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)     

非球面人工晶状体植入术后视功能的临床研究

目的:评价Canon Staar KS—3Ai非球面人工晶状体(IOL)对提高年龄相关性白内障患者术后视功能的作用。方法:年龄相关性白内障患者98例(126眼)随机分成两组。在白内障超声乳化吸除术后,观察组52例(65眼)植入非球面IOL(Canon Staar KS—3Ai),对照组46例(61眼)植入球面IOL(Allergan Sensor AR40e)。观察患者术后的裸眼视力(uncorrected visual activity,UCVA)、最佳矫正视力(best corrected visual activity,BCVA)、屈光状态、对比敏感度(contrast sensitivity,CS)、波前像差的均方根(root mean square,RMS)值。随访时间为术后6mo。结果:术后6mo两组UCVA、BCVA、屈光状态差异无统计学意义。无眩光环境下12,18c/d空间频率和眩光环境下6,12,18c/d空间频率上观察组CS明显优于对照组。在瞳孔直径6mm时,观察组4阶像差、4阶球差、总高阶像差RMS值低于对照组。在瞳孔直径6mm时3阶像差、5阶像差RMS值及瞳孔直径3mm时两组高阶像差RMS值差异无统计学意义。结论:非球面IOL眼视觉质量明显优于球面IOL眼。     

非球面人工晶状体植入术后的高阶像差观察

目的 探讨Canon Staar KS-3Ai非球面人工晶状体及Canon Staar KS-3球面人工晶状体植入术后，两组之间人眼波前像差的差异。方法 老年性白内障患者71例（80眼），随机分为两组，每组40眼，行超声乳化白内障吸除术联合人工晶状体植入术，分别植入Canon Staar KS-3Ai非球面人工晶状体及CanonStaarKS-3球面人工晶状体，术后3个月做波前像差检查。测量人工晶状体眼的球差、第三、第四、第五、第六阶像差及总体高阶像差，对检查结果进行T检验。结果 瞳孔直径在5．0mm状态下Canon Staar KS-3Ai非球面人工晶状体组的球差、第四、第五、第六阶像差及总体高阶像差均明显低于Canon Staar KS-3球面人工晶状体组，两组间差异具有统计学意义（P〈0．05）.结论 非球面人工晶状体眼视觉质量明显优于球面人工晶状体眼。     

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.     

非球面人工晶状体植入术后视觉质量对比分析

目的:评价3种非球面人工晶状体(AcrySof SN60WF、TecnisZ9001和KS-3Ai)植入术后的视觉质量。方法:采用前瞻性随机对照研究方法,收集我院老年性白内障手术患者88例126眼,平均年龄67.3±8.7岁,将入选患者按植入不同的人工晶状体(Intraocular lens,IOL)随机分为4组:AcrySofSN60WF(IQ)组(23例33眼)、TecnisZ9001组(23例33眼)、KS-3Ai组(20例29眼),SN60AT球面人工晶状体组为对照组(22例31眼)。术后随访3mo,观察指标:裸眼视力(uncorrected visual acuity,UCVA)及最佳矫正视力(best corrected visual acuity,BCVA),眼压,等效球镜度数,角膜Q值,瞳孔直径,6mm全眼球总高阶像差及四阶球差均方根值(root mean square,RMS),夜光、昼光及夜眩光3种视觉条件下的对比敏感度(contrast sensitivity,CS)。结果:术后各组的UCVA、BCVA、等效球镜度数和瞳孔直径均无统计学差异。总高阶像差和四阶球差RMS:非球面组低于球面组,差异具有统计学意义(P<0.05);非球面组间比较无统计学差异。术后角膜Q值与球差成正相关(r=0.183,P<0.05)。术后对比敏感度:与球面IOL相比,IQ,Tecnis可提高术后3种视觉条件下的CS,KS-3Ai可提高术后夜光、夜眩光两种视觉条件下的CS;非球面IOL组间比较,IQ组在昼光、夜眩光视觉条件下的CS好于Tecnis组和KS-3Ai组,TECNIS组和KS-3Ai组之间在3种视觉条件下均无统计学差异。结论:3种非球面IOL均可有效地减少术眼的总高阶像差和四阶球差。3种非球面IOL均可以提高术眼术后的CS,IQ组在昼光、夜眩光视觉条件下的CS与Tecnis组和KS-3Ai组相比较差异具有统计学意义,Tecnis组和KS-3Ai组之间在3种视觉条件下的CS均无统计学差异。     

