【摘要】 目的 对不同类型老年性白内障患者高阶像差进行量化，以探讨不同类型白内障高阶像差变化特点。方法 选择矫正视力在０.５及以上的不同类型的老年性白内障患者７４例９３眼，排除其他眼部疾病，其中皮质性３０眼，核性２９眼，后囊下３４眼，并选择年龄相匹配的２１例２８眼作为对照，散瞳裂隙灯检查无明显晶体混浊，使用主观波前像差仪进行波前像差检测。结果 各种类型白内障的总高阶像差均高于对照组，差异具有统计学意义。皮质性白内障组总高阶像差为（０.４１３±０.１４６） μｍ，与对照组相比，主要是Ｘ轴方向彗差（Ｚ３１，Ｐ＝０.０３５）和Ｙ轴方向次阶彗差（Ｚ５－１，Ｐ＝０.０８）的不同，核性白内障组总高阶像差为（０.４９８±０.２４６） μｍ，主要是球差（Ｚ４０，Ｐ＝０.０１）和Ｙ轴方向三叶草（Ｚ３－３，Ｐ＝０.０２１）的不同；后囊下性白内障组总高阶像差为（０.４２０±０.１４７） μｍ，但各项高阶像差与对照组相比仅大小不同而方向个体差异较大。结论 不同类型老年性白内障产生不同特点的高阶像差，皮质性白内障主要引起彗差的改变，其球差为正球差；核性白内障主要使球差增加，其球差为负球差；后囊下性白内障总高阶像差明显增加，但各项高阶像差方向因人而异，说明像差的改变不仅与其病变部位有关，可能相同的混浊部位具有不同的病理生理特点。
【关键词】 白内障；晶状体混浊；高阶；波前像差
Ｈｉｇｈｅｒ－ｏｒｄｅｒ ａｂｅｒｒａｔｉｏｎｓ ｏｆ ｄｉｆｆｅｒｅｎｔ ｔｙｐｅｓ ｏｆ ｓｅｎｉｌｅ ｃａｔａｒａｃｔｓ
ＷＡＮＧ Ｋａｉｊｉｅ， ＺＨＵ Ｓｉｑｕａｎ， ＳＵＮ Ｊｉｎｇ， ｅｔ ａｌ.
Ｓｈａｎｄｏｎｇ Ｅｙｅ Ｉｎｓｔｉｔｕｔｅ ＆ Ｈｏｓｐｉｔａｌ， Ｑｉｎｇｄａｏ Ｃｈｉｎａ，２６６０７１
［Ａｂｓｔｒａｃｔ］ Ｏｂｊｅｃｔｉｖｅ To measure and quantify the higher-order aberrations (HOA) induced by different types of senile cataracts. Methods Seventy-four people with different types of senile cataracts were recruited from outpatient clinics and 93 eyes were assessed. The criterion used for inclusion in the study was a corrected visual acuity of 0.5 or better with no co-existing ocular pathology. Among the recruited subjects, 30 eyes had cortical cataract, 29 had nuclear cataract, and 34 had posterior subcapsular cataract. Wavefront aberrations were measured using a subjective aberrometer (WFA1000B). For comparison, 28 eyes of 21 subjects with no lenticular opacity (control group) as determined by slit-lamp examination with dilated pupils were recruited and assessed in an identical manner. Results The root mean square (RMS) values for all higher aberrations with different types of cataracts were statistically higher than RMS values for the control group. In eyes with predominantly cortical opacification, the mean RMS for all higher aberrations was （0.413±0.146） μm and revealed a difference in coma X（Z31, P=0.035）and secondary coma Y (Z5-1, P=0.08) compared to eyes in the control group. In eyes with predominantly nuclear opacification, the mean RMS of all higher-order aberrations was （0.498±0.246） μm and revealed a difference in spherical aberration (Z40, P=0.01) and trefoil Y (Z3-3,P=0.021). In eyes with predominantly posterior subcapsular opacification, the mean RMS of total higher-order aberrations was （0.420±0.147） μm, but all the higher-aberrations revealed a difference in magnitude but not in polarity compared to eyes in the control group. Conclusion This pilot study suggests that different types of senile cataracts induce different wavefront aberration profiles. Cortical cataracts mainly produced the change in coma and the polarity of spherical aberrations was positive. Nuclear cataract mainly produced an increase in spherical aberration and its polarity was negative. Posterior subcapsular cataracts induced an increase in higher-order aberrations, but the polarity of all types of higher-order aberrations shows individual variations, which illustrated that the change in aberrations was not only related to the diseased regions, but the same opacified region may have different characteristics of physiopathology.
［Ｋｅｙ ｗｏｒｄｓ］ ｃａｔａｒａｃｔ; ｃｒｙｓｔａｌ ｏｐａｃｉｔｙ; ｈｉｇｈｅｒ－ｏｒｄｅｒ； ｗａｖｅｆｒｏｎｔ ａｂｅｒｒａｔｉｏｎ
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