μm vs (0.42±0.16) μm,P=0.377)]差异均无统计学意义(P＞0.05).(3)暗环境下对比度视力:100％对比度视力(0.16±0.19vs.0.19±0.17 P=0.64) 25％对比度视力(0.39±0.20 vs.0.47±0.22 P=0.31)、10％对比度视力(0.65±0.29vs.0.78±0.31 P=0.22)、5％对比度视力(0.90±0.24 vs.0.99±0.27 P=0.40)亦均无统计学意义(P＞0.05).结论 (1)零球差非球面低度数人工晶状体植入高度近视患者,与低度数球面人工晶体比较,术后球差和像差值无减少.(2)零球差非球面人工晶状体植入高度近视患者后,夜间对比度视力未好于球面人工晶状体.     

非球面和球面人工晶状体植入术后高阶像差的比较

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。     

白内障手术植入球面和非球面人工晶状体后视觉质量的比较

目的 评估白内障手术植入负球差设计的非球面折叠式人工晶状体(Intraocularlen,IOL)后的视觉质量.方法 取112例(152只眼)白内障超声乳化手术患者按数字表法被分为三组,第一组植入TecnisZ9003IOL(美国 AMO 公司),第二组植入AcrysofIQIOL(美国Alcon公司),第三组植入HQIOL(法国Hexavision公司).于术后一周、一月、三月分别检测裸眼视力、最佳矫正视力,无眩光及有眩光环境下的白天夜晚对比敏感度,同时检测全眼的球差、第三、第四、第五阶像差均方根(root mean square,RMS)、总高阶像差(higher-order aberration,HOA)RMS以及总像差(total ocular aberration,TOA)RMS.结果 术后三次随访三组患者的裸眼视力和最佳矫正视力差异均没有统计学意义.术后一周、一月时三组白天对比敏感度未见显著差异,术后一月、三月时TecnisZ9003组和AcrysofIQ组的夜间对比敏感度在中、低空间频率上明显好于HQ组,同时术后三月时该两组的白天对比敏感度亦好于HQ组,差异均具有统计学意义(P＜0.05).另外,术后三次随访TecnisZ9003组和AcrysofIQ组全眼的球差、RMS4均低于HQ组,在术后一月、三月时HOA较HQ组低,同时术后三次随访在瞳孔直径6mm大小时TOA亦较低,差异均有统计学意义(P＜0.05).结论 植入负球差设计的非球面人工晶状体可提高白内障患者术后对比敏感度,降低球差和高阶像差,获得更好的视觉质量.     

白内障手术植入球面和非球面人工晶状体后视觉质量的比较

目的 评估白内障手术植入负球差设计的非球面折叠式人工晶状体(Intraocularlen,IOL)后的视觉质量.方法 取112例(152只眼)白内障超声乳化手术患者按数字表法被分为三组,第一组植入TecnisZ9003IOL(美国 AMO 公司),第二组植入AcrysofIQIOL(美国Alcon公司),第三组植入HQIOL(法国Hexavision公司).于术后一周、一月、三月分别检测裸眼视力、最佳矫正视力,无眩光及有眩光环境下的白天夜晚对比敏感度,同时检测全眼的球差、第三、第四、第五阶像差均方根(root mean square,RMS)、总高阶像差(higher-order aberration,HOA)RMS以及总像差(total ocular aberration,TOA)RMS.结果 术后三次随访三组患者的裸眼视力和最佳矫正视力差异均没有统计学意义.术后一周、一月时三组白天对比敏感度未见显著差异,术后一月、三月时TecnisZ9003组和AcrysofIQ组的夜间对比敏感度在中、低空间频率上明显好于HQ组,同时术后三月时该两组的白天对比敏感度亦好于HQ组,差异均具有统计学意义(P＜0.05).另外,术后三次随访TecnisZ9003组和AcrysofIQ组全眼的球差、RMS4均低于HQ组,在术后一月、三月时HOA较HQ组低,同时术后三次随访在瞳孔直径6mm大小时TOA亦较低,差异均有统计学意义(P＜0.05).结论 植入负球差设计的非球面人工晶状体可提高白内障患者术后对比敏感度,降低球差和高阶像差,获得更好的视觉质量.     