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     

非球面与球面人工晶状体在不同全眼球差下调制传递函数的比较

目的比较不同非球面和球面人工晶状体（IOL）在不同全眼球差和空间频率下的高阶像差调制传递函数（MTF）值,为非球面IOL的球差设计及人眼的最佳球差值提供理论基础。方法选取白内障术后3个月相同材料、不同设计的非球面IOL共102眼（其中Z9003IOL40眼,PY60ADIOL20眼,920HIOL15眼,AkreosAOIOL15眼,IQIOL12眼）和球面IOL共60眼（其中AR40eIOL40眼,YA60BBIOL20眼）进行iTrace视觉功能分析仪检查,记录6mm瞳孔直径下的全眼高阶像差成分及MTF值,将非球面IOL组根据全眼球差的大小和方向分组,连同球面IOL组比较不同频率下各组高阶像差的MTF值。结果在不同全眼球差下,非球面IOL各组总高阶像差值比较,差异有统计学意义（P〈0.05）,而彗差和三叶草像差间差异无统计学意义（P〉0.05）。除15cpd外,其他空间频率下球差0.05～0.15μm组非球面IOL的MTF值最高,但各组间差异无统计学意义（P〉0.05）。在低空间频率下,0.05μm≤球差〈0.15μm组和0.15μm≤球差〈0.5μm组比较MTF值差异有统计学意义（P〈0.05）。非球面IOL和球面IOL的全眼高阶像差各成分及不同空间频率MTF值的比较,差异均有统计学意义（P〈0.05）。结论非球面IOL组较小的眼内球差较球面IOL组对MTF有更大的提高作用。对于非球面IOL植入术后6mm瞳孔直径下全眼球差在0.05～0.15μm,即＋0.1μm左右可能具有更好的客观视觉质量。     

两种不同非球面人工晶状体眼像差与视觉质量的研究

目的 比较植入两种不同非球面人工晶状体(intraocular lens,IOL)的老年性白内障患者术后的视觉质量以及像差与瞳孔变化的关系.方法 取66例单纯性老年性白内障患者66只眼,33只眼随机植入眼力健公司的TECNISZA9003,33只眼植入博士伦公司的ADAPT-AO,术后3个月观察患者的裸眼视力,最佳矫正视力(BCVA),3mm及5mm瞳孔下的总4阶球差,总彗差,总高阶像差,内眼4阶球差,及角膜的4阶球差,测量患者在白天,白天加眩光,夜间,夜间加眩光四种背景下的对比敏感度(CS).对数据进行两组独立样本非参数检验.结果 瞳孔由3mm到5mm,两组角膜球差,总彗差,总高阶像差显著增大,差异有统计学意义;TECNIS组总球差与ADAPT-AO组内眼球差随瞳孔增大无显著变化,差异无统计学意义.两种瞳孔直径下ADAPT-AO组总高阶与总球差大于TECNIS组,差异有统计学意义;两种瞳孔直径下两组角膜球差与总彗差差异无统计学意义.在白天,白天加眩光,夜间,夜间加眩光四种背景模式下,各空间频率CS差异均无统计学意义.结论 与ADAPT-AO非球面IOL眼相比,ZA9003非球面IOL在大瞳孔和小瞳孔下都能降低全眼球差与高阶像差,但两组对比敏感度差异无统计学意义.     

