三种非球面人工晶状体在高度近视眼囊袋内偏中心和倾斜的比较

目的　高度近视眼患者囊袋内植入３种不同的一片式非球面人工晶状体（ｉｎｔｒａｏｃｕｌａｒｌｅｎｓ，ＩＯＬ），分析术后ＩＯＬ偏中心和倾斜等位置改变的差异及可能的影响因素。方法　将行白内障超声乳化的高度近视患者分为３组:其中ＩＱ组植入疏水丙烯酸酯ＩＯＬ（ＳＮ６０ＷＦＩＱ，Ａｌｃｏｎ）３６眼；ＨＤ组植入亲水丙烯酸酯ＩＯＬ（ＳｏｆｔｅｃＨＤ，Ｌｅｎｓｔｅｃ）４０眼；ＭＣＸ组植入亲水丙烯酸酯ＩＯＬ（ＭＣＸ１１ＡＳＰ，Ｈｕｍａｎｏｐｔｉｃｓ）３２眼，所有患者无术中、术后并发症。记录术后１个月、３个月的裸眼视力（ｕｎｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ，ＵＣＶＡ）与最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ，ＢＣＶＡ），ＩＯＬ倾斜和编中心值。取随访时测量的ＩＯＬ偏中心和倾斜的最大值作为最后结果。用Ｐｅｎｔａｃａｍ三维测量系统采集术后眼前节图像，用Ｉｍａｇｅ-ｐｒｏｐｌｕｓ６．０系统测量分析得出ＩＯＬ的偏中心量和倾斜度，比较各组间差异。结果　各组间术后１个月及３个月时的ＵＣＶＡ和ＢＣＶＡ相比，差异均无统计学意义（均为Ｐ＞０．０５）。术后１个月，ＩＱ组、ＨＤ组与ＭＣＸ组的偏中心值分别为（５９１．４９±１７７．０８）μｍ、（６１９．３６±１８９．７０）μｍ和（４８３．５９±１４１．９１）μｍ，３组比较差异有统计学意义（Ｆ＝１．４２１，Ｐ＝０．０４６）。组间两两比较:ＩＱ组与ＨＤ组间差异无统计学意义（ｔ＝１．０９２，Ｐ＝０．０８９）；ＩＱ组与ＭＣＸ组、ＨＤ组与ＭＣＸ组之间差异有统计学意义（ｔ＝３．０８７、３．２７６，Ｐ＝０．０３７、０．０３１，均为Ｐ＜０．０５）；术后３个月时３组的偏中心值分别为（６０６．３５±１６７．９４）μｍ、（６２１．９４±１９６．３３）μｍ和（４９７．３３±１３４．７１）μｍ，３组比较差异有统计学意义（Ｆ＝１．４９９，Ｐ＝０．０３９）。组间两两比较，ＩＱ组与ＨＤ组间差异无统计学意义（ｔ＝１．１４９，Ｐ＝０．０７４）；ＩＱ组与ＭＣＸ组、ＨＤ组与ＭＣＸ组之间差异有统计学意义（ｔ＝３．００３、３．１１７，Ｐ＝０．０４１、０．０３９）。术后１个月时，３组的倾斜度分别为（２．５１±１．０４）°、（２．７０±１．４１）°、（２．２７±０．９６）°；术后３个月时３组的倾斜度分别为（２．６６±１．３９）°、（２．４６±１．８３）°、（２．３１±１．０６）°，各组内及组间比较差异均无统计学意义（均为Ｐ＞０．０５）。结论　对于高度近视眼，多襻支撑的大光学面ＩＯＬ在囊袋内的居中稳定性优于双襻支撑的ＩＯＬ，但在倾斜度的变化上无明显差异。高度近视眼中ＩＯＬ囊袋内位置的改变受多种因素影响，建议高度近视患者术前测量白对白（ｗｈｉｔｅ-ｔｏ-ｗｈｉｔｅ），挑选个体化的ＩＯＬ。

Comparison of tilt and decentration of three different one-piece designed aspheric intraocular lens implantation for high myopia

Objective To compare the changes of tilt. decentration and related influencing factors of different one-piece designed aspheric intraocular lens ( IOL) implantation for high myopia. Methods A total of 108 eyes of 69 patients with high myopia were selected and divided into three groups: 36 eyes were implanted SN60WF IQ ( Alcon) ,40 eyes with Softec HD ( Lenstec) and 32 eyes with MCXII ASP ( Humanoptics). No intraoperative or postoperative complications were observed of all patients. The maximum measurement values were selected. The tilt and decentration of IOL were quantified using a Scheimpflug videophotography system ( Pentacam.Oculus) and image-pro plus 6. 0 software at I month and 3 months after surgery. The values were compared among the three groups. Results There was no significant difference in UCVA and BCVA between 3 group at I month and 3 months after operation (P > 0. 05). At postoperative I month .the respective mean IOL decentration measurements for IQ. HD and MCX were ( 591. 49 + 177. 08) ym , (619. 36 + 189. 70) Vm and (483. 59 + 141. 91 ) ym , respectively , the significant difference was showed in overall comparison( F = 1. 421 .P = 0. 046). There was no significant difference in IQ and HD between inter-groups ( t = 1. 092 .P = 0. 089 ) ; But in IQ and MCX. HD and MCX, the significant differences were found ( t = 3. 087 , 3. 276 , P = 0. 037 , 0. 031 ) . At postoperative 3 months , the respective mean IOL decentration measurements were ( 606. 35 + 167. 94 ) Vm, (621. 94 + 196. 33) ym and (497. 33 + 134. 71) ym, respectively , which showed significant difference in overall comparison ( F = 1. 499 .P = 0. 039 ) . There was no sigruficant difference in IQ and HD between inter-groups ( t = 1. 149 .P = 0. 074 ) ; But in IQ and MCX, HD and MCX. the significant differences were found ( t = 3. 003 .3. 117 .P = 0. 041 , 0. 039 ) . At postoperative I month.the average titl values of the 3 groups were ( 2. 51 + 1. 04 ) o . ( 2. 70 + 1. 21 ) o . (2. 27 +0. 96) o respectively ; At postoperative 3 months, the average titl values of the 3 groups were ( 2. 66 + 1. 39) o , ( 2. 46 + 1. 84 ) o . ( 2. 31 + 1. 06 ) o , respectively , there was no statistical difference between all or each two groups ( all P > 0. 05) . Conclusion In high myopia eyes , the stability of large optical surface IOL in the middle capsular bag with multi point support is better than that of IOL with double support , but no significant difference changes in the tilt. The stability of IOL in high myopia eye is influenced by many factors , so for high myopia patients , the preoperative white-to-white measurement is needed , and the individual IOL should be chosen.