目的 比较常规上方透明角膜切口与角膜地形图引导切口并植入不同类型人工晶状体(IOL)的白内障合并角膜散光患者术后角膜散光、波前像差的差异.方法 采用前瞻性随机对照临床研究方法.对术前存在角膜散光的年龄相关性白内障患者90例(90只眼),采用分段随机分组法分为3组:常规上方透明角膜切口超声乳化白内障吸除联合AcrySof SN60AT IOL植入组(A组),角膜地形图引导切口超声乳化白内障吸除联合AcrySof SN60AT IOL植入组(B组),角膜地形图引导切口超声乳化白内障吸除联合AcrySof SN60WF IOL植入组(C组),术后1周、1个月、3个月及6个月复查角膜地形图,术后3个月使用以Tscheming原理建立的波前像差分析仪测量3组患者术后IOL眼的像差,并在瞳孔直径为6 mm条件下比较3、4、5、6阶像差,总体高阶像差,总体像差及球差、彗差的均方根(RMS)值.统计学分析方法采用重复测茸资料方差分析、卡方检验、单因素方差分析及SNK法两两比较.结果 角膜地形图检查显示术前各组散光值差异无统计学意义(F=0.08,P>0.05),3组患者角膜散光经矢量分解为J0,J45和P,经重复测量资料方差分析,对于反映垂直和水平方向散光的J0和矢量长度的P,A组与B、C组比较差异有统计学意义(F=9.54,18.69;均P<0.01),而B、C组比较无统计学意义(P>0.05),处理组与时间有交互效应(F=13.45,50.22;均P<0.01),3组患者手术前后不同时间的散光值差异有统计学意义(F=74.33,92.11;均P<0.01);术后3个月波前像差检查显示,A组总体像差(RMSg)、彗差、高阶像差(RMSh)、3阶像差(RMS3)及5～6阶像差显著高于B组及C组(F=93.40,471.94,176.95,216.99,44.37,37.19;均P<0.01),而且A组RMS4及球差显著高于C组(q=25.30,26.23;均P<0.01),但RMS4及球差与B组比较差异无统计学意义(q=0.57,2.34;均P>0.05),B组RMS4,RMSh,RMSg及球差显著高于C组(q=24.73,7.90,6.41,23.89;均P<0.01).结论 对于合并角膜散光的白内障患者,角膜地形图引导超声乳化切口联合负球面像差IOL植入可以矫正术前的角膜散光,减少IOL眼的球差、高阶像差及总像差,从而提高患者的视觉质量.
目的 比較常規上方透明角膜切口與角膜地形圖引導切口併植入不同類型人工晶狀體(IOL)的白內障閤併角膜散光患者術後角膜散光、波前像差的差異.方法 採用前瞻性隨機對照臨床研究方法.對術前存在角膜散光的年齡相關性白內障患者90例(90隻眼),採用分段隨機分組法分為3組:常規上方透明角膜切口超聲乳化白內障吸除聯閤AcrySof SN60AT IOL植入組(A組),角膜地形圖引導切口超聲乳化白內障吸除聯閤AcrySof SN60AT IOL植入組(B組),角膜地形圖引導切口超聲乳化白內障吸除聯閤AcrySof SN60WF IOL植入組(C組),術後1週、1箇月、3箇月及6箇月複查角膜地形圖,術後3箇月使用以Tscheming原理建立的波前像差分析儀測量3組患者術後IOL眼的像差,併在瞳孔直徑為6 mm條件下比較3、4、5、6階像差,總體高階像差,總體像差及毬差、彗差的均方根(RMS)值.統計學分析方法採用重複測茸資料方差分析、卡方檢驗、單因素方差分析及SNK法兩兩比較.結果 角膜地形圖檢查顯示術前各組散光值差異無統計學意義(F=0.08,P>0.05),3組患者角膜散光經矢量分解為J0,J45和P,經重複測量資料方差分析,對于反映垂直和水平方嚮散光的J0和矢量長度的P,A組與B、C組比較差異有統計學意義(F=9.54,18.69;均P<0.01),而B、C組比較無統計學意義(P>0.05),處理組與時間有交互效應(F=13.45,50.22;均P<0.01),3組患者手術前後不同時間的散光值差異有統計學意義(F=74.33,92.11;均P<0.01);術後3箇月波前像差檢查顯示,A組總體像差(RMSg)、彗差、高階像差(RMSh)、3階像差(RMS3)及5～6階像差顯著高于B組及C組(F=93.40,471.94,176.95,216.99,44.37,37.19;均P<0.01),而且A組RMS4及毬差顯著高于C組(q=25.30,26.23;均P<0.01),但RMS4及毬差與B組比較差異無統計學意義(q=0.57,2.34;均P>0.05),B組RMS4,RMSh,RMSg及毬差顯著高于C組(q=24.73,7.90,6.41,23.89;均P<0.01).結論 對于閤併角膜散光的白內障患者,角膜地形圖引導超聲乳化切口聯閤負毬麵像差IOL植入可以矯正術前的角膜散光,減少IOL眼的毬差、高階像差及總像差,從而提高患者的視覺質量.
