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.

Clinical comparison and obrvation of the value of RMSh and MTF after implantation of blue light-blocking aspherical intraocular lens

Objective To observe the value of RMSh and MTF 3 months after implantation of bluelight-blocking aspherical intraocular lens. Methods Patients were divided into three groups according to their selection among three kinds of implant IOL: GroupⅠ(PY-60AD), Group Ⅱ (Acrysof IQ),and Group Ⅲ (YA-60BB), Wavefront aberrations were measured across different pupil diameters (PD)(3mm,4mm,5mm,6mm) to record the values of the Z40, coma,total higher order aberration and modulation transfer function (MTF) under pupil diameters of 3mm,5mm three months after cataract phacoemusification and implantation of IOL. Results The values of Z40 in the two aspherical IOL groups were significantly lower than the spherical IOL group at all different pupil diameters (P＜0.05).There was no significant difference between two aspherical IOL groups about the value of Z40.There were no statistically significant differences about the values of coma among three groups (P ＞0.05). The values of RMSh in the two aspherical IOL groups were significantly lower than the spherical IOL group (P＜0.05) when the PD≥5mm, but had no significant difference when the PD＜5mm(P＞0.05).There was no significant difference between two aspherical IOL groups about the RMSh at all different pupil diameters (P＞0.1). At a 3mm pupil diameter,there were no statistically significant differences about the values of MTF at all spatial frequency (5,10,15,20,25,30cpd) among three groups (P＞0.05).At a 5mm pupil diameter,the values of MTF in the two aspherical IOL groups were significantly lower than the spherical IOL group at spatial of 5,10,15,20,25cpd (P＜0.05). There was no significant difference between two aspherical IOL groups about the values of MTF, but in the following order group Acrysof IQ＞group PY-60AD (P＞0.05). Conclusions PY-60AD and Acrysof IQ IOL can decrease the spherical aberration even when the pupil diameter at only 3mm and decrease the higher order aberration when the pupil diameter at or greater than 5mm. Thereby the patients who implanted with aspherical IOLs can acquire better visual quality.There is no significant difference when PY-60AD comparing to Acrysof IQ about the values of wavefront aberrations and MTF. And HOYA PY-60AD is a preloaded IOL that have many advantages fit for widely applied in clinical field.