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

Comparison of different types of aspherical IOLs based on wavefront aberration analysis

Objective To assess the visual quality of eyes with four types of aspherical intraocular lens implants by analyzing higher-order aberrations. Methods Ninety-one patients （114 eyes） with cataract volunteered to undergo surgery from March to September 2007 and were randomly divided into 5 groups. Group Ⅰ included 22 patients （27 eyes）： Z9003 （AMO）; Group Ⅱ included 24 patients （30 eyes）： AcrySof IQ SN60WF （Alcon）; Group Ⅲ included 18 patients （25 eyes）： KS-3Ai （Cannonstaar）; Group Ⅳ included 10 patients （12 eyes）： Acri.Smart 36A （Germany）; Group Ⅴ included 17 patients （20 eyes）： AR40e （AMO）. Patients with glaucoma, retinal pathology, age-related macular degeneration and other complications were excluded from the study. All surgery was performed by the same doctor. Patients were examined 3 months after surgery for complaints of discomfort, visual acuity and the position of the IOL. Wavefront aberrations were measured across different pupil diameters （4 mm, 5 mm, 6 mm） using an aberration analyzer （Wavelight, Germany） and contrast sensitivity was tested with the Kontrastometer BA-4 （Bkg Medizin Technik, Germany）. The following contrast measurements were done： without glare--wog, with glare--wg, red contrast measurement--red test, and a readaptation test. ANOVA was used to analyze the data at 3 months postoperatively. Results The average uncorrected visual acuity （UCVA） was ≥4.8 and the average best corrected visual acuity （BCVA） was ≥4.9 in all groups. The values of Z40 and RMS4 in the four aspherical IOL groups were significantly lower than that for the spherical IOL group at all different pupil diameters （P〈0.05）. The value of RMSh for the four aspherical IOL groups was significantly lower than that of the spherical IOL group only at a 6 mm pupil diameter. The changes in the values of Z40 and RMS4 among the four aspherical groups were in the following order： group Z90030.05）. There were no significant differences