正常瞳孔下非球面与球面人工晶状体眼高阶像差对比观察

目的 探讨正常瞳孔下非球面及球面晶状体眼高阶像差的差别,分析计算非球面与球面晶状体消除球面像差的差值,以客观评价非球面人工晶状体的临床效果.方法 回顾性临床对照研究.选取2010年1～4月在深圳市眼科医院行白内障超声乳化联合人工晶状体植入术的患者50例(66只眼).病人进行随机分组,分别植入非球面人工晶状体(KS-AIN)和球面人工晶状体(KS-X).术后1月正常瞳孔下(3～5mm),由itrace波前像差仪测量高阶像差及i-trace3.1软件模拟瞳孔直径3mm及5mm的调制传递函数值MTF.运用两样本t检验进行比较分析.结果 正常瞳孔下非球面组球面像差小于球面组,其差异具有统计学意义(P<0.05);非球面晶状体与球面晶状体相比较可消除球面像差(0.069 ±0.026)μm(D-Value);非球面组高阶像差均方根小于球面组,但差异无统计学意义(P>0.05);彗差、三叶草比较亦无统计学意义(P>0.05);3mm瞳孔下两组晶状体MTF值的比较仅在空间频率5周/度差异有统计学意义(P<0.05).5mm瞳孔下非球面晶状体眼在各空间频率的MTF值均好于球面晶状体眼,比较有统计学意义(P<0.05).结论 正常瞳孔下非球面人工晶状体眼与球面人工晶状体相比,可以有效减少球面像差,提高部分空间频率的对比敏感度,使患者拥有更好地视觉质量,但其不能体现可以减少术眼高阶像差的优势.

Abstract：

Objective To compare the high order aberrations between implantations of aspherical and spherical intraocular lens with normal pupil diameter, calculate and analyze the differences in spherical aberration between the eyes implanted with aspherical and spherical intraocular lens in order to assess the visual quality and investigate the clinical results. Methods Fifty patients(66 eyes)with cataract underwent surgery from Jan 2010 to Apr 2010, and were divided into 2 groups randomly. Group 1: unifocal and aspherical intraocular lens(negative aberration KS-AIN), Group2: unifocal and spherical intraocular lens(KS-X). Sixty-six eyes were included in this study. The aberrations at normal pupil diameter(interval 3mm-5mm)were measured with the i-Trace wavefront aberrometer. Modulation transfer functions were collected at 3mm and 5mm pupil size. Independent-Samples t Test was used to analyze the data. Results No post-operative complication occurred in each group. The average uncorrected visual acuity(UCVA)was ≥ 0.5, and the average best corrected visual acuity(BCVA)was ≥ 0.6. With normal pupil diameter(mean 3.73± 0.49mm), aspheric IOL group showed less spherical aberration than spherical IOL group with statistical significance(P =0.0040.05, t =-3.216), the difference value(D-value)of spherical aberration was 0.069± 0.026?m. Also aspheric IOL group showed less aberration than spherical IOL group in total higher-order root-mean-square(total HOA RMS)values, but with no statistical difference(P >0.05). There were no significant differences in coma and trefoil values between each group(P >0.05). With 3mm pupil diameter, aspheric IOL group provided a statistically better contrast sensitivity only in 5 cycle/degree while a statistically better contrast sensitivity in all spatial frequencies with 5mm pupil diameter. Conclusions The aspheric lens provides the patients better quality of vision at normal pupil size compared to spherical lens because of the decreased spherical aberration and a better contrast sensitivity in part frequencies. However, aspheric lens cannot express its superiority in decreasing total HOA RMS with normal pupil diameter.     

