单焦点IOL植入术后RGPCL诱导屈光参差后的视觉质量

目的 探讨在年龄相关性白内障手术中,应用单眼视概念,双眼植入不同度数单焦点人工晶状体(IOL)的可行性.方法 前瞻性非随机临床对照研究.选取双眼白内障摘除联合单焦点IOL植入术后符合标准的患者40例(80眼),做2种矫正处理:以硬性透氧性角膜接触镜(RGPCL)一眼矫正为正视,一眼矫正为-2.0 D近视,即屈光参差状态或双眼矫正为正视,即全矫状态.分别检测其远方三级视功能、近立体视及远、近对比敏感度,并对生活满意度进行调查评估.对数据进行配对t检验,配对符号秩和检验或x2检验.结果 立体视检查显示:矫正状态远融合功能、立体视优于屈光参差状态(x2=9.03、16.88 ,P＜0.01),屈光参差状态的近立体视优于矫正状态,差异有统计学意义(Z=-3.230,P＜0.01).但屈光参差状态仍有相当数量患者存在远立体视,矫正状态有近立体视患者数量较少.对比敏感度检查显示:在低频段,无论明亮还是昏暗条件,2种状态下远近对比敏感度差异无统计学意义;在中高频段,矫正状态远对比敏感度优于屈光参差状态(t=0.37、0.51、0.35、0.46、0.44、0.46、0.51、0.40,P＜0.01),而屈光参差状态近对比敏感度优于矫正状态(t=0.18、0.34、0.49、0.38、0.20、0.34、0.24、0.38,P＜0.O1).生活质量调查显示,屈光参差状态总体视力满意度较全矫状态高,差异有统计学意义(t=-3.05,P＜0.01).结论 年龄相关性白内障术后双眼诱导屈光参差,视远视觉质量下降,但仍有相当数量患者存在远立体视,视近视觉质量明显提高,生活满意度提高.

Visual quality of anisometropia induced by rigid gas permeable contact lenses after monofocal intraocular lenes implantation

Objective To study the feasibility of implanting different degrees of monofocal intraocular lenses after bilateral cataract phacoemulsification.Methods A prospective nonrandomized controlled study was carried out.Forty patients were chosen after cataract phacoemulsification combined with monofocal intraocular lens implantation.Astigmatism was corrected in both eyes with RGPCLs.Far and near visual acuity, stereoacuity, and contrast sensitivity were measured.Then one eye of the same 40 patients wore a lens for correcting astigmatism and the other eye wore a-2.0 D lens to simulate myopia.The same tests were then repeated.A paired t test was used to compare the measurement data, which conformed to a normal distribution.A chi-square test or rank sum test was used to compare the variables in the test categories.Results The patients in the astigmatism group had better far stereoacuity (x2=9.03, 16.88, P＜0.01) and better far contrast sensitivity at night and at high frequencies (t=0.37, 0.51, 0.35, 0.46, 0.44, 0.46, 0.51, 0.40, P＜0.01) than those with induced anisometropia.The difference was significant.But the patients with anisometropia had better near stereoacuity (Z=-3.230, P＜0.01) and better near contrast sensitivity (t=0.18, 0.34, 0.49, 0.38, 0.20, 0.34, 0.24, 0.38, P＜0.01).Some patients with anisometropia had better far stereoscopic vision.The anisometropic patients were more comfortable for overall visual quality (t=-3.05, P＜0.01).Conclusion Anisometropia induced after cataract surgery, visual quality of patients for far declined, but there are still a considerable number of patients with far stereoacuity.Visual quality for near site improve greatly, and life satisfaction improved.