两种TECNIS多焦点人工晶状体不同组合方式植入术后视力对比

目的：对比双眼均植入Tecnis Symfony ZXR00(ZXR00)、双眼分别植入ZXR00和Tecnis ZMB00(ZMB00)以及双眼均植入ZMB00患者术后视力、视觉质量及患者满意度。

方法：回顾性病例对照研究。收集2020-08/2021-12行白内障超声乳化吸除联合人工晶状体(IOL)植入的白内障患者117例(234眼),根据IOL不同分为三组：37例(74眼)双眼植入ZMB00为MM组; 44例(88眼)双眼分别植入ZXR00和ZMB00为MR组; 36例(72眼)双眼均植入ZXR00为RR组。观察三组患者术后3 mo裸眼远视力(UDVA,5 m)、裸眼中视力(UIVA,80 cm)、裸眼近视力(UNVA,40 cm)、矫正远视力(CDVA)、离焦曲线、立体视及VF-14、QoV视觉质量评分表问卷调查。

结果：MM和MR组UNVA优于RR组(P<0.05); 而MM组与MR组不具有统计学差异。RR组UIVA最优。三组的UDVA、CDVA和立体视均不具有统计学意义(P>0.05)。 术后3 mo时MR、MM、RR组40 cm近立体视锐度分别为107.27±80.53、105.67±83.79、108.69±97.66(20-400)弧秒(P>0.05)。MR、MM、RR组的满意度均达到90%以上。

结论：三组术后均具有良好的远、中、近视力和双眼近立体视。其中,MR组具有更优异的全程视力。三组患者术后满意度均较高,可以根据患者的不同需求选择合适的多焦点人工晶状体。     

Visual acuity and defocus curves with six multifocal intraocular lenses

International Ophthalmology - The purpose of this prospective, randomized, double-masked, study was to compare the visual performance of patients after bilateral implantation of six different IOLs....     

非球面多焦点人工晶状体植入眼不同背景亮度及不同对比度视功能观察

目的 分析非球面多焦点人工晶状体（MIOL）[ReSTOR MIOL（SN6AD3）]植入眼在不同背景亮度不同对比度下的视功能.方法 采用前瞻性研究.2009年2月至2009年7月行白内障超声乳化吸除并植入SN6AD3且随访资料完整的病例26例（42眼）,术后6个月在最佳远矫正状态下,采用多功能电子视力测量仪（MFVA-100）测试不同背景亮度（250、85、25 cd/m^2）下不同对比度（100%、25%、10%、5%）视标的LogMAR视力.采用Dunnett＇s T3多重比较法对所得视力进行统计分析.结果 在250 cd/m^2背景亮度下,不同对比度（100%、25%、10%、5%）视力平均值分别为0.01、0.23、0.40、0.62;85 cd/m^2背景亮度下为0.02、0.26、0.46、0.74;25 cd/m^2背景亮度下为0.08、0.32、0.49、0.63;在这3种背景亮度下,视力随着对比度下降而下降,差异有统计学意义（P均＜0.05）.同一对比度视标,不同背景亮度（250、85、25 cd/m^2）下的视力采用Dunnett＇s T3多重比较法分析,结果示差异无统计学意义（P均＞0.05）.结论 植入非球面ReSTOR MIOL（SN6AD3）患者无论在高亮（250 cd/m^2）、标准（85 cd/m^2）、中间（25 cd/m^2）背景亮度下均可获得满意的视力.视标的对比度对视力的影响较背景亮度更大.     

