山东大学耳鼻喉眼学报 ›› 2022, Vol. 36 ›› Issue (6): 32-37.doi: 10.6040/j.issn.1673-3770.0.2021.251

• 临床研究 • 上一篇    

关于Alpha角0.5~0.8 mm的患者植入区域折射型人工晶状体的短期临床观察

孙璐,张顺华,吴昱舟,陈露璐,曹迪,干霖洋   

  1. 中国医学科学院/北京协和医院 眼科, 北京 100730
  • 发布日期:2022-12-07
  • 通讯作者: 张顺华. E-mail:Pumchzhang@hotmail.com

Short-term clinical outcomes of regional refractive intraocular lens implantation in patients with an angle alpha of 0.5-0.8 mm

SUN Lu, ZHANG Shunhua, WU Yuzhou, CHEN Lulu, CAO Di, GAN Linyang   

  1. Department of Ophthalmology, Peking Union Medical College Hospital/Chinese Academy of Medical Sciences, Beijing 100730, China
  • Published:2022-12-07

摘要: 目的 研究Alpha角≤0.5 mm与Alpha角0.5~0.8 mm的患眼通过个性化手术设计植入区域折射型人工晶体的效果对比评估。 方法 患眼根据术前OPD检查的Alpha角数值分为观察组(Alpha角0.5~0.8 mm)和对照组(Alpha角≤0.5 mm),行超声乳化白内障摘除并植入区域折射型人工晶状体SBL-3,观察组采用个性化手术设计确定人工晶状体放置方向。对比两组术后1个月裸眼远视力(UDVA)、裸眼中视力(UIVA)、裸眼近视力(UNVA)以及4 mm瞳孔直径内全眼像差、角膜像差及眼内像差、对比两组术前术后Alpha角的变化。采用Mann-Whitney U检验方法对数据进行分析。 结果 观察组16例(16只眼),对照组17例(17只眼)。术后1个月2组的UDVA(P=0.286)、UIVA(P=0.318)、UNVA(P=0.449)差异无统计学意义;2组全眼及角膜的高阶像差(P全眼=0.368,P角膜=0.705)、总像差(P全眼=0.407,P角膜=0.387)、慧差(P全眼=0.957,P角膜=0.599)、三叶草差(P全眼=0.101,P角膜=0.576)、球差(P全眼=0.785,P角膜=0.443)的变化量差异无统计学意义;眼内高阶像差(P=0.387)、总像差(P=0.249)、慧差(P=0.33)、三叶草差(P=0.139)的变化量差异无统计学意义,眼内球差(P=0.007)的变化量差异有统计学意义;观察组(p=0.985)与对照组(P=0.890)患者术前术后Alpha角差异无统计学意义。 结论 Alpha角0.5~0.8 mm的患者通过个性化设计放置区域折射型人工晶体SBL-3使视轴落在视远区可以达到与Alpha角≤0.5 mm的患者相同的手术效果。

关键词: Alpha角, 多焦点人工晶状体, 白内障, 高阶像差, 视力

Abstract: Objective To evaluate and compare the effect of regional refractive intraocular lens implantation through a personalized surgical design in eyes with an angle alpha of less than or equal to 0.5 mm and 0.5-0.8 mm. Methods The patients were divided into two groups based on OPD examination before the surgery. The observation and control groups included patients with an angle alpha of 0.5-0.8 mm and less than or equal to 0.5 mm, respectively. Phacoemul-sification cataract extraction and regional refractive intraocular lens SBL-3 implantation were performed. The observation group used an individualized surgical design to determine the direction of intraocular lens placement. We compared the uncorrected distance visual acuity(UDVA), uncorrected intermediate visual acuity(UIVA), uncorrected near visual acuity(UNVA), total eye aberration, corneal aberration, and intraocular aberration within a 4 mm pupil diameter between the two groups at one month after surgery. In addition, we compared the changes in angle alpha before and after surgery between the two groups. The Mann-Whitney U test was used to analyze the data. Results The observation and control groups comprised 16 cases(16 eyes)and 17 cases(17 eyes), respectively. There was no statistical difference between the two groups of patients in terms of UDVA(P=0.286), UIVA(P=0.318), UNVA(P=0.449). High-order aberrations(Pwhole eye=0.368,Pcornea changes=0.705), all intraocular aberration(Pwhole eye=0.407,Pcornea changes=0.387), coma aberration(Pwhole eye=0.957,Pcornea changes=0.599), intraocular clover aberration(Pwhole eye=0.101, Pcornea changes=0.576), and spherical aberration(Pwhole eye=0.785, Pcomea changes=0.443)of the whole eye and cornea changes were not statistically significant; intraocular high-aberrations(P=0.387), intraocular clover aberration(P=0.139), all intraocular aberration(P=0.249), and coma aberration(P=0.33)were not statistically significant; intraocular spherical aberration(P=0.007)was statistically significant. There was no significant difference in angle alpha between the observation and control groups(P=0.985, P=0.890)before and after surgery. Conclusion Patients with an angle alpha of 0.5-0.8 mm can achieve the same surgical effect as that of patients with angle alpha less than or equal to 0.5 mm, by rotating the lens SBL-3 to make the visual axis land in the distal region.