Contrast sensitivity after implantation of a spherical versus an aspherical intraocular lens in biaxial microincision cataract surgery

PURPOSE: To determine whether implantation of a microincision intraocular lens (IOL) with a modified anterior surface, designed to compensate for the positive spherical aberration of the cornea in eyes of cataract patients, results in improved pseudophakic quality of vision in pseudophakic eyes after biaxial microincision phacoemulsification. SETTING: Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. METHODS: In a nonrandomized parallel cohort investigation, the visual performance of 52 eyes of 52 patients unilaterally implanted with the aspherical Acri.Smart 36 A IOL (Acri.Tec) were compared with those of 25 eyes of 25 age-matched patients unilaterally implanted with the spherical Acri.Smart 46 S IOL (Acri.Tec). Eight weeks after surgery, the following parameters were assessed: uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), pupil size under various illumination conditions, high-contrast and low-contrast visual acuities, photopic and mesopic contrast sensitivities, capsulorhexis size, and wavefront aberration of the cornea and eye. The primary clinical endpoint of the comparison was defined as the area under the cycles per degree (cpd) curve of the contrast sensitivity profile. RESULTS: The aspherical IOL group and the spherical IOL group did not differ in baseline characteristics. The median age was 71 years and 68% were women in the aspherical group versus 69 years and 62% women in the spherical group. The preoperative median UCVA was 20/80 in both groups. The UCVA, BCVA, pupil size, and capsulorhexis size were not statistically different between the 2 groups. Furthermore, no clinically relevant or statistically significant between-group differences were observed in the primary clinical endpoint. The median postoperative low mesopic contrast sensitivity without glare was 73 cpd in the aspherical group and 84 cpd in the spherical group (P = .624); a similar tendency was observed under high mesopic conditions (median 80 cpd and 83 cpd, respectively) (P = 1.000). Implantation of both IOL types resulted in a negative spherical aberration Z(4)(0), which was significantly different between the 2 groups (median -0.09 mum aspherical and -0.29 microm aspherical at a pupil size of 4.5 mm) (P<.001). CONCLUSIONS: No clinically relevant postoperative differences in contrast sensitivity were observed between the aspherical microincision IOL and the spherical equivalent model. The development of microincision IOLs, which fit through corneal incisions smaller than 2.0 mm and improve night-driving conditions (eg, reduction of glare), could optimize modern biaxial cataract surgery.     

Spherical aberration after implantation of an aspheric versus a spherical intraocular lens in high myopia

Purpose: To compare visual performance and wavefront aberration in high myopia implanted with an aspheric intraocular lens (IOL) and a spherical IOL. Methods: In this prospective investigation, 31 highly myopic patients were randomized to receive two IOL types: aspheric IOL (Acri.Smart 36A, 22 eyes) and spherical IOL (Rayner Superflex 620H, 23 eyes). Complete ophthalmological examination including best‐corrected visual acuity (BCVA) and corneal aberration (Humphrey corneal topography) were performed preoperatively, 1 and 3 months postoperatively. Ocular aberration (WASCA wavefront analyser) was performed 1 and 3 months postoperatively. Contrast sensitivity under different lighting condition (CSV‐1000) was performed 3 months postoperatively. Results: The aspheric IOL group and the spherical IOL group did not differ in baseline characteristics, including corneal spherical aberration Z₄⁰ (for 5‐mm pupil diameter 0.13 ± 0.06 vs. 0.15 ± 0.08 µm, P = 0.317; for 6‐mm pupil diameter 0.30 ± 0.11 vs. 0.29 ± 0.13 µm, P = 0.764). Compared with the spherical IOL group, the aspheric IOL group showed statistically significant less induction of Z₄⁰ of total ocular aberration at a pupil size of 5 and 6 mm 3 months postoperatively (0.07 ± 0.06 vs. 0.12 ± 0.06 µm, P = 0.017; 0.17 ± 0.11 vs. 0.27 ± 0.12 µm, P = 0.010), but not for 4‐mm pupil (0.03 ± 0.04 vs. 0.02 ± 0.04 µm, P = 0.54). The BCVA and contrast sensitivity were not statistically different between the two groups postoperatively. Conclusions: The aspheric IOL induces significantly less spherical aberration than the spherical IOL after implantation in high myopia. Implantation of an aspheric IOL may reduce spherical aberration in high myopia, but clinically superior vision is not achieved.     

