不同设计多焦点人工晶状体植入后视觉质量差异的临床研究

目的比较三焦点衍射型人工晶状体(IOL)和双焦点折射型IOL植入后患者的术后视觉质量差异。 方法回顾性队列研究。收集2019年3月至2020年7月于北京大学第三医院眼科行超声乳化白内障吸除联合后房型IOL植入的52例(104只眼)患者。其中，男性17例(34只眼)，女性35例(70只眼)；年龄36~87岁，平均年龄(69.3±11.2)岁。根据患者植入IOL种类分为区域折射组和衍射三焦组。区域折射组植入Lenstec SBL－3型IOL；衍射三焦组植入AT LISA tri 839MP型三焦点IOL。比较患者术后3个月裸眼近视力(UNVA)、裸眼中视力(UIVA)及裸眼远视力(UDVA)，最佳矫正视力(BCVA)、离焦曲线、客观视觉质量、脱镜率、不良视觉现象及满意度。两组患者视功能相关生活质量问卷评分以(±s)表示；UNVA、UIVA、UDVA、BCVA、调制传递函数截止频率(MTF cut－off)、斯特列尔比(SR)、客观散射指数(OSI)、对比度视力(VA)及患者满意度以中位数和四分位数表示，组间比较采用Mann－Whitney U检验。等效球镜屈光度(SE)的分布、脱镜率及不良视觉率以百分比表示，组间比较采用χ²检验。Spearman相关性分析患者术后客观视觉质量与BCVA的关系。 结果衍射三焦组术后最小分辨角度对数视力(logMAR)UNVA、UIVA、UDVA及BCVA分别为0.10(0.05，0.10)、0.10(0.00，0.20)、0.10(0.10，0.20)及0.00(0.00，0.05)；区域折射组分别为0.05(0.00，0.10)、0.10(0.00，0.20)、0.10(0.00，0.20)及0.00(0.00，0.05)，UNVA比较的差异有统计学意义(Z＝－2.596，P<0.05)。衍射三焦组SE在±0.25 D、±0.50 D、±0.75 D及±1.00 D处，分布分别占34.6%、65.4%、90.4%及100.0%；区域折射组SE在±0.25 D、±0.50 D、±0.75 D及±1.00 D处，分别占57.7%、71.2%、78.9%及92.4%。两组SE整体分布比较的差异有统计学意义(χ²＝27.083，P<0.05)。两组平均SE分别为(－0.38±0.43)D和(－0.25±0.49)D，差异无统计学意义(t＝0.667，P>0.05)。离焦曲线分析显示，球镜屈光度为2.00 D、－2.00 D及－2.50 D时两组患者的logMAR BCVA比较的差异均有统计学意义(Z＝－2.378，－2.416，－2.821；P<0.05)。衍射三焦组术后MTF cut－off、SR、OSI、VA 100%、VA 20%及VA 9%分别为27.7(21.2，37.6)c/deg、0.14(0.10，0.21)、2.4(1.7，2.9)、0.9(0.7，1.3)、0.6(0.4，0.8)及0.3(0.2，0.5)；区域折射组分别为18.8(14.1，24.4)c/deg、0.11(0.09，0.13)、2.4(1.8，3.2)、0.6(0.5，0.8)、0.4(0.3，0.5)及0.2(0.2，0.3)。两组患者术后MTF cut－off、SR、OSI、VA 100%、VA 20%及VA 9%与logMAR BCVA呈正相关，且有统计学意义(r＝－0.352，－0.211，0.542，0.324，－0.314，－0.287；P<0.05)。OSI与logMAR BCVA的相关度最高且两组间OSI比较的差异无统计学意义(Z＝－0.807，P>0.05)。两组患者视功能相关生活质量问卷总分分别为(88.28±11.41)分和(87.43±12.62)分；视近脱镜率分别为80.8%和84.6%；不良视觉现象出现概率分别为23.1%和19.2%；平均满意度分别为3(3，4)和3(3，4)。 结论两种多焦点IOL均能提高患者术后的主客观视觉质量，术后的有效性、准确性、生活质量、术后脱镜率及满意度相当；此外，区域折射组的术后UNVA优于衍射三焦组，衍射三焦组客观视觉质量均优于区域折射组，OSI可作为早期后囊膜混浊发现及手术时机选择的指标。

Comparative analysis of visual quality after implantation different multifocal intraocular lens in patients with cataract

