白内障手术中生物测量的优化以达到最佳屈光效果。

Optimization of biometry for best refractive outcome in cataract surgery.

机构信息

Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.

Department of Ophthalmology, Government Doon Medical College, Dehradun, Uttarakhand, India.

出版信息

Indian J Ophthalmol. 2024 Jan 1;72(1):29-43. doi: 10.4103/IJO.IJO_1219_23. Epub 2023 Dec 22.

Abstract

High-precision biometry and accurate intraocular lens (IOL) power calculation have become essential components of cataract surgery. In clinical practice, IOL power calculation involves measuring parameters such as corneal power and axial length and then applying a power calculation formula. The importance of posterior corneal curvature in determining the true power of the cornea is increasingly being recognized, and newer investigative modalities that can estimate both the anterior and posterior corneal power are becoming the standard of care. Optical biometry, especially using swept-source biometers, with an accuracy of 0.01-0.02 mm, has become the state-of-the-art method in biometry. With the evolution of IOL formulas, the ultimate goal of achieving a given target refraction has also moved closer to accuracy. However, despite these technological efforts to standardize and calibrate methods of IOL power calculation, achieving a mean absolute error of zero for every patient undergoing cataract surgery may not be possible. This is due to inherent consistent bias and systematic errors in the measurement devices, IOL formulas, and the individual bias of the surgeon. Optimization and personalization of lens constants allow for the incorporation of these systematic errors as well as individual bias, thereby further improving IOL power prediction accuracy. Our review provides a comprehensive overview of parameters for accurate biometry, along with considerations to enhance IOL power prediction accuracy through optimization and personalization. We conducted a detailed search in PubMed and Google Scholar by using a combination of MeSH terms and specific keywords such as "ocular biometry," "IOL power calculations," "prediction accuracy of refractive outcome in cataract surgery," "effective lens position," "intraocular lens calculation formulas," and "optimization of A-constants" to find relevant literature. We identified and analyzed 121 relevant articles, and their findings were included.

摘要

高精度的生物测量和准确的人工晶状体(IOL)屈光力计算已成为白内障手术的重要组成部分。在临床实践中,IOL 屈光力计算涉及测量角膜曲率和眼轴等参数,然后应用屈光力计算公式。人们越来越认识到后角膜曲率在确定角膜真实屈光力方面的重要性,能够评估前、后角膜曲率的新型检查方法正在成为标准。光学生物测量,特别是使用扫频源生物测量仪,精度可达 0.01-0.02mm,已成为生物测量的最新方法。随着 IOL 公式的发展,实现给定目标屈光度的最终目标也越来越接近准确性。然而,尽管这些技术努力使 IOL 屈光力计算方法标准化和校准,但对于每个接受白内障手术的患者,实现平均绝对误差为零可能并不现实。这是因为测量设备、IOL 公式以及外科医生的个体偏差都存在固有一致的偏差和系统误差。晶状体常数的优化和个性化允许将这些系统误差以及个体偏差纳入其中,从而进一步提高 IOL 屈光力预测的准确性。我们的综述全面概述了准确生物测量的参数,并考虑了通过优化和个性化来提高 IOL 屈光力预测准确性。我们在 PubMed 和 Google Scholar 上进行了详细的搜索,使用了 MeSH 术语和特定关键词的组合,如“眼生物测量”、“IOL 屈光力计算”、“白内障手术中屈光结果的预测准确性”、“有效晶状体位置”、“IOL 计算公式”和“A-常数的优化”,以查找相关文献。我们确定并分析了 121 篇相关文章,并纳入了它们的发现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5287/10841781/000edc098e1c/IJO-72-29-g001.jpg

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