ReSTOR多焦点人工晶状体植入术后早期远、中、近视力的测量

目的 探讨植入ReSTOR多焦点人工晶状体患者远、中、近距离视力变化及其变化趋势.方法 为前瞻性系列病例研究.选择行超声乳化联合ReSTOR多焦点人工晶状体植入术的患者共22例(30只眼),术后3个月随访时分别进行远、中、近距离的裸眼视力检查;在远矫正的基础上,递增-0.50 D并且分别记录视力;进行生活质量问卷调查,并对远、中、近视力满意度进行自我评分.结果 28只眼(93.3%)术后屈光误差在±1.00 D内,23只眼(76.7%)术后散光在+1.00 D内.裸眼远距离(5 m)视力、中距离(60 cm)视力、近距离(33 cm)视力的平均值分别是0.91、0.40、0.64.远距矫正状态下,0、-1.50、-3.00 D调节力时视力的平均值分别为1.00、0.49、0.79.问卷调查中,5例患者走路和上下楼梯时有踏空感,2例计算机使用者抱怨无法看清屏幕,1例理发工作者抱怨无法看清顾客头发;远、中、近距离视力满意度的自我评分分别为8.0、7.5分、8.0分.结论 ReSTOR多焦点人工晶状体能提供优良的裸眼远、近视力,良好的中距离视力;与远、近视力比较,中间段距离视力有所下降,可能是影响对中间距离有特殊要求者生活质量的原因.     

Wavefront measurements of diffractive and refractive multifocal intraocular lenses in an artificial eye

PURPOSE: To investigate whether wavefront measurements taken in eyes that have implanted multifocal intraocular lenses (IOLs) are reliable when creating laser refractive surgical treatments to remove residual refractive error from these eyes. METHODS: A specially designed fluid-filled model eye holding a multifocal IOL was refracted using a commercial wavefront eye refractor. The wavefront findings were then compared to the expected refractive error. The fluid-filled model was designed to match the optical characteristics of a human eye and to hold the IOL at the same distance from the cornea as in a human eye. Lenses tested were AMO Tecnis ZM900 series (diffractive design, +25.00 D, +4.00 D add), AMO ReZoom NXG1 series (refractive design, 25.00 D, +4.00 D add), and AMO 811E (diffractive with aspheric design 25.00 D, +4.00 add). The visible pupil diameter was 5.75 mm. RESULTS: Diffractive bifocal IOLs were found to create spot doubling in the Shack-Hartmann sensor image as expected from theoretical considerations. However, the residual sphere power and cylinder power reported were those expected. In addition, the higher order aberrations reported were reasonable in light of expected results. Refractive multifocal IOLs were found to create distorted Shack-Hartmann images as expected. The residual sphere power and cylinder power reported were not those expected nor were the higher order aberrations. In addition, the higher order values were sensitive to the position of the eye with respect to the refractor. CONCLUSIONS: Wavefront measurements from eyes with diffractive IOLs can be used, with caution, to plan laser refractive treatments. Wavefront measurements from eyes with refractive multifocal IOLs should not be used to plan post-implant laser refractive correction.     

Compared optical performances of multifocal and monofocal intraocular lenses (contrast sensitivity and dynamic visual acuity)

The functional results (contrast sensitivity and dynamic visual acuity) of 19 multifocal (3M design) and 14 all polymethylmethacrylate biconvex monofocal intraocular lenses (IOLs), 6 mm in optical diameter were compared. Best corrected visual acuity was > or = 8/10 (Monoyer chart) Parinaud 2 in all cases. Major differences of functional performance in favour of monofocal IOLs were found outside standard conditions of vision (low contrast and illumination levels). A significant difference in contrast sensitivity was found for each spatial frequency in favour of multifocal IOLs (0.0016 < p < 0.05). Mesopic vision was statistically higher in the monofocal IOL group (p = 0.0015). Moreover, dynamic visual acuity allowed accurate evaluation of the difference in performance between these two models of implant. In view of these results multifocal IOLs should be reserved for patients with normal psychosensitive adaptation; an ocular pathology that could alter contrast sensitivity or mesopic vision is a contraindication for multifocal IOLs.     

