摘要
目的
1.探讨球面与非球面人工晶状体球面像差的特性及其对视功能的影响。
2.评价非球面人工晶状体对波前像差的影响。
3.利用ZEMAX光学设计软件模拟人工晶状体在Hwey-Lan Liou模型眼中的成像质量。
方法
1.在实验室搭建IOL波前像差测量光路,采用Hartmann-Shack波前测量仪进行像差测量。实验分为三组,第一组为CeeOn911 A与Tecnis Z9001,第二组为AR40e与Tecnis ZA9003,第三组为AcrySof Natural与AcrySof IQ,对每种IOL分别进行5种通光孔径下(3mm、4mm、5mm、6mm及7mm)像差测量。
2.检索Medline,中国期刊全文数据库,中国生物医学期刊数据库,有关白内障超声乳化联合非球面与传统球面IOL植入的随机临床对照试验,对纳入文献的患者术后最佳矫正视力及波前像差进行同质性检验和合并效应量的检验。
3.利用ZEMAX optical design program,将Liou眼睛模型的结构参数及IOL各项参数输入其中。(1)模拟550nm波长下,各IOL的单色像差,瞳孔直径分别为3mm、4 mm、5 mm和6mm; (2)模拟强光下及暗光下,各IOL的色像差,瞳孔直径分别为3mm和4.5mm。强光环境采用下列5种波长:470, 510,555, 610及650 nm,其权重分别为0.091, 0.503, 1.000, 0.503和0.107。暗光环境采用下列5种波长:420, 455, 505, 550及580 nm,其权重分别为0.097, 0.513, 0.998, 0.481和0.121; (3)位置色差(LCA)从zernike多项式中的离焦项Z_2~0直接读取。
结果
1.球面IOL(CeeOn911A、AR40e、AcrySof Natural)在不同通光孔径下的球面像差均为正值;非球面IOL (Tecnis Z9001、Tecnis ZA9003、AcrySof IQ)在不同通光孔径下的球面像差均为负值,组内比较行t检验,有显著性差异,P值均<0.01。
2.随通光孔径的增大,球面与非球面IOL总像差、球面像差均增大,呈正相关关系(r值分别为0.9257、0.8274、0.7992, p<0.001)。
3.15篇随机临床对照试验,其中非球面IOL 436眼,球面IOL 452眼。眼球总体Z4~0、内部Z4~0、球差(Z4~0+Z6~0)、高阶像差、总体像差、眼内彗差非球面IOL组均较球面IOL组降低,总体加权的平均差值及95%可信区间分别为-0.12,[-0.13,-0.11];-0.08, [-0.09,-0.07];-0.17, [-0.19,-0.16],-0.07,[-0.10,-0.04];-0.56,[-0.73,-0.39];-0.06,[-0.10,-0.01],有显著性差异,表明非球面IOL组的数值低于球面IOL组。最佳矫正视力、眼球总体彗差、眼内水平彗差、眼内垂直彗差及眼球总体三叶草像差,总体加权的平均差值及95%可信区间分别为0.12,[-0.06, 0.29] ; 0.02,[-0.01, 0.04] ; 0.02,[ 0.00, 0.04] ;0.02,[ 0.00, 0.04]; 0.00,[-0.04, 0.05],两组比较无统计学差异,尚不能认为非球面IOL组的数值低于球面IOL组。
4.单色光及复色光条件下,非球面IOL眼的MTF均随瞳孔直径增大而减小。
5.非球面IOL在3mm、4mm、5mm及6mm瞳孔直径下,MTF均大于球面IOL。
6.无论强光或暗光环境下,低色散系数IOL Hoya (Abbe=43)的MTF均大于高色散系数IOL SA60AT (Abbe=37)。
结论
1.球面IOL(CeeOn911A、AR40e、AcrySof Natural)在不同通光孔径下的球面像差均为正值;非球面IOL (Tecnis Z9001、Tecnis ZA9003、AcrySof IQ)在不同通光孔径下的球面像差均为负值,弥补了正常人群角膜的正球面像差,降低人眼总体波前像差,从而提高人眼的视觉质量。
2.随通光孔径的增大,球面与非球面IOL总像差、球面像差均增大。
3.非球面IOL组患者术后眼球总体Z4~0、眼球内部Z4~0、SA、HOA及总体像差均较球面IOL组显著降低。
4.非球面IOL植入术后彗差的变化及由于角膜切口所引致的像差变化尚需探讨。
5.单色光及复色光条件下,非球面IOL眼随瞳孔直径增大,成像质量随之下降。
6.IOL的色散系数越低,MTF越好。
Objective
1.To study the spherical aberrations(SA)of spherical and aspherical intraocularlenses(IOLs)in vitro.