Microincision cataract surgery with implantation of an Acri. Smart 48S lens

PURPOSE: To evaluate visual and refractive outcome and complications after microincision cataract surgery (MICS) with implantation of an Acri.Smart 48S intraocular lens (IOL). MATERIAL AND METHODS: This study comprised 22 eyes of 11 patients having bilateral microincision cataract surgery. MICS was performed through a 1.4 mm clear corneal incision using the MacKool System and low ultrasound power. The IOL was implanted through a 1.7 or smaller clear corneal incision with a Acri.Smart Glide System. The final size of the clear corneal incision, postoperative uncorrected and best corrected distance visual acuity, best corrected near visual acuity (Snellen, Jaeger Table), astigmatism, pseudoaccommodation possibility of Acri.Smart 48S IOL, complications and patient satisfaction were analyzed. The follow up was 1 month. RESULTS: The Acri.Smart 48S lens was implanted through mean incision of 1.56 +/- 0.07 mm. One month after surgery the mean uncorrected distance visual acuity (UCVA) and the best corrected visual acuity (BCVA) significantly improved (UCVA: preoperatively--0.49 +/- 0.33; postoperatively--0.97 +/- 0.11; p < 0.001; BCVA: preoperatively 0.68 +/- 0.3; postoperatively--1.0; p < 0.001) as well as BCVA for near (BCVA: preoperatively--5.27 +/- 3.30; postoperatively--2.91 +/- 1.48; p = 0.002). One month after surgery, there was not significant increase of astigmatism and the pseudoaccommodative ability of Acri.Smart 48S was not observed. There were no serious intraoperative and postoperative complications. All the patients were highly satisfied with the quality of the vision. CONCLUSIONS: Our preliminary results show that MICS with Acri.Smart 48S lens implantation is safe and effective procedure. This conclusion has to be confirmed by studies with longer follow up period and larger series of patients.     

微切口超声乳化加非球面人工晶状体植入治疗白内障的临床评价

目的:探讨超声乳化联合非球面人工晶状体植入对白内障患者术后视觉质量的影响.方法:年龄相关性白内障患者(50例63眼)随机分为试验组25例33眼和对照组25例30眼,两组患者手术方法相同,试验组植入非球面人工晶状体,对照组植入球面人工晶状体;比较术后裸眼视力、最佳矫正视力,并检查两组患者对比敏感度和像差.结果:术后1wk;1,3mo两组患者裸眼视力相比差异无统计学意义(P＞0.05),术后3mo两组最佳矫正视力相比差异亦无统计学意义(P＞0.05).在非眩光和眩光条件下,两组患者在3.0,6.0,12.0,18.Ocd频段下对比敏感度比较差异无统计学意义(P＞0.05);在1.5cd频段下,试验组对比敏感度值显著高于对照组,组间比较差异具有统计学意义(P＜0.05);术后3 mo试验组球差、彗差均显著低于对照组,两组间比较差异具有统计学意义(P＜0.05).结论:非球面人工晶状体在低频段对比敏感度显著优于球面人工晶状体,并能够降低白内障患者术后的总像差,从而提高白内障患者术后的视觉功能.     

