Davison James A, Potvin Richard
Wolfe Eye Clinic, Marshalltown, IA.
Science in Vision, Akron, NY, USA.
Clin Ophthalmol. 2017 May 17;11:923-929. doi: 10.2147/OPTH.S135659. eCollection 2017.
This study aimed to assess the value of intraoperative aberrometry (IA) in determining the intraocular lens (IOL) sphere power in eyes with no previous ocular surgery.
We conducted a retrospective review of patients who underwent uncomplicated cataract surgery where standard preoperative (Preop) measurements and IA were performed. Calculated IOL sphere powers and postoperative refractions, both actual and theoretical, were compared based on the measurement method and lens type; lens types included multifocal, toric and aspheric single-vision non-toric IOLs.
A total of 160 eyes of 112 patients were analyzed. The Preop lens power calculated was the same as the IA lens power 46% of the time, though this percentage was lower for multifocal IOLs. Across all lens types, there was a statistically significant bias (chi-square test, <0.01) toward the IA method suggesting a lower powered lens. Actual postoperative refractive errors were not statistically significantly different when categorized by measurement method. Calculated errors by measurement method showed no statistically significant differences in expected outcomes. There were 63 cases where the Preop calculation and the intraoperative aberrometer calculation differed by 0.5 D. In 56% (35/63) of these cases, the IA result was a better option, and in 44% (28/63) of cases, the Preop calculation was better; this was not statistically significantly different from random expectation (50/50, =0.53). In the three cases where calculated powers differed by 1.5 D, there appeared to be a positive effect of adjusting the Preop power toward the IA power.
The use of IA for the determination of sphere power in eyes with no previous ocular surgery does not appear to improve overall expected clinical outcomes, but it may be helpful in cases where the difference between IA and Preop calculations is high.
本研究旨在评估术中像差仪（IA）在确定既往无眼部手术史患者的人工晶状体（IOL）球镜度数方面的价值。
我们对接受了无并发症白内障手术且进行了标准术前（Preop）测量和IA测量的患者进行了回顾性研究。根据测量方法和晶状体类型比较计算出的IOL球镜度数以及实际和理论术后屈光情况；晶状体类型包括多焦点、环曲面和非球面单焦点非环曲面IOL。
共分析了112例患者的160只眼。Preop计算的晶状体度数与IA计算的晶状体度数在46%的时间内相同，不过多焦点IOL的该比例较低。在所有晶状体类型中，对IA方法存在统计学显著偏差（卡方检验，<0.01），提示晶状体度数较低。按测量方法分类时，实际术后屈光不正无统计学显著差异。按测量方法计算的误差在预期结果方面无统计学显著差异。有63例Preop计算与术中像差仪计算相差0.5 D。在这些病例中，56%（35/63）的情况下IA结果是更好的选择，44%（28/63）的情况下Preop计算更好；这与随机预期（50/50，=0.53）无统计学显著差异。在计算度数相差1.5 D的3例病例中，将Preop度数向IA度数调整似乎有积极效果。
对于既往无眼部手术史的患者，使用IA确定球镜度数似乎并未改善总体预期临床结果，但在IA与Preop计算差异较大的情况下可能会有帮助。
