零像差设计的非球面人工晶状体的临床应用研究

目的 比较零像差设计的非球面人工晶状体(IOL)与传统球面IOL对超声乳化自内障吸除联合IOL植入术后患者眼球差、视觉功能以及表观调节力的影响.方法 采用前瞻性随机对照设计,将130例(132只眼)拟行超声乳化白内障吸除联合IOL植入术的年龄相关性白内障患者按随机数字表法分为2组,分别植入零像差设计的非球面IOL(试验组)和传统球面IOL(对照组).术后检测IOL眼的球差、矫正远视力、矫正远视力后的近视力、对比敏感度、眩光敏感度及表观调节力;随访时间为3个月.采用χ~2检验和独立样本t检验分别对计数资料和计量资料进行统计学分析.结果 术后3个月,瞳孔直径5 mm情况下IOL眼的球差试验组为(0.141±0.070)μm,对照组为(0.210±0.108)μm,差异有统计学意义(t=4.365,P=0.000).2.5°视角的对比敏感度试验组为30.62±12.50,对照组为25.92±7.36,差异有统计学意义(t=2.606,P:0.010);眩光敏感度在4.0°、2.5°及1.6°视角上分别为31.25±8.65、26.35±8.72和12.35±4.01,显著高于对照组在相应视角上的26.70±7.98(t=3.116,P=0.002)、22.43±7.35(t=2.772,P=0.006)及9.82±4.12(t=3.553,P=0.001);两组的矫正远视力、矫正远视力后近视力、表观调节力比较,差异均无统计学意义.结论 与传统球面IOL比较,零像差的非球面IOL Akreos AO可以显著减少IOL眼的总球差,改善白内障患者术后的视觉质量,且对患者术后的表观调节力无明显影响.     

In vitro analysis of AcrySof intraocular lens glistening

PURPOSE: The authors studied the effects of changes in packaging solution temperature on the development of glistening in acrylic intraocular lenses (AcrySof, Alcon). METHODS: Glistening was examined by slit lamp at each condition. In Experiment 1, AcrySof lenses were soaked in physiologic saline adjusted to 15 degrees C and 37 degrees C in an incubator. In Experiment 2, AcrySof lenses were soaked in physiologic saline adjusted to 37 degrees C and 60 degrees C for 5 min, then stored in physiologic saline adjusted to 15 degrees C. In Experiment 3, glistening formation was induced in AcrySof lenses by soaking them in warm water (37 degrees C). The lenses were allowed to dry at 15 degrees C and then soaked in physiologic saline adjusted to 15 degrees C. After storage of dry AcrySof lenses at 37 degrees C in an incubator for 10 months followed by soaking in physiologic saline adjusted to 15 degrees C, glistening formation was evaluated in Experiment 4. RESULTS: Glistening became observable after 1 month, despite the temperature having been lowered to 15 degrees C. No glistening was observed in the lenses soaked in physiologic saline adjusted to 37 degrees C after 5 min, but glistening was observed 1 month after soaking. When allowed to dry at 15 degrees C, the glistening decreased. After 1 month of soaking at 15 degrees C, glistening was again observable. CONCLUSIONS: AcrySof lenses soaked in warm water for a short time may change characteristics, and therefore, close monitoring of the temperature and time of soaking is necessary to prevent glistening formation.     

复曲面人工晶状体个体化模型眼成像质量的优化

背景 复曲面人工晶状体(IOL)植入术后术眼的视觉质量受陡峭轴和平坦轴放大率的差异、散光残留及角膜个体球差等因素的影响,通过矫正复曲面IOL的球差是否能有效提高其对患者个体的成像质量是值得研究的问题. 目的 采集患者眼部解剖参数,利用Zemax光学设计软件建立个体化模型眼,研究不同球差的Toric IOL植入后的视觉质量,即不同空间频率的对比敏感度(CSF).方法 采用前瞻性研究设计.连续纳入2012年8月至2013年10月于河北医科大学第二医院眼科拟行白内障超声乳化手术的白内障患者45例45眼,应用Pentacam测量患眼角膜地形图参数,包括角膜前后表面高度、角膜厚度、角膜前表面散光平坦轴和陡峭轴曲率半径、屈光度以及角膜后表面曲率半径,然后应用Matlab 4.5数学计算软件并使用Toric面型公式1描述角膜散光,用非球面状态设置角膜前表面散光模型和角膜后表面模型,根据Holladay Ⅰ公式计算Toric IOL在眼中的有效位置,采用Zemax光学设计软件构建个体化模型眼.根据调制传递函数神经传递函数值分别测定强光环境(300 Td)下瞳孔直径为3 mm以及暗光环境(0.3～1.0Td)下瞳孔直径为5 mm时不同球面Toric IOL在各空间频率的对比敏感度(CSF). 结果 个体化模型眼与受检眼Pentacam测定的角膜散光度分别为(1.51±0.36)D和(1.49±0.37)D,散光轴向分别为(101.5±59.8)°和(101.9±58.5)°,差异均无统计学意义(t=0.886、0.652,均P＞0.05);Bland-Ahman检验显示个体化模型眼与受检眼Pentacam测定的角膜散光度和轴向具有较好的一致性.强光和暗光环境下非球面不同球差Toric IOL模型眼在1.5、3.0、6.0、12.0和18.0 c/d空间频率条件下LogCSF值均高于球面IOL模型眼,非球面球差为-0.13 μm和-0.26 μm Toric IOL模型眼在各空间频率条件下LogCSF值均明显高于0μm球差Toric IOL模型眼,差异均有统计学意义(均P＜O.05).结论 本研究中依据白内障患者眼部解剖参数,利用Zemax光学设计软件成功建立了精确的个体化角膜散光模型,表明非球面Toric IOL能消除角膜球差,提高模型眼的视觉质量.     

