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目的对比同一个体两眼分别植入非球面和球面人工晶状体(IOL)后高阶像差的差异。设计前瞻性、病例对照研究。研究对象33例(66眼)双眼老年性白内障患者。方法患者接受超声乳化白内障吸除术后,两眼分别植入球面(Canon Staar KS-3)和非球面(Canon Staar KS-3Ai)IOL。按照IOL设计的差异分成两组,球面组和非球面组,手术后3个月观察患者的视力、最佳矫正视力、IOL位置、屈光状态、高阶像差、瞳孔大小等指标。比较两组高阶像差的差异。主要指标视力、最佳矫正视力,IOL的居中性、屈光状态、瞳孔直径、3阶像差、4阶像差、4阶球差(Z40)、5阶像差及总高阶像差的均方根(RMS)。结果在瞳孔直径6mm时,非球面IOL组的4阶像差(0.193±0.098)μm、4阶球差(0.037±0.099)μm、总像差RMS(0.498±0.072)μm均低于球面IOL组(0.403±0.155)μm、(0.381±0.142)μm、(0.737±0.164)μm,而在瞳孔直径6mm时的3阶和5阶像差RMS,瞳孔直径5mm时总像差RMS两组间比较差异无统计学意义(P均>0.05)。低对比度条件下,10例(30%)非球面组患者视物较球面组患者清晰。瞳孔6mm时,非球面组和球面组平均近视漂移分别是(-0.29±0.09)D和(-0.87±0.16)D,差异有统计学意义(P=0.033)。结论植入非球面IOL后,虽然可以明显降低4阶球差,但是两组间在术后视力和最佳矫正视力方面并没有统计学差异,高阶像差的差异主要表现夜间近视漂移的减少和瞳孔直径5mm以上时的低对比度视力的提高。
Objective To compare the higher-order aberrations of the same individual after implantation of both aspheric and spherical intraocular lenses (IOLs). Design prospective, case-control study. Participants 33 patients (66 eyes) with binocular cataract patients. Methods After receiving phacoemulsification, both eyes were implanted with a Canon Staar KS-3 and a Canon Staar KS-3Ai IOL. According to IOL design differences were divided into two groups, spherical group and aspherical group, 3 months after surgery to observe the patient’s vision, best corrected visual acuity, IOL position, refractive status, higher order aberrations, pupil size and other indicators. Differences between higher-order aberrations of the two groups were compared. The main indicators of visual acuity, best corrected visual acuity, IOL neutral, refractive status, pupil diameter, third-order aberrations, fourth-order aberrations, fourth-order spherical aberration (Z40), fifth-order aberrations and total high order aberrations Root mean square (RMS). Results The 4th order aberration (0.193 ± 0.098) μm, the fourth order spherical aberration (0.037 ± 0.099) μm and the total aberration RMS (0.498 ± 0.072) μm in the aspherical IOL group were all lower than those in the spherical IOL group at the pupil diameter of 6 mm (0.403 ± 0.155) μm, (0.381 ± 0.142) μm, (0.737 ± 0.164) μm, while the third and fifth order aberrations RMS at pupil diameter 6mm and total RMS RMS at pupil diameter 5mm No statistical significance (P> 0.05). Under low contrast conditions, 10 patients (30%) aspheric group of patients than the spherical group of patients with clear vision. The pupil 6mm, the average myopic shift of aspheric group and spherical group were (-0.29 ± 0.09) D and (-0.87 ± 0.16) D, the difference was statistically significant (P = 0.033). Conclusions There is no significant difference between the two groups in postoperative visual acuity and best corrected visual acuity although the aspheric IOL implantation can significantly reduce the 4th order spherical aberration. The difference of higher order aberrations mainly reflects the decrease of nighttime myopic drift And the pupil diameter of 5mm or more when low contrast vision improvement.