【摘要】 目的:评价非球面人工晶状体（intraocular lens,IOL）Tecnis Z9000对提高年龄相关性白内障患者术后视功能的作用。 方法:选取年龄相关性白内障患者 34例36眼，其中18眼为Tecnis Z9000组，18眼为传统球面人工晶状体组。检查术后3mo最佳矫正远视力，不同亮度环境及有、无散瞳条件下的对比敏感度(contrast sensitivity,CS)。 结果:手术后3mo最佳矫正远视力Tecnis Z9000组为0.89±0.17，球面人工晶状体组为0.76±0.16，两组差异有显著性（P<0.05）。正常瞳孔下，两组晶状体在不同空间频率（1.5，3，6，12，18c/d）、不同照明条件下CS无显著差别。散瞳后Tecnis组亮环境（亮度为85cd/m2）下的12，18c/d CS及暗环境（亮度为3cd/m2）下1.5，3c/d CS均分别与同条件下的球面人工晶状体组比较差异有显著性。结论:白内障术后早期，Tecnis Z9000可提高最佳矫正远视力和对比敏感度，改善术眼视功能。
【关键词】 非球面人工晶状体；对比敏感度；视觉质量
Clinical study of visual function after Tecnis Z9000 intraocular lens implantation
YingYing Chen, ShaoJian Tan, Yu Ling, Hao Liang, Xia Li
Foundation item:Guangxi Zhuang Autonomous Region Graduate Fund Innovative Projects (No.2006105981002M15)
Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Abstract AIM: To investigate the effectiveness of aspheric intraocular lens, Tecnis Z9000, in the treatment of phacoemulsification for the patients with agerelated cataract.
METHODS: Thirtyfour agerelated cataract patients (36 eyes) were selected and treated with phacoemulsification. Group 1 (18 eyes) was implanted the aspheric IOL (Tecnis Z9000, AMO) and group 2 (18 eyes) was implanted the spheric IOL (Acrysof SA60AT, ALCON). Complete ophthalmologic examination was performed preoperatively, on day 1 and month 3 postoperatively. Bestspectacle corrected visual acuity (BSCVA) and contrast sensitivity (CS) were performed on month 3 postoperatively.
RESULTS: The mean best corrected visual acuity (BCVA) of Tecnis group after 3 months was 0.89±0.17, while the Acrysof SA60AT group was 0.76±0.16. BCVA of both groups were significantly improved. But Tecnis group got better BCVA than Acrysof SA60AT group (P=0.02). As for physiologically dilated pupil, there was no significant difference in contrast sensitivity between two groups. After mydriasis, contrast sensitivity in log unit at 12, 18cpd in Tecnis group were significantly higher than those in Acrysof SA60AT group under photopic condition (P<0.05). Contrast sensitivity at 1.5cpd and 3cpd in Tecnis group were significantly higher than those in Acrysof SA60AT group under mesopic condition (P<0.05).
CONCLUSION: Early period after cataract surgery, aspheric IOLs (Tecnis IOL) can improve BCVA and increase the contrast sensitivity of higher frequencies under photopic condition and middle and low frequencies under mesopic condition in patients with large pupils and improve functional vision.