Key words: Angle alpha, Multifocal intraocular lens, Cataract, Higher-order aberration, Vision

中图分类号: 

  • R765.21
[1] 陈祥菲, 侯培莉, 陆燕, 等. 多焦点散光型与单焦点散光型人工晶状体植入术后视觉质量对比[J]. 中华眼视光学与视觉科学杂志, 2015,17(8): 474-479. doi: 10.3760/cma.j.issn.1674-845X.2015.08.007. CHEN Xiangfei, HOU Peili, LU Yan, et al. Comparative analysis of visual quality after implantation of multifocal toric and monofocal toric intraocular lenses[J]. Chinese Journal of Optometry & Ophthalmology, 2015, 17(8): 474-479. doi: 10.3760/cma.j.issn.1674-845X.2015.08.007.
[2] 毕宏生. 精准屈光性白内障手术规划[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 1-4. doi: 10.6040/j.issn.1673-3770.1.2017.026. BI Hongsheng. Design of treatment protocol in refractive cataract surgery is important for postoperative visual outcomes[J]. J Otolaryngol Ophthalmol Shandong Univ, 2017,31(4): 1-4. doi: 10.6040/j.issn.1673-3770.1.2017.026.
[3] 徐金华, 卢奕, 陆国生. 多焦点人工晶体[J]. 国外医学(眼科学分册), 2000(1):1-5.
[4] Moshirfar M, Hoggan RN, Muthappan V. Angle Kappa and its importance in refractive surgery[J]. Oman J Ophthalmol, 2013, 6(3): 151-158. doi:10.4103/0974-620x.122268.
[5] Maxwell A, Holland E, Cibik L, et al. Clinical and patient-reported outcomes of bilateral implantation of a +2.5 diopter multifocal intraocular lens[J]. J Cataract Refract Surg. 2017, 4(1): 29-41. doi: 10.1016/j.jcrs.2016.10.026.
[6] 中华医学会眼科学分会白内障及人工晶状体学组.中国多焦点人工晶状体临床应用专家共识(2019年)[J].中华眼科杂志, 2019, 55(7): 491-494.
[7] Kuthirummal N, Vanathi M, Mukhija R, et al. Evaluation of Barrett universal II formula for intraocular lens power calculation in Asian Indian population[J]. Indian J Ophthalmol, 2020, 68(1): 59-64. doi:10.4103/ijo.ijo_600_19.
[8] 陈琛, 屈思萌, 林珊, 等. 区域折射多焦点人工晶状体SBL-3的临床应用[J]. 国际眼科杂志, 2018, 18(3): 446-450. doi: 10.3980/j.issn.1672-5123.2018.3.10. CHEN Chen, QU Simeng, LIN Shan, et al. Clinical efficacy of segmented bifocal intraocular lens SBL-3[J]. Int Eye Sci, 2018, 18(3): 446-450. doi: 10.3980/j.issn.1672-5123.2018.3.10.
[9] 唐唯, 李元彬. 屈光性白内障手术新进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 149-158. doi: 10.6040/j.issn.1673-3770.0.2018.325. TANG Wei, LI Yuanbin. New progress in refractive cataract surgery[J]. J Otolaryngol Ophthalmol Shandong Univ, 2019, 33(2): 149-158. doi: 10.6040/j.issn.1673-3770.0.2018.325.
[10] 马健利, 王文亭, 姜雅琴, 等. Alpha角对多焦点人工晶状体植入术后视觉质量影响[J].中华眼视光学与视觉科学杂志, 2019, 21(12): 906-909. doi: 10.3760/cma.j.issn.1674-845X.2019.12.005. MA Jianli, WANG Wenting, JIANG Yaqin, et al. Effect of angle alpha on visual quality after multifocal intraocular lens implantation[J]. Chinese Journal of Optometry Ophthalmology And Visual Science, 2019, 21(12): 906-909. doi: 10.3760/cma.j.issn.1674-845X.2019.12.005.
[11] 赵云娥. 多焦点人工晶状体的研究进展及临床应用[J]. 中华眼科杂志, 2006(10): 942-945. doi: 10.3760/j:issn:0412-4081.2006.10.021.
[12] Lian H, Ma W, Wei Q, et al. A comparative study on early vision quality after implantation of refractive segmental and diffractive multifocal intraocular lens[J]. Pak J Med Sci, 2020, 36(7): 1607-1612. doi:10.12669/pjms.36.7.3364