In vitro and in vivo evaluation of a hydrophilized silicone intraocular lens.

The surface of a silicone-disc intraocular lens (IOL) was hydrophilized by plasma etching (oxygen plasma) and compared to an untreated but otherwise identical IOL. Various methods of surface analysis were used to characterize the modification (e.g., X-ray photoelectron spectroscopy, contact angle estimation). A cytotoxic effect of the modified surface was excluded by cell culture experiments evaluating cell spreading, cell morphology, DNA and protein synthesis. In vivo experiments on rabbits indicated that the postoperative foreign-body reaction was not significantly affected by the hydrophilization of the IOL surface. Throughout the entire follow-up (12 weeks) we found less induced posterior synechias in the eyes with hydrophilized lenses than in those with untreated lenses (P = .009). While the IOL dislocations out of the capsular bag and the posterior capsular opacification rate did not differ significantly between the two groups of eyes, we did see special patterns of posterior capsular opacification on the posterior capsules of eyes with the hydrophilized IOL.     

In vitro protein adsorption to 2 intraocular lens materials.

PURPOSE: To study in vitro protein adsorption to poly(methyl methacrylate) (PMMA) and foldable AcrySof intraocular lenses (IOLs). SETTING: Department of Ophthalmology, United Medical and Dental Schools of Guy's and St. Thomas' Hospitals, London, United Kingdom. METHODS: Poly(methyl methacrylate) (Alcon Surgical, model MC60BM) and AcrySof (Alcon Surgical, model MA60BM) IOLs were incubated in physiological concentrations of radiolabeled albumin or fibronectin at 37 degrees C for periods between 5 minutes and 1 week. The IOLs were removed and rinsed in buffered saline, and the amount of adsorbed protein was calculated by measuring the radioactivity with scintillation spectrometry. RESULTS: The adsorption of both proteins occurred rapidly over the first 2 hours; the rate of adsorption was concentration dependent. Quantitative differences were found: PMMA lenses bound significantly greater quantities of albumin. Initial fibronectin adsorption to both materials was similar, but increased adsorption to AcrySof IOLs was found at days 1 and 7. CONCLUSIONS: The differences in protein absorption to PMMA and AcrySof IOLs in vitro may contribute to the differences in the biological response to these IOLs, including the lower rates of posterior capsule opacification associated with acrylic lenses.     

比较标准超声波测量仪和新型光学生物测量仪计算人工晶状体屈光度的准确性

目的：比较超乳手术时应用新型光学生物测量仪和标准超声波测量仪计算人工晶状体的屈光度及屈光结果。
　　方法：前瞻性研究。研究包含37例37眼白内障患者接受白内障超声乳化联合人工晶状体植入术。同一测量人员分别使用新型光学生物测量仪( Aladdin)与标准超声波测量仪( Sonoled AB 5500)对白内障患者进行检测。通过这两种设备记录生物测定参数,包括眼轴长度、角膜曲率、前房深度及人工晶状体屈光度数。分析术后实际屈光不正与两台设备根据SRK/T公式计算的误差,比较两台设备检查结果的平均估计误差( EE )、平均绝对估计误差( AEE)及生物测定参数。
　　结果：Aladdin测量仪(23.45±0.73 ll )较超声波测量仪(23.2±0.75 ll)检测出的眼轴显著较长(P=0.01)。Aladdin测量仪的EE与AEE均明显小于超声波测量仪( P=0.0006与0.03)。应用Aladdin测量的大多数眼与目标屈光度相差在±0.5(67%)及±1.00(97%)以内。
　　结论：Aladdin光学生物测量仪较超声波测量仪更精确,屈光结果更准确。     

三焦点与单焦点人工晶状体植入术效果的比较

目的：观察并比较AT LISA tri 839MP三焦点人工晶状体及CT SPHERIS 209M单焦点人工晶状体植入术后白内障患者的视力、对比敏感度和视觉质量。

