比较两种人工晶状体矫正老视效果的临床研究

目的比较非对称区域折射型多焦点人工晶状体(IOL)与衍射型三焦点IOL治疗年龄相关性白内障的疗效。 方法回顾性研究。收集2016年11月至2018年6月于成都爱尔眼科医院白内障中心行超声乳化白内障吸除联合IOL植入术57例(57只眼)患者的病历资料。其中，男性28例(28只眼)，女性29例(29只眼)；年龄50~76岁，平均年龄(63.3±5.5)岁。按照植入IOL的类型将患者分为区域折射组和衍射三焦组。检查并记录两组患者术前与术后3个月的术眼屈光度、裸眼远距离视力(UDVA)、裸眼中距离视力(UIVA)、裸眼近距离视力(UNVA)、最佳矫正远视力(BCDVA)、客观散射指数(OSI)、调制传递函数截止空间频率(MTF cutoff)、斯特列尔比值(SR)以及对比度视力。根据中文版VF-14视功能指数量表对上述指标进行评分，并对患者进行问卷调查。两组患者患眼的眼轴长度、角膜散光、术前UDVA、术前BCDVA、术后OSI、MTF cutoff、SR及中文版VF-14视功能指数量表评分等指标采用均数±标准差表示，并以独立样本t检验进行比较。UDVA、UIVA、UNVA、BCDVA及对比度视力采用中位数和四分位数间距表示。采用Mann-Whitney U检验，比较两组患者术后3个月术眼的UDVA、UIVA、UNVA、BCDVA以及对比度视力。 结果区域折射组和衍射三焦组患者的术后球镜屈光度分别为-0.75 D~+0.50 D和-0.50 D~+1.00 D。两组患者球镜屈光度位于-0.50 D~+0.50 D区间者占比的比较，差异无统计学意义(χ²＝0.000，P>0.05)。两组患者术后柱镜屈光度分别为0.00 D~-0.75 D和0.00 D~-1.00 D。两组患者柱镜屈光度位于-0.75 D~-1.00 D者占比的比较，差异无统计学意义(χ²＝0.459，P>0.05)。区域折射组患者术后的UDVA、UIVA、UNVA及BCDVA分别为0.10(0.00，0.10)、0.20(0.20，0.20)、0.20(0.10，0.20)及0.00(0.00，0.10)；衍射三焦组患者术后分别为0.05(0.00，0.10)、0.20(0.10，0.20)、0.10(0.10，0.20)及0.00(0.00，0.05)。经Mann-Whitney U检验，两组患者术后UDVA、UNVA和BCDVA的比较，差异无统计学意义(Z＝-0.169，-1.265，-1.410；P>0.05)；UIVA的比较，差异有统计学意义(Z＝-2.708，P<0.05)。区域折射组患者术后的OSI、MTF cutoff及SR分别为(1.9±0.7)、(24.755±7.751)c/deg和(0.126±0.029)；衍射三焦组患者术后分别为(1.6±0.7)、(35.813±9.984)c/deg和(0.195±0.083)。经t检验，两组患者MTF cutoff和SR的比较，差异有统计学意义(t＝-5.419，-4.822；P<0.05)；OSI的比较，差异无统计学意义(t＝1.959，P>0.05)。区域折射组患者术后在100%、20%和9%对比度下的对比度视力分别为0.70(0.60，0.90)、0.50(0.40，0.60)和0.30 (0.20，0.30)；衍射三焦组分别为1.20(0.95，1.50)、0.70(0.60，0.90)和0.50(0.30，0.70)。经Mann-Whitney U检验，两组患者对比度视力的比较，差异有统计学意义(Z＝-4.882，-4.829，-3.676；P<0.05)。区域折射组与衍射三焦组的中文版VF-14视功能指数量表评分分别为(94.39±4.74)分与(96.86±3.63)分，两者比较的差异无统计学意义(t＝-0.075，P>0.05)。区域折射组与衍射三焦组眩光的发生率分别为10.7%与6.9%。两组近脱镜率和眩光发生率的比较，差异无统计学意义(χ²＝0.181，0.002；P>0.05)。区域折射组与衍射三焦组轻度光晕的发生率分别为3.57%与27.59%，差异有统计学意义(χ²＝4.505，P<0.05)。 结论两种老视矫正型IOL均能为年龄相关性白内障患者提供较好的全程视力，术后患眼屈光度可预测性好，而衍射型三焦点IOL客观视网膜成像质量的评估方面较区域折射型多焦点IOL略好。