Visual acuity and contrast sensitivity comparison between Tecnis and AcrySof SA60AT intraocular lenses: A multicenter randomized study

PURPOSE: To evaluate best corrected visual acuity (BCVA) and photopic and mesopic contrast sensitivity in pseudophakic patients implanted either with the aspheric intraocular lens (IOL) designed to correct for corneal spherical aberration or with a conventional IOL. SETTING: Three surgical centers participated this prospective randomized masked comparative study. METHODS: Thirty eyes of 30 patients after aspheric lens implantation (Pfizer/Pharmacia Tecnis Z9000) were compared with 30 eyes of 30 age-matched patients after conventional lens implantation (Alcon AcrySof SA60AT). Two to three months after surgery, best spectacle corrected distance visual acuity was measured using the Early Treatment Diabetic Retinopathy Study chart. Contrast sensitivity was measured by sinusoidal grating charts for distance at photopic (85 cd/m(2)) and mesopic (6 cd/m(2)) luminance level with optical correction in place. Tested spatial frequencies were 1.5, 3, 6, 12, and 18 cycles per degree (cpd). RESULTS: The mean BCVA was -0.053 +/- 0.044 logMAR in eyes with the aspheric Tecnis IOL and 0.006 +/- 0.059 logMAR in eyes with the conventional AcrySof IOL (P=.0001). Eyes with the aspheric IOL showed better contrast sensitivity at spatial frequencies of 3 cpd (P<.05) and 6, 12, and 18 cpd (P<.01) in photopic and in mesopic conditions. Peak improvement occurred at 18 cpd and was 36% (0.29 log units) in photopic and 54% (0.27 log units) in mesopic conditions. CONCLUSIONS: The aspheric Tecnis IOL yielded better BCVA and better distance contrast sensitivity than the conventional IOL. The differences were clinically significant for higher spatial frequencies. The results give some suggestions for further studies.     

不同类型非球面人工晶状体植入眼的波前像差的对比研究

目的 通过对在白内障术中植入四种非球面人工晶状体（intraocular lens,IOL）（Z9003、Acrysoft SN60WF、KS-3Ai和Acri.smart 36A）的患眼进行波前像差和对比敏感度的比较分析,以客观评价非球面人工晶状体的临床效果。方法 选取2007年3月至2007年9月间到我院进行白内障超声乳化联合人工晶状体植入术的患者91例（114眼）,年龄在60~70岁之间,平均年龄（64.4±5.0）岁。将其随机分成5组：Ⅰ组Tecnis Z9003（AMO）,22例（27眼）;Ⅱ组Acrysoft SN60WF（Alcon）,24例（30眼）;Ⅲ组KS-3Ai（Canon Staar）,18例（25眼）;Ⅳ组Acri.Smart 36A（ACRI.Tec）,10例（12眼）;Ⅴ组AR40e（AMO）,17例（20眼）。植入的人工晶状体度数为18.50~25.50 D,平均为（21.16±2.53）D。术后第3个月检测患者的主观症状、视力情况、波前像差和对比敏感度。运用方差分析方法对各组的波前像差及对比敏感度进行两两比较分析。结果 术后3个月内均未发现任何并发症和后发障,而且IOL亦无偏心和倾斜。各组裸眼视力均≥4.8,最佳矫正视力均≥4.9。（1）不同瞳孔直径下（4、5、6 mm）,四组非球面IOL的球面像差（Z40）＜球面IOL组（P＜0.05）,四组非球面IOL之间球面像差（Z40）差异无统计学意义,但有如下趋势：Ⅰ组〈Ⅱ组〈Ⅳ组〈Ⅲ组,在对比敏感度（wog、wg、readaption test）的比较中与球差的趋势相同。（2）不同瞳孔直径下（4、5、6 mm）,四组非球面IOL第三阶像差均方根（3th-order RMS）与球面IOL组差异无统计学意义（P＞0.05）,显示了五组IOL均有良好的囊袋稳定性。（3）不同瞳孔直径下（4、5、6 mm）,四组非球面IOL的四阶像差均方根（4th-order RMS）＜球面IOL组（P＜0.05）,四组非球面IOL之间的第四阶像差均方根（4th-order RMS）差异无统计学意义（P＞0.05）。（4）在瞳孔直径为4 mm和5 mm时,非球面IOL组与球面IO