Refractive outcomes after bilateral multifocal intraocular lens implantation

PURPOSE: To evaluate the efficacy and safety of bilateral multifocal intraocular lens (IOL) implantation after cataract surgery. SETTING: Oftalmológico de Valencia-CEOVAL, Valencia, Venezuela. METHODS: This retrospective study evaluated patient charts for the patient selection method, preoperative evaluation, surgical technique, postoperative visual and refractive outcomes, and complications. It included 70 eyes of 35 patients who had lens extraction with bilateral implantation of an Array multifocal IOL. Fourteen eyes of 7 patients had hyperopia with presbyopia, and 56 eyes of 28 patients had cataract. RESULTS: All eyes achieved an uncorrected distance acuity of 20/40 or better and an uncorrected near acuity of J5 or better. Six patients (18%) reported moderate halos, and 22 patients (63%) occasionally wore glasses. CONCLUSION: Bilateral multifocal IOL implantation was effective and safe in cataract and hyperopic patients with presbyopia, providing good uncorrected distance and near acuities.     

Quality of vision after AMO Array multifocal intraocular lens implantation

PURPOSE: To evaluate safety and efficacy of Array SA40N multifocal intraocular lens (IOL) (AMO) implantation in cataract surgery. SETTING: Helsinki University Eye Hospital, Helsinki, Finland. METHODS: In this prospective randomized comparative trial, 80 patients scheduled for cataract surgery were selected based on preoperative counseling and randomized to have multifocal or monofocal IOL implantation. Fifty-three eyes of 35 patients received a multifocal IOL and 67 eyes of 40 patients, a monofocal IOL. The incidence of complications and visual outcome in the multifocal and monofocal IOL groups were compared. Quality of vision was measured by comparing the severity of visual symptoms (glare, halos, and cataract symptoms score), changes in functional impairment measured by a 7-item visual function test (VF-7), changes in global measures of vision (trouble and satisfaction with vision), and range of accommodation and contrast sensitivity. RESULTS: Intraoperative and postoperative complications and adverse events were few and required no further surgical intervention. Both distance and near visual acuities were significantly better in the multifocal group than in the monofocal group; the difference was most prominent in distance corrected near acuity (P<.001). Thirty-five eyes (67.3%) in the multifocal group and 10 eyes (14.9%) in the monofocal group achieved a distance corrected near acuity of J6 (20/40) or better; 30 eyes (56.6%) and 19 eyes (28.4%), respectively, achieved a best corrected distance acuity of 20/20 or better. Glare symptoms decreased postoperatively in both groups but were slightly more common in the multifocal group. In contrast, halos were significantly more common at 1 month in the multifocal group (P<.001). Contrast sensitivity values were slightly lower with multifocal IOLs at almost all spatial frequencies, but the difference was not significant. The change in the quality of life postoperatively, measured with the VF-7, was significant and identical in both groups. CONCLUSIONS: Pseudophakic eyes with multifocal IOLs had better distance and near acuity and range of accommodation than eyes with a monofocal IOL. Slightly lower contrast sensitivity and increased perception of halos by subjects with the multifocal IOL appear to be an acceptable compromise to enhanced near and distance vision.     

Cataract extraction with multifocal intraocular lens implantation: clinical, functional, and quality-of-life outcomes. Multicenter clinical trial in Germany and Austria

PURPOSE: To compare bilateral implantation of a multifocal intraocular lens (IOL) versus a monofocal lens with respect to visual function, patient satisfaction, and quality of life. SETTING: Seven clinical sites in Germany and 1 site in Austria. METHODS: A prospective randomized masked clinical trial included 124 randomly assigned bilateral pseudophakic individuals, 64 of whom had bilateral implantation of an Array(R) foldable multifocal IOL (model SA-40N, Allergan) and 60 of whom had bilateral implantation of an AMO(R)PhacoFlex II(R) silicone monofocal IOL (model SI-40NB). Clinical data included binocular uncorrected and corrected distance and near visual acuities, complications, adverse events, and reports of halos and glare. Quality-of-life data were collected on 3 occasions using the modified Cataract TyPE Specification instrument. The functional status of the 2 groups was compared from baseline to final postoperative interview. RESULTS: Three months after surgery, a higher proportion in the Array group achieved a Jaeger value of J3 (20/40 Snellen) or better uncorrected binocular near visual acuity and 0.5 (20/40) or better distance-corrected binocular near visual acuity than in the monofocal groups (97% versus 68% and 95% versus 59%, respectively; P <.001). A higher proportion in the multifocal group achieved both 0.5 (20/40) and J3 or better uncorrected binocular distance and near visual acuities (97% versus 66%; P <.001). Those in the Array group were more likely than those in the monofocal group to never wear glasses overall (41% versus 12%; P <.001). Multifocal patients rated their vision without glasses better overall, at near and at intermediate distances (P <.05), and demonstrated better visual function for near tasks and social activities. CONCLUSIONS: Those who had bilateral implantation of the Array multifocal IOL obtained better uncorrected and distance-corrected near visual acuities and reported better overall vision, less limitation in visual function, and less spectacle dependency than patients with bilateral monofocal IOLs.     