KEYWORDS: aspheric lenses; contrast sensitivity; visual function
Chen YY, Tan SJ, Ling Y, et al. Clinical study of visual function after Tecnis Z9000 intraocular lens implantation. Int J Ophthalmol
(Guoji Yanke Zazhi)2008;8(11):22322234
0引言
白内障是全球首位致盲眼病,随着白内障手术技术的发展和人们生活水平的提高,人们对术后视功能恢复的期望也越来越高,以往白内障摘除植入球面人工晶状体,患者在术后视觉质量上仍存在问题，如眩光、暗视力差、视物变色、对比敏感度低等。有研究认为，人眼中球差和彗差的影响较大，随着波前像差技术的引入，新型的非球面IOL开始出现，美国AMO公司生产的Tecnis Z9000衍射型非球面人工晶状体的全面上市,补偿了角膜正性球面像差。我院于2006 08开始应用Tecnis Z9000非球面人工晶状体,现将结果报告如下。
1对象和方法
1.1对象 2006 08/200711我院行白内障超声乳化吸除联 表1术后3mo不同照明条件下对比敏感度比较（n＝18）
瞳孔IOL照明1.5c/d3.0c/d6.0c/d12c/d18c/d未散瞳Tecnis Z9000昏暗35.0±13.251.0±24.474.2±31.851.4±21.514.2±5.7Acrysof SA60AT34.8±15.548.6±24.368.2±29.050.3±21.714.2±6.0Tecnis Z9000明亮34.9±13.861.2±25.273.4±22.642.4±16.813.4±8.1Acrysof SA60AT34.7±14.261.9±22.372.7±23.547.7±19.914.4±6.1散瞳Tecnis Z9000昏暗34.8±13.846.1±13.454.9±21.040.5±15.216.7±7.9Acrysof SA60AT22.7±11.5a36.3±10.8a55.2±18.739.7±10.217.1±7.9Tecnis Z9000明亮29.2±10.848.7±16.362.5±24.844.0±15.221.5±7.1Acrysof SA60AT30.6±11.843.1±14.064.6±24.930.9±10.0a15.1±8.4a
aP<0.05 vs Tecnis Z9000组
合折叠式Tecnis Z9000非球面IOL植入术患者16例18眼为研究组,同期行白内障超声乳化吸除联合折叠式球面IOL Acrysof SA60AT植入术患者18例18眼为对照组。非球面IOL组:男7例8眼,女9例10眼,年龄58～78(平均69.0±7.61)岁,植入IOL平均度数19.78±1.49D，瞳孔直径2.86±0.29mm；球面IOL组:男10例10眼,女8例8眼,年龄57～80(平均68.5±8.55)岁，植入IOL平均度数20.25±1.86D，瞳孔直径2.81±0.23mm。两组患者以上基本情况差异无统计学意义。全部患者排除糖尿病、高血压、青光眼、黄斑病变等合并症；术眼角膜散光度数均<1.50D，全部患者视力为手动/眼前～0.4；术前裂隙灯显微镜检查晶体核硬度II～Ⅳ级。术前检查包括普通视力表检查视力、裂隙灯检查眼前节、散瞳眼底检查、测眼A超和B超、角膜曲率、应用SRK II公式计算出预植入IOL度数等。尽量使术后屈光状态为正视。
1.2方法 表面麻醉下做3.2mm透明角膜切口,中央连续环形撕囊,直径5.0～5.5mm,水分离,囊袋内超声乳化晶状体核,灌注系统清除残留晶状体皮质,推进器植入人工晶状体于囊袋内，所有术眼由同一人完成。术后1d:使用标准对数视力表,测术眼的裸眼远视力、矫正远视力，常规的裂隙灯及检眼镜检查观察有无并发症。并分别于术后1wk；1,2,3mo门诊随诊。术后3mo后复查裸眼远视力，Topcon验光仪测最佳矫正远视力，复方托吡卡胺眼液散瞳前、后（瞳孔散至5mm以上）充分矫正近视力情况下,美国Stereo Optical公司生产的CS测试卡（F.A.C.T）测明亮条件（亮度为85cd/m2）及昏暗条件（亮度为3cd/m2）下的对比敏感度。每眼检查3次，取平均值，统一取3.0mm， 5.0mm瞳孔直径做比较。术后视觉不良症状采用问卷调查形式。
统计学处理:采用t检验及χ2检验对数据进行统计学分析。
2结果
2.1视力 术后3mo，最佳矫正远视力Tecnis Z9000组为0.89±0.17，Acrysof SA60AT组为0.76±0.16，差异有统计学意义（P=0.03）
2.2对比敏感度 术后3mo，使用规尺测得两组自然状态下和复方托吡卡胺眼液散瞳后瞳孔直径（mm）为2.91±0.22，2.85±0.18和6.02±0.23，6.13±0.15，两者间统计学上无显著性差异。正常瞳孔下，两组病例在不同空间频率（1.5，3，6，12，18c/d）、不同的照明条件下对比敏感度差别没有统计学意义。散瞳后Tecnis Z9000组亮环境（85cd/m2亮度）下12，18c/d对比敏感度与Acrysof SA60AT组对比差异有统计学意义（P<0.05）。Tecnis Z9000组暗环境（3cd/m2亮度）下1.5，3c/d的对比敏感度与Acrysof SA60AT组对比差异有统计学意义（P<0.05，表1）。
2.3不良症状 术后无1例发生并发症；裂隙灯检查无1例发生IOL偏中心或偏斜。术后3mo通过问卷调查了解患者术后眩光、光晕情况，球面IOL组有2例诉看强光刺眼偶见光晕,但不影响其生活，非球面IOL组1例偶有看东西出现光晕症状,两组差异无统计学意义。
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