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.

The comparison of visual quality following cataract surgery with aspheric and spherical intraocular lens implantation

Objective To assess the visual quality in eyes having cataract surgery and implantation of aspheric negative-aberration intraocular lens (IOL). Methods This randomized prospective clinical study included 152 eyes of 112 patients having phacoemulsification and implantation of foldable intraocular lens. Patients were randomly divided into three groups depending on the type of the IOL implanted: Tecnis Z9003,Acrysof IQ or HQ. Visual acuity including uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), contrast sensitivity and ocular wavefront aberration were evaluated 1 week, 1 month, and 3 months postoperatively. Contrast sensitivity testing was determined under photopic (85 cd/m2) and mesopic (3 cd/m2) conditions with no glare and with glare. Wavefront analysis of spherical aberration (SA), root mean square (RMS) of Zernike orders (3rd-, 4th-, 5th-order RMS), total higher-order aberration (HOA) RMS and total ocular aberration (TOA) RMS were performed. Results The two aspheric IOL groups and the spherical IOL group did not differ in UCVA and BCVA at three follow-up visits. At 1 week and 1 month postoperatively, there was no evidence of a statistically significant improvement resulting in photopic contrast sensitivity from implantation of these two aspheric IOLs. However, these two aspheric IOLs groups showed better results at low and intermediate spatial frequencies in mesopic contrast sensitivity at 1 month and 3 months postoperatively, and they also present statistically significant differences under photopic conditions with no glare and with glare at 3 months postoperatively. In addition, patients with one of the two aspheric IOLs had less SA, 4th-order RMS at the 3 follow-up visits, less HOA RMS at 1, 3 month postoperatively, and less TOA RMS at 6mm pupil diameter, when compared to those patients with spherical IOL. Conclusions In our study, aspheric IOLs (Tecnis Z9003 and AcrySof IQ) implantation led to improved contrast sensitivity and significant reduction of postoperative ocular SE and HOA. Negative aberration aspheric IOL may apply better quality of vision than conventional spherical IOL.