ReSTOR diffractive versus Array 2 zonal-progressive multifocal intraocular lens: a contralateral comparison

PURPOSE: To evaluate near and distance visual performance after implantation of a diffractive multifocal intraocular lens (MIOL) (AcrySof ReSTOR) or a refractive MIOL (Array 2) in bilateral cataract surgery. METHODS: In this prospective, comparative trial, 18 patients with bilateral cataract were selected to have lens surgery with asymmetric MIOL implantation. Eighteen eyes received ReSTOR MIOL and the 18 fellow eyes were implanted with Array 2. Five months after second lens implantation, main postoperative outcomes were uncorrected and distance corrected near visual acuities (VA). Secondary outcomes were distance VA and near acuity with power add, contrast sensitivity with and without glare (Pelly-Robson Contrast Sensitivity Chart, CSV 1000 HGT). Quality of vision was measured by comparing the severity of visual symptoms as referred to a masked interviewer. RESULTS: Patients reported similar postoperative distance visual acuities for both eyes. ReSTORimplanted eyes showed better uncorrected and distance corrected near acuity than eyes with Array 2 (p=0.002 and p=0.003, respectively). Intermediate VA with distance correction was slightly higher with the Array 2 MIOL (p=0.058). No important difference was observed in contrast sensitivity, glare disability, and subjective rating of light sensations. Severe photic phenomena were reported only for one Array 2-implanted eye. CONCLUSIONS: The diffractive MIOL showed better uncorrected and distance corrected near VA. The refractive Array 2 MIOL had a tendency to better value for intermediate distance. Disturbing photic phenomena were observed only in one case with the Array 2 MIOL.     

高度近视合并白内障患者植入Array多焦点人工晶状体的临床观察

目的:评价白内障超声乳化吸除联合Array SA40N多焦点人工晶状体植入术治疗高度近视合并白内障的临床疗效及其安全性。方法:对25例(31眼)高度近视合并白内障患者行超声乳化白内障吸除联合低度数Array多焦点人工晶状体植入术,观察术中和术后并发症、术后视力和屈光状态。结果:所有患者术中均无并发症发生。术后6mo,所有患者裸眼远视力≥0.5者25眼(81%);最佳矫正远视力≥0.5者28眼(90%)。裸眼近视力≥0.5者12眼(39%);最佳矫正近视力≥0.5者22眼(71%)。术后屈光度数偏差值≤±0.50D者为24眼(77%)。结论:超声乳化白内障吸除联合低度数ArraySA40N多焦点折叠式人工晶状体植入术,是治疗高度近视合并白内障患者安全、有效的手术方法。     

Outcomes of sulcus implantation of Array multifocal intraocular lenses in second-eye cataract surgery complicated by vitreous loss

PURPOSE: To evaluate the outcomes of implantation of the Array((R)) multifocal intraocular lens (IOL) (model SA-40N, AMO) in the ciliary sulcus in second-eye cataract surgery complicated by vitreous loss. SETTING: Department of Ophthalmology, Arrowe Park Hospital, Wirral, United Kingdom. METHODS: This retrospective study comprised 15 patients who had complicated second-eye cataract surgery with loss of posterior capsule support leading to sulcus implantation of an Array multifocal IOL. The patients were recalled for assessment. Objective evaluation included uncorrected and corrected distance and near visual acuities, complications, and IOL centration. Subjective assessment was performed using a questionnaire that included the VF-14 index of visual function; the questions were related to satisfaction with vision, limitations from halos and glare, and the frequency of spectacle wear. RESULTS: Fourteen eyes (93%) had postoperative visual improvement. The best corrected distance acuity was 6/12 or better in 11 eyes (73%). The best corrected near acuity was J2 or better in 12 eyes (80%). The IOL was well centered in 11 eyes (73%) and slightly decentered in 4 eyes (27%). Subjectively, patients indicated a high level of satisfaction with their distance and near vision. The VF-14 indicated high levels of visual function, with 73% of patients having a score higher than 90 (out of 100). Seventy-three percent of patients were not troubled by glare or halos, and 40% did not wear spectacles. CONCLUSION: Implantation of the Array multifocal IOL in the sulcus during complicated phacoemulsification led to good visual outcomes based on objective and subjective patient measures.     