ObjectiveTo compare the visual quality of patients implanted the trifocal diffractive intraocular lens (IOL) and the segmented refractive bifocal IOL after cataract surgery. MethodsRetrospective cohort study. From March 2019 to July 2020, 52 patients (104 eyes) with cataract phacoemulsification and IOL implantation in the Department of Ophthalmology of Peking University Third Hospital were collected. There were 17 males (34 eyes) and 35 females (70 eyes) with the average age of (69.3±11.2) years-old (ranged from 36 to 87 years-old). The patients were divided into segmented refractive group and trifocal diffractive group according to the type of IOL implanted. Lenstec SBL-3 IOL was implanted in segmented refractive group; AT LISA tri 839MP triple focus IOL was implanted in the trifocal diffractive group. The uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), best corrected distance visual acuity (BCVA), spherical equivalent (SE), defocus curve, objective visual quality, off-glasses rate, poor visual events, life quality and satisfaction were evaluated after surgery for 3 months. The questionnaire scores of two groups were expressed by (±s), independent sample t test was used for comparison between groups; UNVA, UIVA, UDVA, BCVA, modulation transfer function cut-off (MTF cut off), strehl ratio (SR), objective scatter index (OSI), contrast visual acuity (VA) and patient satisfaction were expressed by median and quartile intervals, compared by Mann-Whitney U test between groups. The distribution of SE, off-glasses rate and poor visual events were expressed in percentage, and chi-square test was used for comparison between groups. Spearman correlation analysis was used to analyze the correlation between objective visual quality and BCVA. ResultsThe postoperative logMAR UNVA, UIVA, UDVA and BCVA of the trifocal diffractive group were 0.10(0.05, 0.10), 0.10(0.00, 0.20), 0.10(0.10, 0.20) and 0.00 (0.00, 0.05), and those of segmented refractive group were 0.05(0.00, 0.10), 0.10(0.00, 0.20), 0.10(0.00, 0.20) and 0.00(0.00, 0.05), respectively. There was a statistically significant difference in logMAR UNVA between two groups(Z=-2.596, P<0.05). The distribution of SE in ±0.25 D, ±0.50 D, ±0.75 D and ±1.00 D in the trifocal diffractive group were 34.6%, 65.4%, 90.4% and 100.0%, respectively; those of segmented refractive group were 57.7%, 71.2%, 78.9% and 92.4%. There was a statistically significant difference in the total distribution of SE (χ²=27.083, P<0.05). There was not a statistically significant difference in the average distribution of SE (t=0.667, P>0.05). The defocus curve analysis showed that there was a statistically significant difference in the logMAR BCVA when the spherical power was 2.00 D, -2.00 D and -2.50 D between two groups (Z=-2.378, -2.416, -2.821; P<0.05). After operation, the MTF cut off, SR, OSI, VA 100%, VA 20% and VA 9% in trifocal diffractive group were 27.7(21.2, 37.6) c/deg, 0.14(0.10, 0.21), 2.4(1.7, 2.9), 0.9(0.7, 1.3), 0.6(0.4, 0.8) and 0.3(0.2, 0.5); and those of segmented refractive group were 18.8(14.1, 24.4) c/deg, 0.11(0.09, 0.13), 2.4(1.8, 3.2), 0.6(0.5, 0.8), 0.4(0.3, 0.5) and 0.2(0.2, 0.3), respectively. There were significant correlations between MTF cut off, SR, OSI, VA 100%, VA 20%, VA 9% and logMAR BCVA in both patients (r=-0.352, -0.211, 0.542, 0.324, -0.314, -0.287; P<0.05). OSI was related with logMAR BCVA, which was bigger than others and there was not a statistically significant difference in OSI between groups (Z=-0.807, P>0.05). The total scores of visual function related quality of life questionnaire in two groups were (88.28±11.41) scores and (87.43±12.62) scores; the rates of mirror removal rate were 80.8% and 84.6%; the rates of poor visual quality was 23.1% and 19.2%; the satisfaction distribution were 3(3, 4) and 3(3, 4), respectively. ConclusionsBoth 839 MP and SBL-3 multifocal IOLs can improve the subjective and objective visual quality of cataract patients after surgery, and the effectiveness, accuracy, spectacle independence, and patient satisfaction of the two groups of patients are similar. Apart from that, the postoperative UNVA of SBL-3 was better than that of 839MP; the objective visual quality results (MTF cut off, SR, VA) of 839MP were better than those of SBL-3. OSI can be used for early detection of complications such as posterior capsular opacification and selection of surgical opportunity.