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角膜地形图在屈光性白内障手术中人工晶状体选择的应用。

Corneal Topography for Intraocular Lens Selection in Refractive Cataract Surgery.

机构信息

Department of Ophthalmology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan; Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, Higashigaoka, Meguro-ku, Tokyo, Japan; School of Optometry, University of California, Berkeley, California.

Department of Ophthalmology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan.

出版信息

Ophthalmology. 2021 Nov;128(11):e142-e152. doi: 10.1016/j.ophtha.2020.11.016. Epub 2020 Nov 19.

Abstract

The purpose of this review is to evaluate the usefulness of corneal topography to select premium intraocular lenses (IOLs), including aspherical IOLs, toric IOLs, and multifocal IOLs, in refractive cataract surgery. Corneal topography can detect corneal regular astigmatism, corneal irregular astigmatism (higher-order aberrations [HOAs]) including spherical aberration, and corneal shape abnormalities after corneal refractive surgery. Surgeons can explain to the patients with significant corneal HOAs about its effect on postoperative visual function before surgery. Multifocal IOLs should not be selected for such eyes. For eyes with abnormal corneal shape, appropriate IOL power calculation formulae can be applied. In the case of toric IOLs, regular astigmatism and corneal HOAs should be checked. Before implanting an aspheric IOL, it is ideal to confirm spherical aberration of the cornea is not below the normal range. Because corneal HOAs, abnormal corneal shape after corneal refractive surgery, corneal regular astigmatism, and corneal spherical aberration increase postoperative refractive errors and poor vision quality with premium IOLs, corneal topography before cataract surgery is helpful in screening patients who are not appropriate candidates for premium IOLs.

摘要

本综述旨在评估角膜地形学在选择高端人工晶状体(IOL)中的作用,包括非球面 IOL、散光 IOL 和多焦点 IOL,用于屈光性白内障手术。角膜地形学可以检测角膜规则散光、角膜不规则散光(高阶像差[HOA]),包括球差,以及角膜屈光手术后的角膜形状异常。在手术前,外科医生可以向有明显角膜 HOA 的患者解释其对术后视觉功能的影响。对于此类眼睛,不应选择多焦点 IOL。对于角膜形状异常的眼睛,可以应用适当的 IOL 计算公式。对于散光 IOL,应检查规则散光和角膜 HOA。在植入非球面 IOL 之前,理想的情况是确认角膜的球差不在正常范围内。因为角膜 HOA、角膜屈光手术后的异常角膜形状、角膜规则散光和角膜球差会增加使用高端 IOL 的术后屈光误差和较差的视觉质量,所以白内障手术前的角膜地形学有助于筛选不适合使用高端 IOL 的患者。

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