Visual acuity and contrast sensitivity: AcrySof ReSTOR apodized diffractive versus AcrySof SA60AT monofocal intraocular lenses

PURPOSE: To compare the visual acuity and contrast sensitivity in eyes with the AcrySof ReSTOR multifocal intraocular lens (IOL) (Alcon) and eyes with the monofocal AcrySof SA60AT IOL. SETTING: Policlinico Umberto I, Department of Ophthalmology, Rome, and private clinical practice, Rome, Italy. METHODS: One hundred eyes had phacoemulsification cataract extraction and implantation of a ReSTOR multifocal IOL in the capsular bag. Inclusion criteria were corneal astigmatism less than 1.5 diopters (D), myopia less than 4.0 D, and no associated ocular disease. A complete ophthalmic examination, including uncorrected visual acuity, best spectacle-corrected visual acuity, and contrast sensitivity, was performed 6 months postoperatively. Results were compared with those in 40 eyes with the AcrySof monofocal IOL single-piece IOL. RESULTS: In the multifocal group, 90 eyes (90%) had an uncorrected distance visual acuity of 20/25 or better (logMAR<0.10) and an uncorrected near visual acuity at 35 cm of J3 or better (logMAR 0.14). The multifocal group and monofocal group had similar distance uncorrected and best corrected visual acuities; however, the multifocal group had significantly better near uncorrected acuity. The mean contrast sensitivity values were 18.28 dB (static program) and 17.95 dB (dynamic program) in the multifocal group and 19.18 dB (static program) and 21.2 dB (dynamic program) in the monofocal group. CONCLUSIONS: The ReSTOR multifocal IOL provided a satisfactory full range of vision; 92% of the patients achieved total spectacle independence. Contrast sensitivity was lower than with the SA60AT monofocal IOL.     

ReSTOR intraocular lens implantation in cataract surgery: quality of vision

PURPOSE: To compare the visual outcome and subjective visual symptoms in patients who had implantation of the AcrySof ReSTOR multifocal intraocular lens (IOL) (Alcon Laboratories) with those in patients who received the AcrySof SA60AT monofocal IOL (Alcon Laboratories) in cataract surgery. SETTING: Southend Hospital, Essex, United Kingdom. METHODS: Eighty eyes of 40 patients received the ReSTOR multifocal IOL after cataract extraction. They were closely paired in age, sex, and ocular findings with patients who had monofocal IOL implantation during the same period. The distance and near visual acuities were compared, and patient satisfaction with their vision, visual symptoms, and spectacle dependence was assessed using a standardized questionnaire. RESULTS: There was no significant difference in the mean uncorrected and best corrected distance visual acuities between the groups. An uncorrected distance visual acuity of 20/30 or better was achieved in 93.8% eyes in the multifocal group and 82.5% in the monofocal group and of 20/20 or better in 57.5% and 40.0%, respectively (P = .18). Uncorrected near visual acuity was 20/30 or better in 75.0% of eyes in the multifocal group and 3.8% in the monofocal group. Reading glasses were required by 2.5% in the multifocal group and by 92.5% in the monofocal group. Satisfactory uncorrected intermediate distance vision was achieved in 75.0% of eyes in the multifocal group and 87.5% in the monofocal group (P = .089); 85.0% of patients in the multifocal group and 7.5% in the monofocal group never had to wear glasses. Moderate glare was reported by 21.3% in the multifocal group and 7.5% in the monofocal group (P = .008); no patient reported severe glare. In the multifocal group, severe halos and moderate halos occurred in 3.8% [corrected] of eyes and 16.3% [corrected] of eyes, respectively. CONCLUSIONS: The AcrySof ReSTOR IOL provided predictably good uncorrected distance and uncorrected near acuities. Spectacle independence was significantly higher with this multifocal IOL, which outweighed the photic symptoms it caused.     

