Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany South West Peninsula Postgraduate Medical Education, School of Ophthalmology, Plymouth, UK.
Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany Care Vision, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
Br J Ophthalmol. 2014 Nov;98(11):1484-91. doi: 10.1136/bjophthalmol-2013-304786. Epub 2014 May 30.
To provide the first clinical data in determining the feasibility, quality and precision of intraoperative wavefront aberrometry (IWA)-based refraction in patients with cataract.
IWA refraction was recorded at 7 defined measurement points during standardised cataract surgery in 74 eyes of 74 consecutive patients (mean age 69±11.3 years). Precision and measurement quality was evaluated by the 'limits of agreement' approach, regression analysis, correlation analysis, Analysis of variance (ANOVA) and ORs for predicting measurement failure. Wavefront map (WFM) quality was objectivised and compared with the Pentacam Nuclear Staging analysis.
Out of 814 IWA measurement attempts, 462 WFMs could be obtained. The most successful readings (n=63) were achieved in aphakia with viscoelastic. The highest (50.63%, SD 20.23) and lowest (29.19%, SD 13.94) quality of WFMs across all measurement points were found after clear corneal incision and in pseudophakia with viscoelastic, respectively. High consistency across repeated measures were found for mean spherical equivalent (SE) differences in aphakia with -0.01D and pseudophakia with -0.01D, but ranges were high (limits of agreement +0.69 D and -0.72 D; +1.53 D and -1.54 D, respectively). With increasing WFM quality, higher precision in measurements was observed.
This is the first report addressing quality and reproducibility of WA in a large sample. IWA refraction in aphakia, for instance, appears to be reliable once stable and pressurised anterior chamber conditions are achieved. More efforts are required to improve the precision and quality of measurements before IWA can be used to guide the surgical refractive plan in cataract surgery.
提供首例临床数据，以确定白内障患者术中波前像差（IWA）折射的可行性、质量和精度。
在 74 例连续患者的 74 只眼中，在标准化白内障手术期间在 7 个定义的测量点记录 IWA 折射（平均年龄 69±11.3 岁）。通过“一致性界限”方法、回归分析、相关分析、方差分析（ANOVA）和预测测量失败的比值比（OR）来评估精度和测量质量。客观评估波前图（WFM）质量并与 Pentacam 核分期分析进行比较。
在 814 次 IWA 测量尝试中，有 462 次获得了 WFM。在无晶状体眼使用粘弹性剂时，获得了最成功的读数（n=63）。在所有测量点中，WFM 的质量最高（50.63%，SD 20.23%）和最低（29.19%，SD 13.94%）分别出现在角膜透明切口后和粘弹性剂的假性晶状体中。在无晶状体眼的平均球镜等效差异（SE）中发现了高度一致的重复测量结果，为-0.01D，在假性晶状体眼的平均球镜等效差异（SE）中为-0.01D，但范围较大（一致性界限+0.69 D 和-0.72 D；+1.53 D 和-1.54 D，分别）。随着 WFM 质量的提高，测量的精度也随之提高。
这是第一篇报道在大样本中评估 WA 质量和可重复性的报告。例如，一旦在前房稳定和加压的条件下实现，无晶状体眼的 IWA 折射似乎是可靠的。在 IWA 能够用于指导白内障手术的手术屈光计划之前，需要进一步努力提高测量的精度和质量。