[13] Kohnen T, Nuijts R, Levy P, et al. Visual function after bilateral implantation of apodized diffractive aspheric multifocal intraocular lenses with a +3.0 D addition[J]. J Cataract Refract Surg, 2009, 35(12): 2062-2069. doi:10.1016/j.jcrs.2009.08.013.
[14] Cochener B, Vryghem J, Rozot P, et al. Clinical outcomes with a trifocal intraocular lens: a multicenter study[J]. J Refract Surg, 2014, 30(11): 762-768. doi:10.3928/1081597x-20141021-08.
[15] Kretz FT, Attia MA, Linz K, et al. Level of binocular pseudoaccommodation in patients implanted with an apodised, diffractive and trifocal multifocal intraocular lens[J]. Klin Monbl Augenheilkd, 2015, 232(8): 947-952. doi:10.1055/s-0035-1545833.
[16] Tandogan T, Son HS, Choi CY, et al. Laboratory evaluation of the influence of decentration and pupil size on the optical performance of a monofocal, bifocal, and trifocal intraocular lens[J]. J Refract Surg, 2017, 33(12): 808-812. doi:10.3928/1081597x-20171004-02.
[17] McNeely RN, Pazo E, Spence A, et al. Comparison of the visual performance and quality of vision with combined symmetrical inferonasal near addition versus inferonasal and superotemporal placement of rotationally asymmetric refractive multifocal intraocular lenses[J]. J Cataract Refract Surg, 2016, 42(12): 1721-1729. doi:10.1016/j.jcrs.2016.10.016.
[18] Alió JL, Piñero DP, Plaza-Puche AB, et al. Visual outcomes and optical performance of a monofocal intraocular lens and a new-generation multifocal intraocular lens[J]. J Cataract Refract Surg, 2011, 37(2):241-250. doi: 10.1016/j.jcrs.2010.08.043.
[1] 段练,孟凡兰述评党光福审校. 干眼对屈光性白内障手术的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 1-6.
[2] 孙极综述李灿审校. 白内障术后人工晶状体轴向位置预测与稳定性相关影响因素[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 7-12.
[3] 黄子彦综述 段国平审校. 高阶像差对白内障人工晶状体植入术后视觉质量的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 13-18.
[4] 黄子彦综述段国平审校. 不同类型人工晶状体植入术后倾斜和偏心影响视觉质量的研究现状[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 26-31.
[5] 胡尊霞,司马晶,秦波,曹加国,潘伟. 接触镜使用与否在Nd∶YAG激光后囊切开术中的对比研究[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 41-45.
[6] 代诚李宾中. 多焦点软性角膜接触镜应用研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 100-105.
[7] 杨茹,张玉光,徐湘辉,吴雪莲,陶远,谭越. 超声乳化术对老年性白内障黄斑区视网膜结构影响的临床研究[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 97-102.
[8] 胡颖峰,贾玉叶,王艳,张嵘,王峥,叶向彧. Kappa与Alpha角在白内障手术前后的变化分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 83-89.
[9] 彭娇,钟定娟,陈蛟,左筠,王华. 光学区直径与暗瞳直径的关系对不同程度近视患者SMILE术后视觉质量的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 100-107.
[10] 海玥,廖萱. Catquest-9SF的研究进展及临床应用[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 142-146.
[11] 付奕豪,徐逸轩,严宏,张婕. 谷氧还蛋白在眼病中的作用研究进展[J]. 山东大学耳鼻喉眼学报, 2021, 35(3): 125-130.
[12] 刘少华,郝琳琳,马广凤,侯静,张晗. 喀什与济南地区白内障患者眼部生物学参数分析[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 110-113.
[13] 魏佩佩,李灿. 多焦点人工晶体植入术后的视觉质量及并发症[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 141-146.
[14] 王宗沂,曲进锋. 白内障术后后部缺血性视神经病变一例并文献复习[J]. 山东大学耳鼻喉眼学报, 2020, 34(4): 56-59.
[15] 姜洋,李莹,崔歌. 0.1%双氯芬酸钠滴眼液在SMILE术后疗效的观察[J]. 山东大学耳鼻喉眼学报, 2020, 34(2): 57-60.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!