Initial experience with a refractive multifocal intraocular lens in a Japanese population

PURPOSE: To evaluate a poly(methyl methacrylate) refractive, zonal-progressive multifocal intraocular lens (IOL) in patients requiring cataract surgery. SETTING: Department of Ophthalmology, Saiseikai Kurihashi Hospital, Saitama, Japan. METHODS: This open-label noncomparative study evaluated 58 eyes of 31 Japanese patients who had cataract surgery and implantation of a multifocal IOL (Array(R) PA154N, Allergan Surgical). The main outcome measures were visual acuity (VA) (distance and near, with and without correction), glare disability, and contrast sensitivity (CS) (distance and near, with and without glare under day and night conditions). A questionnaire was used to evaluate the effectiveness of the multifocal IOL. RESULTS: Uncorrected distance VA was 0.7 or better (20/30) in 56 eyes (97.0%) and uncorrected near VA, 0.5 or better (20/40) in 52 eyes (89.7%). Corrected distance VA was 0.7 or better in all eyes. Near VA with distance correction was 0.5 or better in 51 eyes (87.9%). Daytime CS was within the normal range. However, nighttime CS with central glare for both distance and near was markedly decreased. Under all conditions, distance CS was significantly better than near CS from middle- to high-frequency areas. Seventy-four percent of patients with the IOL in both eyes did not need glasses for daily activities, and the others needed glasses only to read for long periods. CONCLUSIONS: The results indicate that this refractive multifocal IOL is distance dominant and is beneficial in Japanese patients. However, since there are differences between Western countries and Japan in distance reading of characters and letters, further modification of this multifocal IOL may be required for use in Japanese patients.     

Combination of Toric and multifocal intraocular lens implantation in bilateral cataract patients with unilateral astigmatism

AIM: To assess the binocular visual function in bilateral cataract patients with unilateral astigmatism after combined implantations of Toric with multifocal intraocular lens (IOL), and to compare with that of Toric and monofocal IOL implantation. METHODS: All the 30 patients with unilateral astigmatism suffered bilateral cataract were randomly divided into two groups: Toric plus multifocal IOL group and Toric plus monofocal IOL group. Uncorrected and corrected visual acuity at distance (5.0 m), intermediate distance (0.6 m), and near (0.33 m), contrast sensitivity, and stereopsis were assessed 6mo after surgery. Patients were also surveyed for visual disturbances and spectacle dependence. RESULTS: Binocular uncorrected visual acuity (LogMAR) of Toric/multifocal IOL eyes at distance, intermediate, near were 0.05±0.05, 0.24±0.10, and 0.14±0.06 respectively. The values of Toric plus monofocal IOL eyes were 0.06±0.07, 0.26±0.08, and 0.37±0.10 respectively. These values did not indicate significant differences between two groups with exception of near visual acuity. In the photopic condition (with or without glare), the contrast sensitivity of multifocal IOL eyes was significant lower than the monofocal IOL eyes in 18 cpd. In the mesopic condition, the contrast sensitivity of multifocal group was significant lower than monofocal group in 12 cpd, and in mesopic glare condition, this significant difference was found both in 6 cpd and 12 cpd. The stereopsis of Toric/multifocal IOL eyes decreased slightly (100±80 seconds of arc, t=2.222, P=0.136). Mean near vision for patient satisfaction was statistically significantly higher in Toric/multifocal IOL group patients versus than that in Toric/monofocal IOL group (80% vs 25.5%, P=0.000). Visual disturbance was not noticed in either group. CONCLUSION: Although the combination of Toric and multifocal IOL implantation results in compromising stereoacuity, it can still provide patients with high levels of spectacle freedom and good overall binocular visual acuity.     