Optomechanical eye model with imaging capabilities for objective evaluation of intraocular lenses

PURPOSE: To develop an in vitro procedure providing data on the visual performance obtainable with intraocular lenses (IOLs), for objective comparison between IOL models and direct correlation with the relative visual performance attainable in vivo. SETTING: University Hospital San Raffaele, Milan, Italy. METHODS: An optomechanical eye model was developed to allow simulated in vivo testing of IOLs. The experimental eye mimics the optics and geometry of the Gullstrand's eye model, with an aspheric poly(methyl methacrylate) cornea, variable pupil, and IOL holder. Its detection system is designed to reproduce the mean resolution of the human fovea. The imaging capabilities of the model eye were measured using monofocal IOLs. The tests included qualitative information, such as appearance of optotype chart images, and quantitative information, such as simulated visual acuity tests for far and near distance at variable contrasts. RESULTS: Objective numerical IOL evaluation was made possible on the basis of the visual acuity recorded with the eye model. The maximum recorded far acuity for the monofocal IOLs was about 20/14 at full contrast, progressively decreasing for reduced contrast. Best corrected near acuity ranged between 20/14.7 and 20/15.4. CONCLUSIONS: The optomechanical eye model provided objective grading of IOLs through the evaluation of simulated visual acuity, which can be scaled usefully to human vision. The eye model also allowed the qualitative visualization of IOL imaging properties, making it potentially useful in characterizing and distinguishing different IOL types.     

Near visual acuity for everyday activities with accommodative and monofocal intraocular lenses

PURPOSE: To determine the levels of functional near visual acuity required for everyday social reading activities and to compare the levels to those attained with accommodative and monofocal intraocular lenses (LOLs). METHODS: Font size equivalencies of an Early Treatment Diabetic Retinopathy Study near chart and a variety of commonly read print objects were determined and correlated to the findings of distance-corrected near vision measurements with 2 accommodative (Tetraflex, 1CU) and 1 monofocal (Acrysof MA30) IOLs. RESULTS: The smallest print objects studied were sweetener packets with type between 20/40 (Jaeger [J] 5) and 20/50 (J6). Type in classified ads, stock quotations, and pocket bibles was 20/50 (J6), type in a telephone directory was 20/63 (J8), and type in standard newspapers, journals, and magazines was 20/80 (J9). Tested monocularly, 88% of Tetraflex, 40% of ICU, and 7% of Acrysof MA30 eyes had distance-corrected near vision sufficient to read newspaper and telephone directory print, and 63% of Tetraflex, 30% of 1CU, and 0% of Acrysof MA30 eyes could read classified ads, stock quotations, and pocket bibles, respectively. Tested binocularly after bilateral implantation, 96% of Tetraflex patients could read telephone directory print and 89% could read ads, stock quotations, and pocket bibles. CONCLUSIONS: Functional near visual acuity is not equivalent to the bottom-line objective at 20/20 (J1) near visual acuity. No print size was found at or smaller than 20/40 (J5), indicating that a requirement of nearly perfect near visual acuity, while desirable, may not be necessary for patients' social reading needs for accommodative IOLs.     

多焦点人工晶状体在近视合并白内障患者中的远期疗效评价

目的评价近视合并白内障患者在白内障超声乳化联合多焦点人工晶状体（multifocal intraocular lens，MIOL）植入术后的视觉质量。方法近视眼白内障患者行小切口超声乳化术，植入MIOL（Array SA-40N，AMO）14眼，单焦点人工晶状体（monofocal or single-focal intraocular lens，SIOL）（SA60AT，Alcon）20眼。手术后6个月，观察两组的术后视力、对比敏感度及视觉不良症状．使用Hartmann-Shack波前像差仪测定患者术后高阶像差，Pentacam检测两组人工晶状体（intraocular lens，IOL）的居中性（偏心值和倾斜度）。结果MIOL组术后裸眼近视力≥4．7的患者占64．29％，矫正远视度数下的近视力≥4．7的患者占85．71％，MIOL组裸眼近视力及矫正远视力下的近视力明显好于SIOL组（P〈0．05）。MIOL组在低、中、高频段对比敏感度及眩光对比敏感度与SIOL组差异均无统计学意义（P〉0．05）。分析孔径为5mm时，SIOL组球差显著高于MIOL组（P〈0．05），两组总高阶像差、余各阶像差的差异均无统计学意义（P〉0．05）。两组IOL居中性（偏心值和倾斜度）差异无统计学意义（P〉0．05）。结论MIOL植入治疗近视白内障，可为患者提供较好的全程视力和良好的视觉质量，显著减少了术后对于框架眼镜的依赖。其远期的对比敏感度及眩光对比敏感度均在正常范围,球差低于SIOL。     

