人工晶状体 Alpha 角对连续视程人工晶状体眼视觉质量的影响

Influence of Alpha angle of intraocular lens on visual quality after the implantation of extended depth-of-field intraocular lens

摘要

目的 探讨 IOL Alpha 角对连续视程人工晶体 (extended depth-of-field intraocular lens，EDOF IOL) 植入术后视觉质量的影响。方法 选取行白内障超声乳化联合 EDOF IOLs 植入术的年龄相关性白内障患者 50 例 (50 只眼)。采用 OPD-Scan Ⅲ像差分析仪的日-夜瞳孔测量系统，得到人工晶状体 (intraocular len，IOL) 植入术后 Alpha 角，根据光学路径差扫描仪 Ⅲ (Optical Path Difference Scan Ⅲ，OPD Scan Ⅲ) 测量术后 IOL Alpha 角大小分为 3 组: A 组 19 只眼 (0 mm < Alpha 角 ≤0.2 mm)，B 组 19 只眼 (0.2 mm < Alpha 角 ≤0.4 mm)，C 组 12 只眼 (Alpha 角 >0.4 mm)。采用 OPD-Scan Ⅲ 像差分析仪检测术前 Alpha 角；术后 3 个月检测裸眼远视力 (uncorrected distance visual acuity，UDVA)，OPD-Scan Ⅲ 测量 EDOF IOLs 植入眼的客观视觉质量，包括眼内高阶像差 (higher-order aberrations，HOA)、斯特列尔比 (strehl ratio，SR)、全眼 HOA、彗差 (Coma)、三叶草像差 (Trefoil) 并进行比较分析。采用视功能指数量表-14 (visual function index，VF-14) 评估患者的视功能。结果 术前 Alpha 角与 IOL Alpha 角差异不具有统计学意义 (t=0.11，P=0.915)。经 Pearson 相关性分析，术前 Alpha 角与 IOL Alpha 角之间呈正相关 (r=0.983，P<0.001)。IOL Alpha 角三组间 UDVA、眼内 HOA、SR、全眼 HOA、Coma、Trefoil 差异都具有统计学意义 (P 均<0.05)。眼内 HOA、SR 值及 Coma 值组间两两比较均有统计学差异 (P 均<0.05)；Trefoil 值及全眼 HOA 值仅在 A 组与 C 组之间差异具有统计学意义 (P=0.030，P=0.001)。VF-14 问卷调查显示 A、B、C 组眩光或光晕的发病率分别为 47.4% (9/19)、68.4% (13/19) 和 100% (12/12)，差异具有统计学意义 (χ²=9.365，P=0.009)。结论 IOL Alpha 角可反映 IOL 居中性及在眼内的实际状态，其不仅影响术后患者视觉质量、反映其术后实际视觉效果，较大的 IOL Alpha 角还会增加术后眩光、光晕发生率，进而影响患者生活质量。

Abstract

Objective To study the effect of the IOL Alpha angle on visual quality following the implantation of the EDOF IOL (ZXR 00). Methods A total of 50 cases (50 eyes) that underwent phacoemulsification combined with EDOF IOL implantation were included in the study. Preoperative and IOL Alpha angle assessments were conducted using the OPD Scan Ⅲ wavefront aberrometer. The study eyes were then categorized into three distinct groups based on the IOL Alpha angle values ascertained: Group A (19 eyes, 0 mm < Alpha angle ≤0.2 mm), Group B (19 eyes, 0.2 mm < Alpha angle ≤0.4 mm), and Group C (12 eyes, Alpha angle >0.4 mm). UDVA was recorded three months postoperatively. The OPD Scan Ⅲ was employed to evaluate intraocular aberrations, including SR, total HOA, Coma and Trefoil. The assessment of photic phenomena were conducted utilising the Visual Functioning Index-14. Results The preoperative and IOL Alpha angle were no statistically significant difference (t=0.11, P=0.915). Pearson correlation analysis revealed a significant positive correlation between the preoperative and the IOL Alpha angle (r=0.983, P<0.001). The differences in UDVA, intraocular aberration, SR, total HOA, Coma and Trefoil values among the three groups were statistically significant (all P<0.05). Statistically significant differences in intraocular aberrations were observed in pairwise comparisons among groups (all P<0.05). A statistically significant difference in Trefoil values was found between Group A and Group C (P=0.030), as well as in total HOA values between these two groups (P=0.001). The results of the questionnaire survey indicated that the prevalence of glare/halos among patients in the three groups was 47.4% (9/19), 68.4% (13/19) and 100% (12/12), respectively, with these differences being statistically significant (χ²=9.365, P=0.009). Conclusion The IOL Alpha angle may reflect the decentration and actual position of the IOL within the eye. The IOL Alpha angle may affect the postoperative visual acuity and reflect the actual visual quality after surgery. Larger IOL Alpha angle will increase the incidence of postoperative glare/halos, which may affect the patient’s quality of life.

关键词

Alpha 角 / 光学路径差扫描仪 Ⅲ / 连续视程人工晶体 / 视觉质量

Key words

Alpha angle / Cataract / OPD-Scan Ⅲ / Extended depth-of-field intraocular lens / Visual quality

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基金资助

山东省教育发展促进会教育科研规划课题(JCHKT2023423)

潍坊医学院教育教学改革与研究课题(2023YBD003, 2023ZX024)