A comparative study of two kinds of intraocular lens for presbyopia correction

ObjectiveThe aim of this study was to evaluate the clinical outcomes of asymmetric segmented refractive multifocal intraocular lens (IOL) and trifocal diffractive IOL for presbyopia correction. MethodsRetrospective cohort study. 57 patients (57 eyes) with age-related cataract diagnosed at the Cataract Center of Aier Eye Hospital in Chengdu from November 2016 to June 2018 who undergoing phacoemulsification combined with IOL implantation were selected as study subjects. There were 28 male patients (28 eyes) and 29 female patients (29 eyes) with the average age of (63.3±5.5) years-old. They were divided into two groups according to the type of IOL implanted: the regional refraction group and the diffraction trifocal group. The uncorrected distance visual acuity (UDVA), uncorrected Intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), best corrected distance visual acuity (BCDVA) of naked eye were measured and recorded. Optical quality analysis system Ⅱ(OQAS Ⅱ) was used to evaluate the visual quality, including the objective scatter index (OSI), modulation transfer function cut off (MTF cutoff), strehl ratio (SR) and contrast vision. The score was based on the VF-14 scale, and the rate of near deoscopy, adverse visual disturbance and quality of life were investigated by questionnaire. The measurement data are expressed by mean±standard deviation. Age, ocular axis, corneal astigmatism, implantation of IOL diopter, preoperative UDVA, preoperative BCDVA, postoperative OSI, MTF cutoff, SR, and VF-14 scores of two groups patients were analyzed by independent sample t test. The median and quartile interval was used for UDVA, UIVA, UNVA, BCDVA and contrast visual acuity. Three months after the operation, the analysis of UDVA, UIVA, UNVA, BCDVA, contrast vision in two groups of patients was performed by Mann-Whitney U test. ResultsThe spherical diopter after surgery in asymmetric segmented refractive group and trifocal diffractive group was -0.75 D to + 0.50 D and -0.50 D to+ 1.00 D and the cylindrical diopter was 0.00 D to -0.75 D and 0.00 D to -1.00 D, respectively. There is no significant difference in the proportion of spherical diopters between -0.50 D to+ 0.50 D and cylindrical diopters between -0.75 D to-1.00 D in two groups (χ²=0.000, 0.459; P>0.05). Postoperative UDVA, UIVA, UNVA and BCDVA in segmented refractive group were 0.10(0.00, 0.10), 0.20(0.20, 0.20), 0.20(0.10 , 0.20), 0.00(0.00, 0.10); and those of trifocal diffractive group were 0.05(0.00, 0.10), 0.20(0.10, 0.20), 0.10(0.10, 0.20), 0.00(0.00, 0.05), respectively. There was no significant difference in UDVA, UNVA, BCDVA between two groups at 3 months after surgery (Z=-0.169, -1.265, -1.410; P>0.05). Trifocal diffractive group had better UIVA than asymmetric segmented refractive group (Z=-2.708, P<0.05). Postoperative OSI, MTF cutoff, SR in segmented refractive group was (1.9±0.7), (24.755±7.751) c/deg, (0.126±0.029) and in trifocal diffractive group was (1.6±0.7), (35.813±9.984) c/deg, (0.195±0.083). There was no statistically difference in OSI between two groups (t=1.959, P>0.05), and there were significant statistical differences in MTF cutoff and SR (t=-5.419, -4.822; P<0.05). OV 100%, OV 20%, and OV 9% in segmented refractive group was 0.70(0.60, 0.90), 0.50(0.40, 0.60), 0.30 (0.20, 0.30) and those of the trifocal diffractive group was 1.20(0.95, 1.50), 0.70(0.60, 0.90), 0.50(030, 0.70) with significant statistical difference between them(Z=-4.882, -4.829, -3.676; P<0.05). VF-14 scores of segmented refractive group and trifocal diffractive group were (94.39±4.74) and (96.86±3.63) with non-significant difference between them (t=-0.075, P>0.05). No difference was found between two groups in near-distance spectacle independence rate and incidence of glare (χ²=0.181, 0.002; P>0.05). But statistical difference was found in the incidence of halo between segmented refractive group (3.57%) and trifocal diffractive group (27.59%) (χ²=4.505, P<0.05). ConclusionsThe two presbyopia-corrected IOLs could provide good full range of clear vision for patients with age-related cataracts. Both of them have good predictability of refractive power. Trifocal diffractive IOL had a better objective retinal image quality.