蓝光滤过型非球面人工晶状体植入术后高阶像差及MTF值临床对比观察

目的 对比观察白内障超声乳化联合植入蓝光滤过型非球面人工晶状体(intraocular lens,IOL)术后3个月的高阶像差及MTF值.方法 单纯年龄相关性白内障92例,依照患者意愿植入PY-60AD,AcrysofIQ,YA-60BB分为Ⅰ组Ⅱ组Ⅲ组,进行白内障超声乳化联合人工晶状体植入术.术后三个月利用波前像差仪i-Trace比较3mm,4mm,5mm,6mm瞳孔直径下各组球差(Z40),慧差(coma),总高阶像差(HOAs)的均方根 (the root meansquare,RMS)及3mm,5mm瞳孔直径下调制解调函数(modulation transferfunction,MTF).结果 ①波前像差检查,在各瞳孔直径下,两组非球面IOLZ40＜球面IOL,且差异具有统计学意义(P＜0.05).两组非球面IOL之间Z40差异无统计学意义(P＞0.05).②各瞳孔直径下三组IOL间coma差异无统计学意义(P＞0.05).③在各瞳孔直径下,两组非球面IOL高阶像差均方根(RMSh)＜球面IOL,但瞳孔直径在＜5mm下,差异无统计学意义(P＞0.05);瞳孔直径5mm下,差异有统计学意义(P＜0.05).在各瞳孔直径下,两组非球面IOL之间RMSh差异无统计学意义(P＞0.05).④3mm瞳孔直径下,去除低阶像差的MTF值每周5,10,15,20,25,30度(cyclesperdegree,cpd)六个空间频率下,两组非球面IOLMTF值＞球面IOL,三组间差异无统计学意义(P＞0.05).5mm瞳孔直径下,去除低阶像差的MTF值在5,10,15,20,25,30cpd六个空间频率下两组非球面IOL＞球面IOL,除30cpd外差异均有统计学意义(P＜0.05);两组非球面IOL间MTF值Ⅱ组＞Ⅰ组,差异无统计学意义(P＞0.05).结论 蓝光滤过型非球面人工晶状体在3mm瞳孔直径下可以明显降低球差,在5mm瞳孔直径下可以明显降低总高阶像差,从而使患者获得更好的视觉质量.且HOYAPY-60AD为预装式具有使用方便,减少人工晶状体装载过程中污染机会等优点,适于临床广泛应用.     

视觉质量分析仪 KR-1 W指导非球面 lOL个性化植入的可行性评估

目的：探讨依据视觉质量分析仪KR-1 W测量患者超声乳化白内障吸除术前角膜球差,指导相对个性化的植入非球面人工晶状体(intraocular lens,IOL),使其术后全眼球差接近于0.1μm的可行性。方法：前瞻性病例系列研究。对73例100眼年龄相关性白内障患者行超声乳化白内障吸除联合非球面IOL植入术,术前1d利用视觉功能分析仪KR-1W测量6.0mm瞳孔直径的角膜球面像差,为使患者术后总球差接近于0.1μm,分别对术前角膜球差小于0.15μm 患者植入Sofport Advanced Optic IOL(AO组,9例16眼),0.25~0.3μm者植入AcrySof IQ IOL ( IQ组,45例57眼),大于0.35μm者植入Tecnis ZA9003 IOL( Tecnis组,19例27眼)。患者均行2.75 mm透明角膜切口的超声乳化白内障吸除联合非球面IOL植入术,术后3mo观察患者的裸眼视力、最佳矫正视力、6.0mm瞳孔直径时的全眼及内眼(主要是IOL)球差。采用t检验和方差分析对获得的数据进行统计学分析。结果：术后所有患者6.0mm 瞳孔直径时的全眼球差为0.084 ± 0.032μm;Tecnis 组：0.091 ± 0.021μm;AO 组：0.0814±0.013μm;IQ组：0.093±0.042μm。所有患者术后全眼球差的预测值与实际值的差异无统计学意义(t=1.932,P=0.061);所有患者全眼球差的预测值与实际值的差值为0.013±0.041μm,差异无统计学意义( F=2.537,P=0.091)。术后3组患者的裸眼视力、最佳矫正视力比较,差异均无统计学意义(F=0.897,P=0.421;F=1.423,P=0.097)。结论：根据视觉质量分析仪KR-1 W给定的角膜球差植入合适的非球面IOL,术后均能够获得较满意的目标球差,提示视觉质量分析仪KR-1 W可为个性化植入非球面IOL提供临床依据。     

