非球面散光型和非球面型人工晶状体植入术后效果

doi:10.3760/cma.j.issn.1674-845X.2020.02.004

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摘要

目的：比较非球面散光型和非球面型人工晶状体（IOL）植入术后效果。方法：前瞻性非随机对照研究。选择2016年5月至2018年1月在抚顺市眼病医院白内障科就诊的术前角膜散光为1.25 D以上的年龄相关性白内障患者106例（172眼）。根据自愿原则，其中50例（80眼）患者行超声乳化白内障吸除术后植入Acrysof IQ Toric IOL（SN6AT）作为Toric组，56例（92眼）患者植入AcrySof IQ IOL（SN60WF）作为对照组。术前Toric组和对照组散光分别为（2.08±0.74）D、（2.14±0.95）D。术后6个月评估2组患者的裸眼远视力（UDVA）、矫正远视力（CDVA）、脱镜率、残余眼散光和轴位旋转、对比敏感度、波前像差、视觉满意度问卷调查等。采用t检验、Mann-Whitney U检验、χ2 检验进行数据分析。结果：9例失访，失访率为8.5%，最终纳入对照组为51例（84眼），Toric组为46例（73眼）。术后6个月对照组和Toric组的UDVA（LogMAR）分别为0.22±0.14和0.15±0.20，差异有统计学意义（t=-2.14， P<0.001）；CDVA（LogMAR）分别为0.11±0.09和0.09±0.08，差异无统计学意义；Toric组看远脱镜率为77.8%（21/27），对照组为27.3%（9/33），二者差异有统计学意义（χ2 =15.15，P<0.001）。Toric组残余眼散光为（0.77±0.39）D，对照组为（1.99±1.12）D，二者差异有统计学意义（t=-7.56，P<0.001）； Toric组的轴位旋转4.6°±5.7°。Toric组低阶像差低于对照组，差异有统计学意义（U=1.57，P=0.006）。 2组术后明视、暗视、暗视眩光情况下对比敏感度、视觉满意度调查问卷比较差异均无统计学意义。结论：与非球面型IOL相比，非球面散光型可有效、安全地矫正白内障患者的术前角膜散光，稳定性好，大大提高术后脱镜率，且低阶像差更低。

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关键词 ：白内障, 非球面散光人工晶状体, 视觉质量, 脱镜率

Abstract：

Objective: To compare effect after aspheric toric and aspheric intraocular lens (IOL) implantation in patients with cataract and corneal astigmatism. Methods: Prospective non-randomized controlled studies. One hundred seventy-two eyes of 106 patients with regular corneal astigmatism above1.25 D underwent implantation of an aspheric toric or aspheric intraocular lens in Fushun Eye Hospital from May 2016 to January 2018, including 80 eyes of 50 patients implanted with Acrysof IQ Toric IOLs (SN6AT) (Toric group) and 92 eyes of 56 patients implanted with AcrySof IQ IOLs (SN60WF) (control group). Mean astigmatism was 2.08±0.74 D and 2.14±0.95 D, respectively. Main outcomes of the two groups were evaluated at 6 months, including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spectacle independence for distance vision, residual refractive cylinder, IOL rotation, contrast sensitivity testing,wavefront aberrations, and refractive error-related quality-of-life questionnaire. Postoperative results were analyzed by a t test, Mann-Whitney test, and χ2 test. Results: Nine patients (8.5%) were lost to postoperative follow-up. The mean UDVA of the toric group and control groups was 0.15±0.20 and 0.22±0.14 LogMAR, respectively (t=-2.14, P<0.001), and the mean CDVA was 0.09±0.08 and 0.11±0.09 LogMAR, respectively (t=-0.62, P>0.05). Spectacle independence for distance vision was achieved in 21 patients (77.8%) in the toric group compared with 9 patients (27.3%) in the control group (χ2 =15.15, P<0.001). The mean residual refractive cylinder of toric and control groups was 0.77±0.39 D and 1.99±1.12 D, respectively (t=-7.56, P<0.001). The mean absolute misalignment of the toric group was 4.6±5.7 degrees. The lower-order aberrations of toric group were lower than those of the control group (U=1.57, P=0.006). No significant differences were found in contrast sensitivity or refractive error-related quality of life between the two groups. Conclusions: In patients with cataract and corneal astigmatism, aspheric toric IOL implantation was an effective and safe method to correct corneal astigmatism during cataract surgery, resulting in a nice rotational stability, a higher spectacle independence for distance vision and a lower lower-order aberrations compared with the control IOL implantation group.

Key words： cataract aspheric toric intraocular lenses visual quality spectacle independency

收稿日期: 2018-11-19

通讯作者: 祁锦艳（ORCID：0000-0002-5611-7393），Email：990537043@qq.com

引用本文:

毕潜龙祁锦艳张轶峰李东胜王禹. 非球面散光型和非球面型人工晶状体植入术后效果[J]. 中华眼视光学与视觉科学杂志, 2020, 22(2): 98-103. Qianlong Bi, Jinyan Qi, Yifeng Zhang, Dongsheng Li, Yu Wang. Clinical Study of Effect after Implantation of Aspheric Toric vs Aspherical Intraocular Lenses in Patients with Cataract and Corneal Astigmatism. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(2): 98-103. DOI: 10.3760/cma.j.issn.1674-845X.2020.02.004

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http://www.cjoovs.com/CN/10.3760/cma.j.issn.1674-845X.2020.02.004 或 http://www.cjoovs.com/CN/Y2020/V22/I2/98

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