Cataract extraction with multifocal intraocular lens implantation: a multinational clinical trial evaluating clinical, functional, and quality-of-life outcomes

OBJECTIVE: Two million cataract extractions are performed annually in the United States. The procedure is nearly always accompanied by implantation of a monofocal intraocular lens (IOL), which corrects the patient's distance vision. The authors' objective was to measure visual function and quality-of-life outcomes associated with bilateral implantation of a multifocal IOL, which corrects distance and near vision, and to compare the outcomes with those of the standard therapy. DESIGN: A prospective, randomized, double-masked, clinical trial was conducted at eight sites in the United States, seven sites in Germany, and one site in Austria. PARTICIPANTS: Participants included 245 cataract patients, 127 of whom received the multifocal IOL bilaterally and 118 of whom received a monofocal IOL of nearly identical construction bilaterally. METHODS: Clinical data included visual acuity (VA), complications, and adverse events. Quality-of-life data were collected using a previously validated survey instrument at baseline, after first eye surgery, and after second eye surgery. RESULTS: At 3 months after surgery, patients who had received multifocal IOLs had significantly better uncorrected and distance corrected binocular near VA compared with patients who had received monofocal IOLs (mean uncorrected VA, 20/26 multifocal vs. 20/40 monofocal; mean distance corrected VA, 20/28 multifocal vs. 20/45 monofocal; P < 0.0001). Additionally, 96% of patients who had received multifocal IOLs and 65% of patients who had received monofocal IOLs achieved both 20/40 and J3 (Jaeger) or better uncorrected, binocular distance and near visual acuities (P < 0. 0001). Patients who had received multifocal IOLs were more likely than patients who had received monofocal IOLs to never wear glasses overall (32% multifocal vs. 8% monofocal; P < 0.0001). On a 4-point scale, patients who had received multifocal IOLs on average reported having between "a little bit" and "some" glare or halo, whereas patients who had received monofocal IOLs reported between "none" and "a little bit" of glare or halo (1.57 vs. 0.43; P < 0.001). Patients who had received multifocal IOLs rated their vision without glasses better overall at near and at intermediate distances (P < or = 0.002) and demonstrated better visual function for near tasks and social activities. CONCLUSIONS: Cataract patients who received multifocal IOLs at time of surgery obtained better uncorrected and distance corrected near VA and reported better overall vision, less limitation in visual function, less spectacle dependency, and more glare or halo than those who received traditional monofocal IOLs.     

Functional outcomes after implantation of Tecnis ZM900 and Array SA40 multifocal intraocular lenses

PURPOSE: To evaluate the functional outcome after implantation of the Tecnis ZM900 multifocal intraocular lens (IOL) (AMO) and the Array SA40 multifocal IOL (AMO). SETTING: Department of Ophthalmology, Bundesknappschaft s Hospital, Sulzbach, and the Department of Ophthalmology, Marienhospital, Aachen, Germany. METHODS: In a prospective comparative 2-center trial, Tecnis ZM900 and the Array SA40 multifocal IOLs were bilaterally implanted in 50 patients (50 eyes Tecnis, 50 eyes Array) by 1 surgeon at each center. The following parameters were assessed 30 to 60 days and 120 to 180 days after surgery in both eyes: refraction, pupil size, uncorrected and best corrected visual acuities for distance and near at different contrast levels, and photopic and mesopic contrast sensitivity at different spatial frequencies. Patient satisfaction (spectacle independence, photic phenomena, overall satisfaction) was assessed by a questionnaire. RESULTS: The main differences between the 2 multifocal IOLs were the better uncorrected near visual acuity (P<.001), distance-corrected near visual acuity (P<.001), the mesopic contrast sensitivity at high spatial frequencies (P<.05) as well as greater independence from spectacles in patients with the Tecnis multifocal IOL, resulting in higher levels of patient satisfaction. CONCLUSION: The aspherical diffractive Tecnis multifocal IOL gave better outcomes than the Array multifocal IOL.     

KTP激光治疗下泪小管吻合术后泪道阻塞的临床分析

目的：通过对Acrysof ReSTOR SA60D3多焦点人工晶状体植入和Acrysof SN60AT单焦点人工晶状体植入术后3a远近视力及拟调节力的对比研究,探讨Acrysof ReSTOR SA60D3多焦点人工晶状体中期的临床应用效果。

方法：对在同一时期接受白内障超声乳化人工晶状体植入手术的年龄相关性白内障患者68例80眼进行回顾性分析。其中A组40眼植入Acrysof ReSTOR SA60D3多焦点人工晶状体,B组40眼植入Acrysof SN60AT单焦点人工晶状体。术后3a随访观察术眼的屈光状态,裸眼远、近视力,矫正远、近视力, 最佳远矫下近视力,对比敏感度,问卷调查视觉质量和满意度,术后脱镜率及并发症等。

结果：术中术后两组均无严重并发症。两组患者术后均有良好的远视力和最佳矫正近视力,差异无统计学意义; A组患者裸眼近视力明显优于B组,A组脱镜率达82%,B组脱镜率16%; 术后对比敏感度差异无统计学意义,术后视觉症状无明显差异,但是术后满意度A组明显高于B组。

结论：Acrysof ReSTOR SA60D3多焦点人工晶状体植入安全有效,可为患者同时提供良好的远、近视力,值得临床推广应用。     

Five-year postoperative outcomes of apodized diffractive multifocal intraocular lens implantation

Purpose

To assess the long-term postoperative visual performance of an apodized diffractive multifocal intraocular lens (IOL).

