三种人工晶状体植入术后静态视力和动态视力的评估及比较

目的：对三焦点、双焦点及连续视程人工晶状体植入术后的单眼视力和动态视力（DVA）进行评估及比较。方法：前瞻性临床研究。选取2020年1月至2021年1月于重庆医科大学附属第一医院眼科行白内障超声乳化摘除联合人工晶状体植入且资料完整的白内障患者65例（81眼）。根据所选择的IOL 类型分为3组：双焦点组33眼，植入Tecnis ZMB00 IOL；三焦点组20眼，植入AT Lisatri.839MP IOL；EDOF组28眼，植入Tecnis ZXR00 IOL。术后3个月分别检测每眼的裸眼静态视力（SVA）：包括裸眼远视力（UDVA）、裸眼中视力（UIVA）、裸眼近视力（UNVA）（LogMAR视力）。采用运动视标法检测裸眼DVA（检测速度分别为4、8、12、24fps）：包括裸眼动态远视力（UDDVA)、裸眼动态中视力（UIDVA）、裸眼动态近视力（UNVA）（LogMAR视力），并进行评估比较。通过“手抓尺子试验”检测患者反应速度。数据采用卡方检验、方差分析、Kruskal-WallisH检验进行统计分析。结果：3组的总体UDVA、UNVA差异均无统计学意义；3组的总体UIVA差异有统计学意义（H=23.13，P<0.001），进一步两两比较发现EDOF组优于双焦点组（P<0.001）；三焦点组优于双焦点组（P=0.016）；EDOF 组与三焦点组差异无统计学意义。3组的总体UDDVA在4、8fps时差异均无统计学意义；而在12、24fps时总体差异均有统计学意义（H=10.96，P=0.004；H=11.52，P=0.003），进一步比较发现双焦点组优于三焦点组（H=-16.21，P=0.003；H=-17.98，P=0.004），EDOF组优于三焦点组（H=-12.67，P=0.030；H=-16.48，P=0.009），双焦点组与EDOF组差异无统计学意义。3组的总体UIDVA在8fps 时差异无统计学意义，而在4、12、24fps时差异均有统计学意义（H=8.17~11.36，P<0.05）：4、12fps 时，EDOF组优于双焦点组（H=14.61，P=0.013；H=14.52，P=0.009），与三焦点组差异无统计学意义；24fps时，EDOF组优于双焦点组、三焦点组（H=15.31，P=0.008；H=-16.60，P=0.027）。3组的总体UNDVA在4、8、12、24fps时差异均有统计学意义（H=11.25~17.61，P<0.05），且EDOF组均分别优于双焦点组（H=12.71~17.87，P<0.05）和三焦点组（H=-23.04~-15.87，P<0.05），双焦点组与三焦点组差异均无统计学意义（均P>0.05）。结论：在SVA方面，三焦点IOL及EDOFIOL均可获得较好的UDVA、UIVA、UNVA，而双焦点IOL的UIVA较弱。在DVA方面，远距离、低速度时，3种IOL结果相当；但是近距离、高速度时，EDOFIOL的DVA较其余二者更佳。

Evaluation and Comparison of Visual Acuity and Dynamic Visual Acuity after Three Kinds of Intraocular Lens Implantation in Cataract Patients

Objective: To evaluate and compare monocular visual acuity and dynamic visual acuity after implantation of trifocal intraocular lens, bifocal intraocular lens, or extended depth of focus intraocular lens in cataract patients. Methods: This was a prospective clinical study. Eight-one cataract eyes of 65 patients which had cataract surgery in the ophthalmology department of the First Affiliated Hospital of Chongqing Medical University from January 2020 to January 2021 were involved. Thirty-three eyes were implanted with ZMB00 IOL as the bifocal group, 20 eyes implanted with AT Lisatri. 839MPIOL as the trifocal group and 28 eyes implanted with ZXR00 IOL as the EDOF group. The uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), uncorrected distance dynamic visual acuity (UDDVA), uncorrected intermediate dynamic visual acuity(UIDVA), and uncorrected near dynamic visual acuity (UNDVA) (log MAR) were assessed 3 months postoperatively. Data were assessed with a Chi-square test, analysis of variance, and Kruskal-Wallis H test. Results: The UDVA and UNVA of the three groups were not significantly different; the UIVA of the three groups was significantly different (H=23.13, P<0.001). The EDOF group was significantly better than the bifocal group (P<0.001); the trifocal group was significantly better than the bifocal group (P=0.016); there was no significant difference between the EDOF group and the trifocal group. There was no significant difference in the UDDVA of the three groups at 4 and 8 fps, but at 12 and 24 fps (H=10.96, P=0.004; H=11.52, P=0.003). The bifocal group was better than the trifocal group (H=-16.21, P=0.003; H=-17.98, P=0.004), and the EDOF group significantly better than the trifocal group (H=12.67, P=0.030; H=-16.48, P=0.009). The difference between the bifocal group and the EDOF group was not statistically significant. There was no significant difference in the UIDVA of the three groups at 8 fps, but at 4, 12, and 24 fps (H=8.17-11.36, P<0.05): At 4, 12 fps, the EDOF group was better than the bifocal group (H=14.61, P=0.013; H=-14.52, P=0.009), and the difference was not statistically significant with the trifocal group; at 24 fps, the EDOF group was better than the bifocal group and the trifocal group (H=15.31, P=0.008; H=-16.60, P=0.027). The UNDVA of the three groups was significantly different at 4, 8, 12, and 24 fps (H=11.25-17.61, P<0.05): at these four speeds, the EDOF group was better than the bifocal group (H=12.71-17.87, P<0.05) and trifocal group (H=-23.04--15.87, P<0.05), but there was no significant difference between bifocal group and trifocal group. Conclusions: Patients implanted with trifocal IOL and EDOF IOL can obtain same UDVA, UIVA, UNVA, while bifocal IOL has relatively poor UIVA. The three IOLs can obtain same DVA at long distance and low speed; however, at medium or short distance, especially at high speed, the DVA of EDOF IOL is better than the other two.