非球面人工晶状体与球面人工晶状体的比较

随着波前像差技术的发展,人们对影响白内障术后视功能的因素有了更深刻的认识,设计出旨在降低人工晶状体眼球面像差从而提高视功能的非球面人工晶状体。现就非球面人工晶状体眼与球面人工晶状体眼相比,在视功能、波前像差等方面有何差异,非球面晶状体的优越性,以及影响优越性表现的因素综述如下。     

Super-reversed intraocular lens

An intraocular lens (IOL) with an inverse (reversed) optic has the convex surface directed toward the retina, a design which has many advantages. We have developed a "super-reversed" IOL by increasing the angle of the haptic from 10 to 20 degrees and by increasing the convexity of the posterior surface (necessitating a concave anterior surface). The main advantage of this model is the distance of approximately 6.3 mm between the anterior corneal surface and the posterior IOL surface. This configuration mimics the natural situation. We report on the implantation of 473 lenses of this design.     

防紫外线人工晶状体

防紫外线人工晶状体（UVIOL）伴随着白内障手术及人们生活水平的提高而不断完善,以期达到同人晶状体同样的功能。为防止紫外线对视网膜的危害,防紫外线人工晶状体在生物材料选择、老化、评价指标以及各种激光和电离辐射对其产生的影响等多方面进行了研究。     

Clinical Characteristics of recurrent intraocular lens dislocation after scleral-fixated sutured intraocular lens and long-term outcomes of intraocular lens re-fixation

Graefe's Archive for Clinical and Experimental Ophthalmology - This study aimed to investigate the clinical characteristics of patients with recurrent intraocular lens (IOL) dislocation after...     

Comparing corneal outcome between femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery in Fuchs’ endothelial dystrophy patients: a randomized pilot study with 6 months follow up

AIM: To compare the corneal outcome in Fuchs’ endothelial dystrophy (FED) patients between femtosecond laser-assisted cataract surgery (FLACS) and conventional phaco surgery (CPS). METHODS: This was a randomized controlled study comparing one eye surgery by FLACS and the contralateral eye operated by CPS (stop and chop technique) in FED patients. Central corneal thickness, corneal light backscatter, corneal densitometry, and central corneal endothelial cell count and hexagonality (noncontact endothelial cell microscope) and CDVA were assessed preoperatively and at day 1, 40, and 180 postoperatively. RESULTS: Totally 31 patients (16 women) were included. At day 40 postoperatively, the mean endothelial cell loss (ECL) was 23.67% by FLACS and 17.30% by CPS (P=0.53). At day 180 postoperatively, ECL was 25.58% in FLACS and 21.32%in CPS (P=0.69). Densitometry data in all layers and all annuli from anterior layer to posterior layer in annuli 0-2, 2-6,6-10 and 10-12, total densitometry with all layers and all annuli was performed. A significant difference was found in 6-10 (posterior layer) at day 1 with -1.42 GSU (95CI: -2.66 to -0.19) P=0.02. In 10-12 (anterior layer, central layer and all layers) at day 40 were significant different with 7.7 (95CI: 1.89 to- 13.50) P=0.009, 3.97 (95CI: 0.23 to 7.71) P=0.03, 4.73 GSU (95CI: 0.71 to 8.75), respectively P=0.02. In the remaining parameters we found no difference between the two groups (P>0.05). Three CPS eyes suffered from corneal decompensation. CONCLUSION: There is no significant difference in corneal outcome between FLACS and CPS. ECD and pentacam corneal outcome may be inadequate as outcome parameters in FED patients.     