Methods

Twenty-one patients (42 eyes) underwent cataract surgery with bilateral implantation of an apodized diffractive multifocal IOL. The monocular uncorrected and corrected distance visual acuities, uncorrected, distance-corrected and corrected near visual acuities, and manifest refractive spherical equivalent were measured 1 and 5 years postoperatively. The contrast sensitivity, incidence of glare or halos, and rate of neodynium:YAG (Nd:YAG) posterior capsulotomy were evaluated 5 years postoperatively.

Results

No significant differences were found between the distance and near visual acuities at 1 and 5 years postoperatively. The contrast sensitivity was within the normal range for all spatial frequencies. No patients reported severe glare or halos. Six (14.3 %) eyes required Nd:YAG posterior capsulotomy.

Conclusions

The apodized diffractive multifocal IOL provides good, stable distance and near visual acuity levels over a 5-year follow-up period.     

Abbildungseigenschaften multifokaler Intraokularlinsen

BACKGROUND: Reduced contrast sensitivity, glare disability and insufficient bifocality are the main drawbacks of multifocal intraocular lenses (IOL). The bilateral implantation of diffractive IOL with an asymmetrical light distribution for distance and near focus is an alternative concept that aims to improve the contrast sensitivity and bifocality of conventional multifocal IOL. PATIENTS AND METHODS: The optical performance of monofocal (PhacoFlexII SI40) and multifocal IOL (Array SA40N; Acri.Twin 737D/733D) was quantitatively assessed in 18 healthy probands and qualitatively determined by digital photographic recording using an optical apparatus, the "physical eye", according to Reiner and Jacobi. Vision examination included standard tests of distance and near visual acuity, contrast sensitivity and low contrast visual acuity testing under varying pupil size using a video acuity tester. RESULTS: Distance visual acuity was significantly superior with the SI40 and distant-dominant 737D compared to the SA40N and near-dominant 733D. At near, the 733D had the best performance. Contrast sensitivity was better with the 737D than the SA40N when both were compared with the SI40. No normal contrast sensitivity could be determined with the 733D because of the optical phenomenon of 'spurious resolution'. Variation in pupil size had less impact on contrast acuity with the Acri.Twin IOL compared to the SI40 and SA40N. Photographic testing revealed better edge contrast with the Acri.Twin than the SA40N. CONCLUSIONS: The optical performance of multifocal IOL correlates with the properties of physical light distribution. Differences in edge contrast may be discerned using photographic recording.     

Visual performance of patients with bilateral vs combination Crystalens, ReZoom, and ReSTOR intraocular lens implants

PURPOSE: To compare the visual performance of patients with bilateral vs combination Crystalens, ReZoom, and ReSTOR intraocular lens (IOLs) implants. DESIGN: Prospective, nonrandomized study. METHODS: Forty-nine patients were implanted with bilateral Crystalens (Eyeonics, Aliso Viejo, California, USA), ReSTOR (Alcon Laboratories, Fort Worth, Texas, USA), and ReZoom (American Medical Optics, Santa Clara, California, USA) or combined Crystalens and ReSTOR or Crystalens and ReZoom IOLs after phacoemulsification. Monocular and binocular testing four to six months after surgery included uncorrected and best-spectacle corrected visual acuity at distance, intermediate, and near vision; mesopic contrast sensitivity function with and without glare; and quality-of-life and vision surveys six months after surgery. RESULTS: Monocular testing showed that eyes with Crystalens accommodating IOL had statistically better best-spectacle corrected distance, uncorrected and distance-corrected intermediate, and best-corrected near vision. Eyes with the ReSTOR multifocal IOL had better uncorrected near vision, required the lowest reading add, and had the lowest uncorrected and distance-corrected intermediate vision. Monocular mesopic contrast sensitivity with and without glare was better with the Crystalens IOL vs either multifocal IOL at specific spatial frequencies. The binocular subjective quality of vision and quality of life questionnaires were favorable for the bilateral Crystalens group. CONCLUSIONS: Any combination of Crystalens in one or both eyes was better for intermediate vision. Any combination of ReSTOR in one or both eyes was better for near vision. The Crystalens and ReSTOR combination had better mean intermediate and near vision overall. A multifocal IOL in one or both eyes was associated with lower contrast sensitivity and more subjective reports of photic phenomena. The accommodating and multifocal IOL combinations elicited less night glare symptoms than in patients with either bilateral multifocal IOL, but more than with bilateral Crystalens implantation.     

