Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
J Refract Surg. 2013 Sep;29(9):630-5. doi: 10.3928/1081597X-20130819-04.
To introduce a new sequential wavefront device with rapid sampling that can be used as an intraoperative, real-time aberrometer/refractometer for immediate diagnosis and management of refractive outcomes during cataract surgery.
A unique wavefront device uses a rotating prismatic mirror to rapidly shift the incident wavefront emanating from the eye through an aperture for analysis of a sequentially sampled wavefront segment. The sampled segment is then focused onto a quad detector that localizes its angular displacement of the sampled segment's wavefront gradient. Although the device's capability is higher for other applications, the wavefront is herein rapidly sampled at 200 Hz (frames/second), with a 2-mm aperture that moves along a 5-mm outer diameter annulus to capture a real-time analysis of refractive error for intraoperative application (ie, an intraoperative wavefront movie). The prototype wavefront device has been miniaturized into a narrow profile attachment that can be fixed to an operating microscope. In pilot analysis, several eyes undergoing cataract surgery were analyzed to determine both the qualitative and quantitative change in refraction with surgical intervention in an effort to document and improve outcomes intraoperatively.
Clinical application of the device was easily implemented without changing or limiting the working distance, magnification, or illumination of the surgeon's ergonomics intraoperatively. The real-time wavefront outcome was visualized overlaying a live eye image, presenting the refractive error both qualitatively and quantitatively. Qualitative representation of spherical refractive error was seen as a circle, cylinder as a thin ellipse, and emmetropia as a dot. Localization of lower-order aberrations with a practical sample rate of 200 frames/ second enables a real-time visualization of qualitative refractive data coaxially aligned with the eye image and quantitatively as sphere, cylinder, and axis at the bottom of the screen. Practical evaluation of residual cylinder prior to and during limbal relaxing incision placement, rotational accuracy during toric intraocular lens alignment, and refractive effect of subtle surgical maneuvers were all achieved with this device.
Real-time, intraoperative refraction and visualization is possible with a new sequential wavefront device attached to the operating microscope. The precision and accuracy of intraoperative documentation and refinement of outcomes is likely to be enhanced, making this an important future tool for optimizing cataract surgery outcomes.
介绍一种新的快速采样序列波前仪，可作为术中实时像差仪/折射仪，用于即时诊断和管理白内障手术中的屈光结果。
独特的波前仪使用旋转棱镜快速移动来自眼睛的入射波前，通过孔径对顺序采样的波前段进行分析。然后，将采样段聚焦到四元探测器上，该探测器定位采样段波前梯度的角位移。尽管该设备在其他应用中具有更高的能力，但此处以 200 Hz（帧/秒）的速度快速采样，2 毫米孔径沿 5 毫米外径环移动，以捕获术中应用的实时屈光误差分析（即术中波前电影）。原型波前仪已小型化为可固定在手术显微镜上的窄型附件。在初步分析中，对几例接受白内障手术的眼睛进行了分析，以确定手术干预过程中屈光的定性和定量变化，努力记录和改善术中结果。
该设备的临床应用易于实现，而不会改变或限制手术过程中医生的工作距离、放大率或照明。实时波前结果通过叠加实时眼睛图像进行可视化，以定性和定量方式呈现屈光误差。球形屈光误差的定性表示为一个圆，柱镜为一个细椭圆，正视眼为一个点。以 200 帧/秒的实用采样率定位低阶像差，可以同轴地实时可视化定性屈光数据与眼睛图像对齐，并在屏幕底部以定量方式显示球镜、柱镜和轴。通过该设备，可以在进行角膜缘松解切口放置之前和期间对残余柱镜进行实际评估，在进行散光人工晶状体对准期间评估旋转精度，以及对微妙的手术操作的屈光效果进行评估。
通过连接到手术显微镜的新型序列波前仪，可以实现实时术中折射和可视化。术中记录和结果细化的精度和准确性可能会提高，这使其成为优化白内障手术结果的重要未来工具。