三焦点与单焦点人工晶状体植入术效果的比较

目的：观察并比较AT LISA tri 839MP三焦点人工晶状体及CT SPHERIS 209M单焦点人工晶状体植入术后白内障患者的视力、对比敏感度和视觉质量。

方法：行白内障超声乳化摘除联合人工晶状体植入术的患者52例52眼,其中三焦点组26例26眼,术中植入AT LISA tri 839MP三焦点人工晶状体; 单焦点组26例26眼,术中植入CT SPHERIS 209M单焦点人工晶状体。术后3mo检查患者的裸眼远距离视力(UCDVA)、裸眼中距离视力(UCIVA)、裸眼近距离视力(UCNVA)、最佳矫正远视力(BCDVA)、远视力矫正下的中距离视力(DCIVA)、远视力矫正下的近距离视力(DCNVA),明、暗环境中不同空间频率(3、6、12、18c/d)下的对比敏感度,并进行脱镜率、不良视觉症状和满意度等问卷调查。

结果：术后3mo三焦点组UCIVA、UCNVA、DCIVA和DCNVA、脱镜率及满意度均优于单焦点组(P<0.05)。在暗环境中的18c/d空间频率,单焦点组的对比敏感度优于三焦点组(P=0.041)。两组均有轻度眩光和光晕不适主诉(P=0.668)。

结论：AT LISA tri 839MP三焦点人工晶状体较CT SPHERIS 209M单焦点人工晶状体为患者提供了更好的中、近视力,脱镜率和满意度均高于单焦点人工晶状体。     

Accuracy of eight intraocular lens power calculation formulas for segmented multifocal intraocular lens

AIM: To evaluate detailed anterior segment parameters of patients with idiopathic inflammatory myopathies (IIM), including polymyositis (PM), and dermatomyositis (DM), and to clarify the associations between these data and clinical variables of IIM. METHODS: Totally 57 PM, 41 DM patients and 62 controls were enrolled in this cross-sectional, observational, case-control study. All study participants underwent Pentacam evaluation. Laboratory investigations consisted of different antibody assays, while extramuscular clinical assessments included Raynaud''s phenomenon, dysphagia, interstitial lung disease, arthritis/arthralgia, and weight loss. Objective signs and subjective symptoms of dry eye disease (DED) were also evaluated. RESULTS: All pachymetric parameters (center, apex, thinnest and Kmax) and corneal volume (CV) of both sides of PM patients proved to be significantly lower. Some pachymetric data were also noticed as significantly decreased compared to those of controls. Several significant differences were traced between anterior segment values and extramuscular manifestations of myositis, largely in case of arthritis/arthralgia and weight loss, whereas associations between anterior segment parameters and antibodies were weak. Objective clinical tests of dry eye disease (DED) were also significantly decreased in IIM patients. CONCLUSION: The results suggest that all IIM patients have thinner corneas compared with those of controls, and decreased corneal parameters are significantly associated with the occurrence of some extramuscular manifestations. In addition, IIM patients tend to develop objective signs of DED.     

Smartphone-based intraocular lens microscope

Microscopes play an important role in the diagnosis of microorganisms and pathological lesions in ophthalmology guiding us to the appropriate management. The current trend of collecting samples and examination is mostly laboratory-based which consume time, labor, and are costly. Smartphones are being used in different fields of ophthalmology with great ubiquity. The good quality photographs obtained by smartphones along with the ease of mobility has made it possible to warrant its use in the microscopic world. This article describes a simple novel technique of preparing an intraocular lens system which can be used in conjunction with a smartphone to detect microorganisms and pathological lesions.