个性超声乳化切口并不同类型人工晶状体植入术后角膜散光和视觉质量的比较  

The clinical investigation of dynamic changes of corneal astigmatism and visual quality for patients after phacoemulsification surgery through different incision and implantation of different designed intraocular lens

作　　者：王佃科[1] 张杰[1] 王杰[1] 李艳[1] 梁山[1] 刘育霞[1] 

机构地区：[1]潍坊医学院临床学院眼科学教研室,261042

出　　处：《中华眼科杂志》2009年第5期424-429,共6页Chinese Journal of Ophthalmology

摘　　要：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AcrySofSN60WFIOL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Tscherning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6mm条件下比较3、d、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量资料方差分析、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Jn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（RMS，）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RMS。及球差显著高于C组（q=25．30，26．23；均P〈0．01），但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 Tscherning wavefront sensor-ALLEGRETrO 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 Students-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

关 键 词：散光 视觉 角膜地形图 超声乳化白内障吸除术 晶体 人工 

分 类 号：R686[医药卫生—骨科学]