方法：行白内障超声乳化摘除联合人工晶状体植入术的患者52例52眼,其中三焦点组26例26眼,术中植入AT LISA tri 839MP三焦点人工晶状体; 单焦点组26例26眼,术中植入CT SPHERIS 209M单焦点人工晶状体。术后3mo检查患者的裸眼远距离视力(UCDVA)、裸眼中距离视力(UCIVA)、裸眼近距离视力(UCNVA)、最佳矫正远视力(BCDVA)、远视力矫正下的中距离视力(DCIVA)、远视力矫正下的近距离视力(DCNVA),明、暗环境中不同空间频率(3、6、12、18c/d)下的对比敏感度,并进行脱镜率、不良视觉症状和满意度等问卷调查。

结果：术后3mo三焦点组UCIVA、UCNVA、DCIVA和DCNVA、脱镜率及满意度均优于单焦点组(P<0.05)。在暗环境中的18c/d空间频率,单焦点组的对比敏感度优于三焦点组(P=0.041)。两组均有轻度眩光和光晕不适主诉(P=0.668)。

结论：AT LISA tri 839MP三焦点人工晶状体较CT SPHERIS 209M单焦点人工晶状体为患者提供了更好的中、近视力,脱镜率和满意度均高于单焦点人工晶状体。     

Clinical outcomes of a new diffractive multifocal intraocular lens

AIM: To evaluate clinical outcomes after implantation of a new diffractive aspheric multifocal intraocular lens (IOL) with +3.00 addition power. METHODS: This is a retrospective, consecutive case series of cataract patients who underwent bilateral implantation of the Optiflex MO/HF D012 (Moss Vision Inc. Ltd, London, UK) multifocal IOL. Patients followed for 6mo were included in the study. Data on distance, intermediate and near visual acuity, refractive error [manifest spherical equivalent (MSE)], contrast sensitivity, adverse events, subjective symptoms, spectacle independence and patient satisfaction [visual function questionnaire (VFQ)-25 questionnaire] were retrieved from electronic medical records and analyzed. RESULTS: Forty eyes of 20 patients with a mean age of 66.7±8.5y (range: 53-82) were included in the study. Mean uncorrected distance, near and intermediate visual acuity remained stable through postoperative visits and was 0.19±0.19 logMAR, Jaeger 4 and Jaeger 3 respectively at the 6mo visit. At the end of postoperative 6mo, MSE was -0.14±0.42 diopters (D) and 98% of the eyes were within 1.00 D of target refraction. Postoperative low contrast (10%) visual acuity remained stable (P=0.54) through follow up visits with a mean of 0.35±0.17 logMAR at the 6mo visit. There were no reported adverse events. None of the patients reported subjective symptoms of halo or glare. Spectacle independence rate was 90%. Mean VFQ-25 questionnaire score was 93.5±6.12. CONCLUSION: The Optiflex MO/HF-DO12 IOL was safely implanted and successfully restored distance, intermediate and near visual acuity without impairing contrast sensitivity. High levels of spectacle independence were achieved at all distances including intermediate distance.     

Implantation of a new accommodative posterior chamber intraocular lens

PURPOSE: A new, potentially accommodative posterior chamber lens (PCIOL) was designed based on principles elaborated by Hanna using finite element computer simulation methods. We report 3-month postoperative results in patients. METHODS: In a prospective study, 12 eyes of 12 patients (age 45 to 87 yr) underwent phacoemulsification for cataracts and PCIOL implantation. The PCIOL, 1 CU, has haptics designed for anterior optic movement following ciliary muscle contraction. Patients were examined postoperatively after 1 and 2 days, 1, 2 and 6 weeks, and 3 months, and results were compared with a control group of 12 eyes that received standard PMMA or acrylic PCIOLs. RESULTS: Surgery was uncomplicated and all PCIOLs were well-tolerated and stable with good centration in the capsular bag. The results were (mean +/- SD [range] and median; 1 CU versus control PCIOL): near visual acuity (Birkh?user reading chart at 35 cm) with best distance correction 0.34 +/- 0.17 (0.2 to 0.6), 0.3 (J10-J1, median J7) versus 0.15 +/- 0.07 (0.1 to 0.3), 0.15 (J16-J7, median J13), P=.001; subjective near point 59 +/- 10 cm (40 to 100 cm), 53.5 cm versus 93 +/- 20 cm (64 to 128 cm), 86 cm, P=.004; retinoscopic accommodative range 1.2 +/- 0.4 D (0.63 to 1.5 D), 1.2 D versus 0.2 +/- 0.19 D (-0.25 to 0.5 D), 0.25 D, P < .001; decrease of anterior chamber depth after 2% pilocarpine 0.63 +/- 0.16 mm (0.40 to 0.91 mm), 0.63 mm versus 0.15 +/- 0.05 mm (0.08 to 0.20 mm), 0.17 mm, P < .001. CONCLUSIONS: The new PCIOL appears to be safe at short to medium term. Our results indicate pseudophakic accommodation secondary to focus shift with this PCIOL. Additional larger and long-term studies are necessary for exact evaluation of safety and accommodative power of this new PCIOL.