多焦点、可调节和单焦点人工晶状体临床视觉质量的观察

目的 比较植入多焦点( multifocal intraocular lenses,MIOL)、可调节(accommodative intraocular lens,AIOL)和单焦点( monofocal/single focus intraocular lens,SIOL)人工晶状体植入术后的视觉质量.方法 采用同期随机对照研究,选取2010年9月至2011年4月期间,在本科行白内障超声乳化联合人工晶状体植入术的患者,分别植入3种人工晶状体,其中多焦点ZMA00组30例(43只眼),可调节FLEX组33例(49只眼),单焦点AKROS组32例(47只眼).术后1d,1、3个月随访,测定患者裸眼及矫正远视力、矫正远视力下近视力及中视力；离焦法测伪调节力；MFVA-100多功能视力检测仪测量对比敏感度视力,并问卷调查其脱镜率.结果 裸眼远视力ZMA00组和FLEX组略高于AKROS组,但差异无统计学意义(P＞0.05),矫正远视力3组无明显差异(P＞0.05)；矫正远视力下中视力,ZMA00和FLEX组均明显优于AKROS组(P＜0.05),但ZMA00和FLEX 2组间无差异(P＞0.05)；矫正远视力下近视力及人工晶体眼伪调节力均表现为ZMA00组最佳,FLEX组次之,AKROS组最低,差异有统计学意义(P＜0.05).脱镜率ZMA00组86.7％( 26/30),FLEX组63.6％(21/33),均优于AKROS组18.8％(6/32),差异有统计学意义(P＜0.05)；在各百分比对比度下,3组患者的对比敏感度视力无显著差异(P＞0.05).结论 3种人工晶状体均可获得较好的远视力,但多焦点和可调节人工晶状体均拥有更佳的远、中、近视力及较高的调节力和脱镜率.非球面多焦点人工晶状体未带来对比敏感度的缺失,且在近视力及伪调节力方面,比可调节人工晶状体具有更大的优势.

Visual quality of multifocal, accommodative and monofocal intraocular lens: a comparative study of 139 eyes

Objective To assess the visual outcomes of the 3 types of intraocular lens,multifocal intraocular lens(MIOL ZMA00),accommodating intraocular lens(AIOL,FLEX) and monofocal/single focus intraocular lens(SIOL,AKROS),in the treatment of phacoemulsification for the patients with age-related cataract.Methods A randomized concurrent control trial was carried out in 95 patients(139 eyes) with age-related cataract who receiving phacoemulsification and implantation of artificial intraocular lens in our department during September 2010 to April 2011.Forty-three eyes of 30 patients underwent phacoemulsification and implantation of ZMA00,and another 33 age-and sex-matched patients(49 eyes) and 32 patients(47 eyes) had the same surgery but implantated with FLEX and AKROS respectively.All patients were assessed for visual acuity,accommodation amplitude and contrast sensitivity visual acuity in 1 d,1 and 3 months after operation.Results During the follow-up time,the patients in the ZMA00 and FLEX groups had better vision acuity than the AKROS group in uncorrected distance vision acuity(UDVA),but no significant difference was found(P>0.05).And the patients in the ZMA00 and FLEX groups had better corrected intermediate vision acuity(CIVA) than the AKROS group(P<0.05).The corrected near vision acuity(CNVA) in ZMA00 group was the largest,followed by FLEX group and AKROS group in turn(P<0.05).Defocus method showed that the accommodative amplitude had the same trend with CNVA.In all contrast degrees,there was no significant difference of contrast sensitivity among the 3 groups(P>0.05).There were 86.7% patients of the ZMA00 group,63.6% of the FLEX group,and 18.8% of the AKROS group achieving total spectacle independence.Conclusion Three kinds of artificial lens can get better distance vision,but multifocal and accommodative intraocular lens possesses far better,and the higher rate of spectacle independence.Aspheric multifocal intra-ocular lens have no loss in contrast sensitivity,and take greater advantages than accommodating intraocular lens in near vision,and pseudo-conditioning capability.