2.To assess the effects of aspherical IOLs,including effects on visual acuity,spherical aberration,hith-order aberrations(HOA),coma and trefoil,compared toconventional spherical IOLs.
3.Using ZEMAX optical design program to analysis the optical quality of the IOLsin the Hwey-Lan Liou model eye.
Methods
1.A special optical metric system was set up to measure the wavefront aberrations ofIOLs with a Hartmann-Shack aberrometer.The study was divided into 3 groups:group 1 were CeeOn911A and Tecnis Z9001,group 2 were AR40e and TecnisZA9003,group 3 were AcrySof Natural and AcrySof IQ.IOL aberrations weremeasured continuously under 3mm,4mm,5mm,6mm and 7mm apertures.Thedata was then statistically analyzed.
2.Trials were identified by searching for the following electronic database forclinical randomized controlled trials about aspherical IOL,wavefront aberration:Medline,Chinese Medical Current Contents(CMCC),China Nitional KnowledgeInfrastructrue(CNKI).Data were combined for meta-analysis using weighted meandifference (WMD)for discontinous data.
3.Using ZEMAX optical design program,(1)analogue monochromatic aberration ofthe IOLs at the length of 550nm,pupil diameters were 3mm～6mm;(2)analoguechromatic aberration of the IOLs at photopic and scotopic conditions,pupildiameters were 3mm and 4.5mm.five lengths at photopic condition were 470,510,555,610 and 650 nm,the weighted were 0.091,0.503,1.000,0.503 and0.107;at scotopic condition five lengths were 420,455,505,550 and 580 nm,theweighted were 0.097,0.513,0.998,0.481 and 0.121.(3)The longitudinalchromatical aberration (LCA)was estimated directly (from the defocus term inthe polynominal expansion of the wavefront aberration).
Results
1.Spherical IOLs had positive SA,aspherical IOLs had negaitive SA.
2.With the increasement of the aperture sizes,the total aberration and the SA of all ofthe IOLs increased accordingly.There were positive correlations between the sizeof aperture and the total and spherical aberrations.(r=0.9257、0.8274、0.7992,p＜0.001)
3.15 clinical randomized controlled trials with 436 eyes were included in theaspherical IOL group and 452eyes in the spherical IOL group.The total Z4~0,internalZ4~0,spherical aberration(Z4~0+ Z6~0),hith-order aberration,total aberration,intemalcoma were lower in the aspherical IOL group.The WMD and 95% confidenceinternals(CI)were-0.12,[-0.13,-0.11 ];-0.08,[-0.09,-0.07];-0.17,[-0.19,-0.16],-0.07,[-0.10,-0.04];-0.56,[-0.73,-0.39];-0.06,[-0.10,-0.01] respectively,thedifferences were significant.There were no significant differences in the bestspectacle-corrected visual acuity(BSCVA),total coma,internal horizontal coma,internalvertical coma and total trefoil of the two groups.The WMD and 95% (CI)were0.12,[-0.06,0.29];0.02,[-0.01,0.04];0.02,[ 0.00,0.04];0.02,[ 0.00,0.04];0.00,[-0.04,0.05].
4.With the increasement of the aperture sizes,the modulation transfer function (MTF)of the aspherical IOLs decreased,both in the monochromatic and chromaticaberration.
5.In the aperture of 3mm～6mm,the MTF of the aspherical IOLs were superior thanthat of the spherical one.
6.No matter in the photopic or scotopic condition,the MTF is higher in IOL Hoya(Abbe=43)than IOLSA60AT (Abbe=37).
Conclusion
1.Aspherical IOLs produced negaitive SA,they are able to compensate for thepositive corneal SA and reduce ocular wavefront aberration,so they can increasethe visual quality.
2.With the increasement of the aperture sizes,the total aberration and the sphericalaberration of the spherical and aspherical IOLs increased accordingly,the optical performance decreased.
3.After the cataract surgery,the total Z4~0、internal Z4~0、SA、HOA and total aberrationwere significantly decreased in the aspherical IOLs groups than those in thespherical IOLs groups.
4.After implantation of the aspherical IOLs,the coma induced by the cornea incisionneed further discussed.
5.With the increasement of the aperture sizes,the optical performance of theaspherical IOL decreased.
6.The lower the chromatic dispersion of the IOL,the higher the MTF.
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