Decentration, tilt, and near vision of the array multifocal intraocular lens

PURPOSE: To study the periodic changes in decentration, tilt, and near vision in eyes with the Array(R) multifocal intraocular lens (IOL). SETTING: Department of Ophthalmology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. METHOD: This study comprised 20 eyes of 10 patients older than 60 years who had binocular cataract and bilateral implantation of the Array multifocal IOL. Mean patient age was 66.0 years (range 60 to 75 years). After a clear corneal incision and continuous curvilinear capsulorhexis were made, each eye had phacoemulsification and in-the-bag IOL implantation. The amount of IOL decentration and degree of tilt were evaluated using the EAS-1000 anterior eye segment analysis system 1 day and 1 and 2 months postoperatively. Near and far visual acuities were measured at the same examinations. RESULTS: No statistically significant differences were observed in decentration (P =.13) or tilt (P =.32) throughout the follow-up. Mean uncorrected distance visual acuity was 0.68 +/- 0.27 (SD), and mean uncorrected near acuity was 0.49 +/- 0.15 2 months postoperatively. Uncorrected distance acuity better than 0.5 was achieved in 14 eyes (77.8%), in which the mean uncorrected distance acuity was 0.80 +/- 0.18 and the mean uncorrected near acuity was 0. 53 +/- 0.14 2 months postoperatively. CONCLUSIONS: Tilt and decentration of the Array multifocal IOL showed no significant progression up to 2 months after implantation. For near acuity, the Array IOL may be an effective aid.     

单眼白内障患者植入多焦点人工晶状体与单焦点人工晶状体后的双眼视功能比较

目的比较单眼白内障患者植入多焦点人工晶状体（IOL）或单焦点IOL后的双眼视功能。方法前瞻性非随机对照研究。2013年6月至2014年12月期间,在我院行白内障超声乳化联合IOL植入术的单眼白内障患者80例（80眼）,根据植入的IOL类型分为2组,各40例（40眼）。观察组植入多焦点IOL,对照组植入单焦点IOL。术后随访3个月,观察指标包括术眼单眼及双眼远（5 m）、中（70 cm）、近（40 cm）视力,双眼对比敏感度,近立体视,脱镜率,视觉干扰现象及患者满意度。术后视力及对比敏感度比较采用独立样本t检验;脱镜率及光干扰现象发生率的比较采用χ²检验;近立体视、视力满意度评分比较采用Mann-Whitney U检验。结果观察组双眼裸眼远、中、近视力分别为0.03±0.04、0.17±0.07、0.15±0.06,对照组双眼裸眼远、中、近视力分别为0.05±0.05、0.27±0.08、0.31±0.09,观察组双眼裸眼中视力和近视力优于对照组（t=3.925、3.429,P＜0.01）,而2组间双眼裸眼远视力差异无统计学意义（t=0.356,P＞0.05）。双眼在空间频率为3、6、12、18 c/d时,观察组无眩光对比敏感度和有眩光对比敏感度均低于对照组（无眩光：t=3.463、3.361、2.198、2.574,P＜0.05;有眩光：t=3.105、2.432、2.758、3.207,P＜0.05）。观察组近立体视优于对照组（Z=2.578,P＜0.05）,脱镜率（88%）高于对照组（28%）（χ²=8.240,P＜0.05）,2组间视远满意度评分差异无统计学意义（Z=0.598,P＞0.05）,而观察组视中和视近满意度评分均高于对照组（Z=2.314、3.137,P＜0.05）。2组间视觉干扰眩光现象差异无统计学意义（χ²=0.602,P＞0.05）,而观察组光晕现象多于对照组（χ²=8.807,P＜0.05）。结论单眼白内障患者植入多焦点IOL相比单焦点IOL能提供更好的双眼中、近视力,双眼立体视,脱镜率及患者满意度,但对比敏感度有所降低。     

A comparative clinical study of the visual results between three types of multifocal lenses

Purpose

To compare the patients’ visual results after bilateral implantation of the multifocal intraocular lenses (MIOLs): ReZoom (NXG1, Abbott Medical Optics, Abbott Park, IL, USA), Acrysof ReSTOR (SA60D3, Alcon Laboratories, Fort Worth, TX, USA) and Tecnis MF (ZM900, Abbott Medical Optics).

