目的：探讨白内障超声乳化术后患者OPD-Scan像差检查仪像差差异的临床意义。

方法：选取2013-01/2016-12我院行超声乳化人工晶状体植入术的白内障患者1 000例1 425眼(核分级Ⅱ级)，最终符合纳入标准者共996例1 421眼。根据IOL分为两组：球面IOL组和非球面IOL组。所有患者术前1d及术后3mo均由同一名医生进行角膜波阵面像差检查，获6阶27项Zernik系数、1～6阶均方根(RMS1～6)、总体均方根(RMSg)及高阶均方根(RMSh)，对比手术前后Zernik系数、RMS1～6及RMSg和RMSh，分析IOL对术后RMS的影响。

结果： Zernik系数1～27项中Z4、Z9、Z12和Z24术后均较术前显著下降，手术前后比较有统计学差异(P<0.05)。所有患者术后RMS1、RMS2、RMS3、RMS4、RMS5、RMS6及RMSg和RMSh均较术前显著下降，手术前后比较差异有统计学意义(均P<0.05)。术前不同IOL组RMS比较差异无统计学意义(P>0.05)； 术后3mo，非球面IOL组RMS3、RMS4、RMS5、RMSg、RMSh均明显较球面IOL组低，组间差异有统计学意义(P<0.05)。术前两组间LogMAR视力差异无统计学意义(P>0.05)； 术后3mo均显著较术前改善，非球面IOL组术后3mo LogMAR视力较球面IOL组更佳，组间差异有统计学意义(P<0.01)。经Pearson分析，总高阶像差及Z420与术后最佳矫正视力呈一定负相关(r=-0.354、-0.269，P<0.05)，而Z400和术后最佳矫正视力呈一定正相关(r=0.279，P<0.05)。

结论：白内障超声乳化人工晶状体植入术后RMS1～6、RMSg和RMSh像差明显较术前减小，且高阶像差与术后患者最佳矫正视力有一定相关性，眼高阶像差和人工晶状体类型的选择有关，可见像差测量对于选择合适的人工晶状体意义重大。

METHODS: Totally 1000 cataract patients(1 425 eyes)with nuclear grade II with phacoemulsification and IOL implantation in our hospital from January 2013 to December 2016 were selected, with 996 cases(1421 eyes)met the inclusion criteria and received corneal wavefront aberrations examination by the same technicians at preoperative 1d and postoperative 3mo to get the 6 order 27 items Zernik coefficients, RMS1～6, RMSg and RMSh, contrast on Zernik coefficient, RMS1～6 and RMSg and RMSh. Intraocular lens type and RMS's Logistic regression analysis were conducted, the IOL on postoperative RMS was analyzed.

RESULTS: The statistics showed that among 1-27 items of Zernik coefficient, only Z4, Z9, Z12 and Z24 before and after surgery showed significant difference(P<0.05), and each postoperative Zernik coefficient dropped sharply than that before surgery, there was difference before and after surgery(P<0.05). After operation, RMS1, RMS2, RMS3, RMS4, RMS5, RMS6, RMSg and RMSh decreased markedly than those before operation(P<0.05). There was no significant difference on RMS between different types of IOL before operation(P>0.05). RMS3, RMS4, RMS5, RMSg and RMSh of the aspheric surface were significantly lower than those of the spherical IOL group(P<0.05). There was no significant difference on visual acuity(LogMAR)between the two groups before operations(P>0.05). At 3mo after the operation, visual acuity were significantly better than those before surgery, and the LogMAR visual acuity was better in the aspheric IOL group(P<0.01). By Pearson analysis, the overall higher order aberrations and Z420 were negatively correlated with the best corrected visual acuity after surgery(r=-0.354, -0.269; P<0.05), while Z400 had a positive correlation with postoperative best corrected visual acuity(r=0.279, P<0.05).

CONCLUSION: RMS1～6, RMSg and RMSh aberrations reduce markedly than those before operation after phacoemulsification and IOL implantation. There is a certain relevance between the higher order aberrations and postoperative visual acuity. High-order aberrations are related to the choice of intraocular lens type, aberration measurement shall be taken to assure a reasonable and scientific selection of intraocular lens type.