목적 비교상규상방투명각막절구여각막지형도인도절구병식입불동류형인공정상체(IOL)적백내장합병각막산광환자술후각막산광、파전상차적차이.방법 채용전첨성수궤대조림상연구방법.대술전존재각막산광적년령상관성백내장환자90례(90지안),채용분단수궤분조법분위3조:상규상방투명각막절구초성유화백내장흡제연합AcrySof SN60AT IOL식입조(A조),각막지형도인도절구초성유화백내장흡제연합AcrySof SN60AT IOL식입조(B조),각막지형도인도절구초성유화백내장흡제연합AcrySof SN60WF IOL식입조(C조),술후1주、1개월、3개월급6개월복사각막지형도,술후3개월사용이Tscheming원리건립적파전상차분석의측량3조환자술후IOL안적상차,병재동공직경위6 mm조건하비교3、4、5、6계상차,총체고계상차,총체상차급구차、혜차적균방근(RMS)치.통계학분석방법채용중복측용자료방차분석、잡방검험、단인소방차분석급SNK법량량비교.결과 각막지형도검사현시술전각조산광치차이무통계학의의(F=0.08,P>0.05),3조환자각막산광경시량분해위J0,J45화P,경중복측량자료방차분석,대우반영수직화수평방향산광적J0화시량장도적P,A조여B、C조비교차이유통계학의의(F=9.54,18.69;균P<0.01),이B、C조비교무통계학의의(P>0.05),처리조여시간유교호효응(F=13.45,50.22;균P<0.01),3조환자수술전후불동시간적산광치차이유통계학의의(F=74.33,92.11;균P<0.01);술후3개월파전상차검사현시,A조총체상차(RMSg)、혜차、고계상차(RMSh)、3계상차(RMS3)급5～6계상차현저고우B조급C조(F=93.40,471.94,176.95,216.99,44.37,37.19;균P<0.01),이차A조RMS4급구차현저고우C조(q=25.30,26.23;균P<0.01),단RMS4급구차여B조비교차이무통계학의의(q=0.57,2.34;균P>0.05),B조RMS4,RMSh,RMSg급구차현저고우C조(q=24.73,7.90,6.41,23.89;균P<0.01).결론 대우합병각막산광적백내장환자,각막지형도인도초성유화절구연합부구면상차IOL식입가이교정술전적각막산광,감소IOL안적구차、고계상차급총상차,종이제고환자적시각질량.
Objective To compare the corneal astigmatism and wavefront aberration differences of patients with cataract coexisting corneal astigmatism after phacoemulsification surgery through traditional superior clear corneal incision or phacoemulsification surgery through clear corneal incision guided by corneal topography and implantation of different spherical aberration intraocular lenses (IOL). Methods In a prospective randomized sample controlled clinical trial, 90 patients (90 eyes) with age-related cataract and corneal astigmatism were randomly divided into 3 groups: (Group A) traditional superior corneal incision phacoemulsification surgery and AcrySof SN60AT IOL implantation, (Group B) corneal topography guiding incision phacoemulsification surgery and AcrySof SN60AT IOL implantation and (Group C ) corneal topography guiding incision phacoemulsification surgery and AcrySof SN60WF IOL implantation. Corneal topography tests were performed at 1 week, 1 month, 3 months and 6 months postoperatively. The Wavefront aberration was measured using a custom built Tschcming wavefront sensor--ALLEGRETTO WAVE Analyze at 90 days postoperatively. Third-, 4th-, 5th-, total and higher-order aberration (HOA) root-mean-square (RMS), spherical aberration and coma aberration were compared at virtual pupil diameters of 6 mm postoperatively. Statistical analyses were performed using the analysis of chi square test, repeated measurement data analysis of variance, one-way analysis of variance (ANOVA), and multiple comparisons Studcnts-Newman-Keuls test. Results Corneal topography tests indicated that no significant difference for corneal astigmatism was found between these three groups preoperatively( F =0. 08 ,P >0. 05). The corneal astigmatism was decomposed into J0, J45 and P with a Vector-based method, and statistically analyzed . When compared with Group B and GroupC, Group A had higher values of corneal J0 ( F = 9.54, P < 0. 01 ) and P( F = 18.69, P < 0. 01 ). For corneal J0 and P, no significant difference was found between Group B and Group C ( P > 0. 05 ). However groups and times had interactions ( F = 13.45,50. 22, P < 0. 01, respectively) . For astigmatic vectors, there were statistical significances between different times in 3 groups ( F = 74. 33,92. 11, P < 0. 01, respectively ). Wavefront aberration test results indicated that the mean values of RMSg (root mean square of general aberration) , coma aberration ,RMSh,RMS3 ,RMS5 and RMS6 of Group A were obviously higher than that of Group B and C ( F = 93.40,471.94,176. 95,216. 99,44. 37, 37. 19,P < 0.01, respectively). And the values of RMS4 and spherical aberration in Group A were significantly higher than that in Group C ( q = 25.30,26. 23, P < 0. 01, respectively). No statistically significant was found between Group A and Group B of RMS4 and spherical aberration ( q = 0. 57,2. 34, P > 0. 05, respectively). The values of RMS4, RMSh, RMSg and spherical aberration in Group B were statistically significantly higher than that in Group C ( q = 24. 73, 7.90, 6. 41,23. 89, P < 0. 01, respectively). Conclusions Corneal topography guiding incision phacoemulsification surgery and the implantation of negative spherical aberration IOL is a more favorable solution for cataract patients coexisting corneal astigmatism, which can correct the corneal astigmatism, decrease the spherical aberration, high-order aberration and general aberration of pseudophakic eyes and therefore improve the visual quality of patients.