Materials and methods

A prospective, nonrandomized, comparative trial of 30 patients (60 eyes) aged 46–71 (mean age 56.3?±?5.96) divided into three equal groups with implanted bilaterally multifocal lenses: ReZoom IOL, Acrysof ReSTOR IOL and Tecnis MF IOL. The patient selection criteria included no other eye disease besides cataract, and corneal astigmatism of 1.5 diopters or less. In each case, the patients were scheduled to have standard phacoemulsification surgery with IOL implantation into the bag. The postoperative target was emmetropia. The mean follow-up was 6 months in all eyes. The following parameters were assessed/carried out: slit-lamp examination, uncorrected and best spectacle-corrected far and near visual acuity, autorefractometry, intraocular pressure, contrast sensitivity and subjective satisfaction with vision using the VF-14 survey.

Results

After surgery, all eyes were within ±2.0D of target refraction. The mean uncorrected distance visual acuity improved in all cases. The postoperative BCDVA was better than 20/30 at the sixth month in all eyes. Six months postoperatively, the mean uncorrected distance visual acuity (UCDVA) ± standard error (SE) in the ReZoom, ReSTOR and Tecnis MF groups was 0.11?±?0.01, 0.17?±?0.02 and 0.14?±?0.02 (LogMAR) respectively. All results were significantly better compared to preoperative values (p?<?0.001) but did not differ between the study groups (p?>?0.05). At the final visit, 75% of eyes in the ReZoom group achieved J1 (Jaeger standard) in comparison to 85% in the ReSTOR and Tecnis MF groups. Eighty percent of patients with bilaterally implanted ReSTOR and Tecnis MF IOL were spectacle-independent, in comparison to 70% with implanted ReZoom IOL. Thirty percent of patients with implanted Rezoom and Acrysof Restor IOL and 20% with implanted Tecnis multifocal IOL reported little or moderate halo and glare. The patients’ satisfaction after the procedure was excellent; the scoring on the VF-14 survey ranged from 70–100%, with an average of 93%. No patient was dissatisfied with the results of the surgery.

Conclusions

The implantation of tested multifocal intraocular lenses provides good near and distance visual acuity. We did not observe any statistically significant differences between the tested multifocal intraocular lenses with regard to best-corrected distance visual acuity, presence of glare and halo, as well as satisfaction with vision.     

非球面散光矫正型多焦点人工晶状体植入术对白内障患者视力和对比敏感度的影响

目的：观察非球面散光矫正型多焦点人工晶状体植入术对白内障患者视力和对比敏感度的影响。
　　方法：将我院2014-05/2015-05期间行超声乳化人工晶状体植入术的合并有角膜规则散光的白内障患者58例72眼,随机分为两组：观察组植入散光矫正型多焦点人工晶状体29例36眼;对照组植入散光型单焦点人工晶状体29例36眼。术后随访1、6mo,观察术后患者的裸眼远视力(UCDVA)、裸眼近视力(UCNVA)、最佳矫正远视力(BCDVA)、最佳矫正近视力(BCNVA)、残余散光、暗光下对比敏感度。
　　结果：两组术后1、6mo UCDVA、BCNVA、BCDVA 以及残余散光的比较差异无统计学意义(P>0.05);观察组术后1、6mo 的 UCNVA 优于对照组(P<0.05);术后6mo 两组对比敏感度在高空间频率比较上差异有统计学意义(P<0.05)。
　　结论：非球面散光矫正型多焦点人工晶状体植入术治疗合并有角膜规则散光的白内障患者疗效确切,与散光型单焦点人工晶状体植入术比较均可改善患眼视力,且采用非球面散光矫正型多焦点人工晶状体植入术治疗后可获得更好的裸眼近视力和对比敏感度。