摘要
目的:通过对年龄相关性白内障超声乳化后行人工晶状体囊袋内植入患者传统验光和医学验光的比较,评价医学验光的优越性和必要性,为人工晶状体眼患者验光配镜提高视觉质量提供依据。
方法:双眼年龄相关性白内障超声乳化摘除及折叠型人工晶状体囊袋内植入手术的人工晶状体眼患者30例共60眼,男性19例,女11例。按年龄进行分组,其中A组(<50岁)10例,B组(50～59岁)10例,C组(≥60岁)10例。所有患者先后进行传统验光和医学验光,检测最佳矫正远视力(BCDVA)、最佳矫正近视力(BCNVA),并分别记录传统验光和医学验光的球镜、柱镜和轴位,以及等效球镜结果,老视阅读近附加,舒适阅读时间长度,移近法测量两种验光方法远矫正下的调节幅度,在近矫正基础上测量正相对调节(PRA)和负相对调节(NRA)。
结果:1传统验光和医学验光最佳矫正远视力和最佳矫正近视力比较差异无统计学意义(P>0.05)。
2两种验光方法比较60只眼,球镜度数相同9眼,相差(0.25D) 23眼,相差(0.50D～0.75D)28眼,相差(≥1.00D)0眼;柱镜度数和轴位差异:传统验光验出柱镜52眼,医学验光为59眼,柱镜度数相同9眼,相差(0.25D)20眼,相差(0.50D～0.75D)24眼,相差(≥1.00 D)7眼;轴位相同5眼,相差(5～10°)17眼,相差(10～15°)19眼,相差(> 15°)10眼。传统验光和医学验光等效球镜比较差异有统计学意义(P<0.05),传统验光法验出等效球镜屈光度较大。
3与传统验光法相比,医学验光法远矫正下测量调节幅度较小,两者差异有统计学意义(P<0.05);两种验光方法测量的调节幅度均与年龄无相关性(P>0.05)。
4传统验光法测量近附加和负相对调节各年龄组间差异有统计学意义(P<0.05),近附加和年龄呈正相关(r=0.0842,P<0.05),负相对调节和年龄呈负相关(r=-0.0897,P<0.05),医学验光法测量近附加和负相对调节各年龄组间差异无统计学意义(P>0.05),且和年龄无相关性(P>0.05)。
5医学验光法舒适阅读时间为30.13±5.10分,传统验光法舒适阅读时间为17.0±3.06分,两者比较差异有统计学意义(P<0.05),经医学验光法测得的最终度数试戴的舒适阅读时间明显较传统验光法长。
结论:医学验光较传统验光更精确。在进行人工晶状体眼老视验光时,医学验光可取得更有意义的屈光及调节参数,从而对验光处方进行更精确和个性化的调整,达到更舒适、持久用眼的老视验配目的。
Objective: To compare conventional refractive procedure and medical refractive procedure on age-related cataract patients after binocular phacoemulsification and monofocal intraocular lens inter-capsular implanted, to evaluate the superiority and essentiality of medical refractive procedure, to provide a theoretical basis for the improvement of visual quality of pseudophakic eye with refraction and spectacle dependence.
Method: 30 age-related cataract patients with binocular phacoemulsifi- cation and monofocal intraocular lens inter-capsular implanted (60 eyes), 19 males and 11 females. According to the age,attendants were divided into three groups:younger than fifty group(group A, n =20),fifty to fifty-nine group(group B, n =20), reach or older than sixty group(group C, n =20). For the patients above mentioned conventional refractive procedure firstly and then medical refractive procedure after about a week. Best corrected distant vision acuity (BCDVA), best corrected near vision acuity(BCNVA),the diopter of sphere, cylinder and axis after conventional refractive procedure and than medical refractive procedure , mean spherical equivalent (MSE), presbyopic ADD,length of comfortable reading time, accommodative amplitude with push-up test after BCDVA, positive relative accommodation(PRA) and negative relative accommodation (NRA) with BCNVA were measured 3 months after surgery.
Results:1. There were no significant differences in BCDVA and BCNVA acquired from two refractive procedure (P>0.05).
2. 60 pseudophakic eyes received two refraction procedure. The same spherical diopter were acquired in 9 eyes. Difference of spherical diopter in 0.25D were acquired in 23 eyes, difference of spherical diopter between 0.50D to 0.75D were acquired in 28 eyes, difference of spherical diopter equal or more than 1.00D were acquired in no eye .Difference in cylinder and axis: cylinder was check out in 52 eyes by conventional refractive procedure, and 59 eyes by medical refractive procedure. The same cylinder diopter were acquired in 9 eyes,difference of cylinder diopter in 0.25D were acquired in 20eyes, difference of spherical diopter between 0.50D to 0.75D were acquired in 24eyes, difference of spherical diopter equal or more than 1.00D were acquired in 7eyes. The same axis were acquired in 5 eyes,difference of axis between 5°to10°were acquired in 17eyes, difference of spherical diopter between 10°to 15°were acquired in 19eyes, difference of spherical diopter more than15°were acquired in 10 eyes. mean spherical equivalent acquired from two refractive procedure are significantly different(P<0.05).
3. Accommodation amplitudes with BCDVA acquired from two refractive procedure are significantly different (P<0.05),but both have no correlation with age (P>0.05).
4. There is significantly difference between every age group in ADD and NRA acquired from conventional refractive procedure (P<0.05), There existed positive correlation between ADD and age( r=0.0842,P<0.05),and negative correlation between NRA and age(r=-0.0897 , P<0.05). There is no significantly difference between every age group in ADD and NRA acquired from medical refractive procedure(P>0.05),and have no correlation between ADD or NRA with age(P>0.05).
5. Length of comfortable reading time acquired from medical refractive procedure were 30.13±5.10 minutes ,which were significantly longer than the length of comfortable reading time acquired from conventional refractive procedure (P<0.05).
Conclusion: Medical refractive procedure more accurate than conventional refractive procedure. The exact refraction for pseudophakic eye should be based on the parameter acquired from medical refractive procedure, in order to achieve longer and more comfortable reading.
引文
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