| Super-IOL Calculator对角膜屈光手术后人工晶体屈光力计算准确性的研究
广东省人民医院眼科 郭海科 金海鹰 张洪洋 曾锦
摘要
目的：通过比较自行开发的人工晶体屈光力计算软件Super-IOL Calculator与不同计算公式对角膜屈光手术后人工晶体屈光力的计算准确性，探讨角膜屈光手术后人工晶体屈光力的计算方法。
方法：建立人工晶体屈光力计算公式，并将其制作为软件Super-IOL Calculator。选择3例（5眼）角膜屈光手术后白内障患者，角膜曲率计测量角膜屈光力，以OrbscanⅡZ眼前节分析系统测量角膜总体屈光力（Total Axial Power）、角膜地形图（Keratometric Axial Power）和角膜直径， A型超声检测仪测量眼轴长度、前房深度以及晶状体厚度，将测量参数分别输入Super-IOL Calculator和Holladay IOL Consultant计算软件，计算人工晶体屈光力，预测术后眼屈光状态。根据计算结果选择人工晶体，采用超声乳化折叠人工晶体植入手术，以手术后眼屈光状态为标准，比较：（1）Holladay IOL Consultant（SRKⅡ、HofferQ、HolladayI、HolladayⅡ公式）与Super-IOL Calculator计算的准确性。（2）角膜曲率计和OrbscanⅡZ眼前节分析系统对角膜屈光力测量的准确性及其对人工晶体屈光力计算准确性的影响。
结果：（1）SRK-Ⅱ 、Hoffer-Q 、HolladayⅠ、 HolladayⅡ公式与Super-IOL Calculator预测术后眼屈光状态产生的误差分别为：1.96 0.81D、0.55 0.30D、1.62 0.84D、-0.09 0.17D、-0.04 0.26。多因素方差分析除HolladayⅡ与Super-IOL Calculator外其余各公式间的预测误差均有显著性差异（P<0.05），表明Super-IOL Calculator与HolladayⅡ公式计算的准确性高于其他公式。（2）因1例患者双眼角膜屈光力超出角膜曲率计的检测范围，无法进行统计学分析，选用角膜地形图（Keratometric Axial Power）的计算误差为1.85 0.67D，高于选用Orbscan ⅡZ角膜总体屈光力（Total Axial Power）计算产生的误差-0.04 0.26，独立样本T检验，T=5.52,P<0.05。表明Orbscan ⅡZ角膜总体屈光力（Total Axial Power）对角膜屈光手术后角膜屈光力的检测结果较为准确。
结论：Super-IOL Calculator对于角膜屈光手术后白内障患者人工晶体屈光力计算的准确性较高，Super-IOL Calculator与OrbscanⅡ联合应用是确定屈光手术后人工晶体的屈光力的良好方法。
关键词：Super-IOL Calculator；人工晶体屈光力计算； 角膜屈光手术； 白内障
Intraocular Lens Power Calculation with Super-IOL Calculator for Cataract Patients after Previous Corneal Refractive Surgery
Guo Haike, Jin Haiying, Zhang Hongyang
Ophthalmology Department, Guangdong Provincial people’s Hospital
Abstact
Purpose： To investigate the accuracy and predictability of Super-IOL Calculator software and other intraocular lens (IOL) power calculation formulas in eyes that underwent corneal refractive surgery.
Methods: New calculation method was invented and IOL calculating software Super-IOL Calculator was developed. 4 rare cataractous cases that had corneal refractive surgery were selected: One cataractous patient received RK later PRK to correct myopia. two patient received RK, and One patient received received PRK years ago. Keratometer was used to measure keratometric power. Orbscan ⅡZ was used to measure Total Axlial Power and Keratometric Axial Power. Axial length, anterior chamber depth and lens thickness were detected by DGH A-scan. All parameters were entered into Super-IOL Calculator and Holladay IOL consultant software. Phacoemulsification was performed and IOL power was selected according to Super-IOL Calculator. The accuracy of keretometer and Orbscan to measure corneal refractive power were compared. The consultant accuracy of Super-IOL Calculator, SRKⅡ, HofferQ, HolladayI and Holladay Ⅱ formula were also compared according to the eye refraction after IOL implantation.
Results:(1)The refraction after IOL implantation were -0.75D,-0.375D,-0.75D,-0.375D for each case. Super-IOL Calculator and HolladayⅡfomula have more accuracies and predictabilities than other formulas. (2) The Total Axial Power measured by Orbscan ⅡZ is more accurate than the Keratometeric Axial Power and the power measured by kerotometer for eyes underwent corneal refractive surgery.
Conclution: Super-IOL Calculator and Orbscan ⅡZ are perfect implements to the ascertainment of IOL refractive power of special cataract patients
Key words: Super-IOL Calculator, Intraocular Lens Power Calculation, Corneal Refractive surgery, Cataract
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