Visualization of the retinal image in an eye model with spherical and aspheric, diffractive, and refractive multifocal intraocular lenses

PURPOSE: To present a method that visually demonstrates how spherical, aspheric, diffractive, and refractive multifocal intraocular lenses (IOLs) process light received from the cornea. METHODS: Monochromatic green light was projected through an Average Cornea Eye (ACE) Model with a cornea in front of the IOL. The model simulates a human cornea with average spherical aberration and visualizes the converging bundle of light leaving the IOL. Additionally, a US Air Force target was projected through the model, and the projected (retinal) image was captured. Various IOLs of differing designs were evaluated using this test setup. Multifocal IOLs included the aspheric diffractive Tecnis ZM900 and ZMA00 lenses; the refractive ReZoom NXG1 lens; the spherical AcrySof ReSTOR SA60D3 apodized diffractive lens; and the spherical diffractive CeeOn 811E lens. Monofocal IOLs included the spherical CeeOnEdge 911A IOL and the aspheric SofPort LI61AO, AcrySof IQ SN60WF, and Tecnis Z9000 and ZA9003 IOLs. RESULTS: The light paths of the different diffractive and refractive multifocal IOLs showed the variations in the processing of incoming light, illustrating the functional differences of IOL concepts. The US Air Force target projections in the ACE Model gave an impression of the functional optical quality of the different lenses. The value of this visualization method was demonstrated by comparing the results with modulation transfer function measurements. CONCLUSIONS: This visualization technique furthers the understanding of the working principles and quality of the retinal images produced by different mono- and multifocal IOLs.     

Comparison of visual outcomes and reading performance after bilateral implantation of multifocal intraocular lenses with bilateral monofocal intraocular lenses

Purpose

To compare the visual acuity outcomes, contrast sensitivity function (CS) and reading ability in patients with bilateral multifocal intraocular lenses and patients with bilateral monofocal lenses.

Setting

Vizyon Eye Center, Denizli, Turkey.

Design

Comparative case series.

Methods

Consecutive bilateral cataract patients having implantation of Acriva Reviol MFM 611 multifocal IOLs (Group A) or Acriva BB UD 613 monofocal IOLs (Group B) were included. Parameters analyzed 6 months postoperatively included monocular uncorrected distance (UDVA), binocular uncorrected intermediate (UIVA), binocular uncorrected near (UNVA), CS and bilateral reading performance using MN Read.

Results

The study evaluated 42 eyes in Group A and 40 eyes in Group B. There were no statistically significant differences in UDVA between two groups postoperatively (p = .39). Binocular UIVA and binocular UNVA are better in Group A (p = .00, p = .00). Under photopic and scotopic conditions, contrast sensitivity results were decreased in Group A, especially at high spatial frequencies. No statistically difference were found in reading acuity, critical print size and maximum reading speed between two groups (p = .57, p = .62, p = .22).

Conclusions

This study concludes that multifocal lenses are reliable and efficient replacements for reading glasses since they significantly improve the vision for near or intermediate distance activities.

     

Halo size under distance and near conditions in refractive multifocal intraocular lenses

AIMS: To calculate the diameter of halos perceived by patients with multifocal intraocular lenses (IOLs) and to stimulate halos in patients with refractive multifocal IOLs in a clinical experiment. METHODS: Calculations were done to show the diameter of halos in the case of the bifocal intraocular lens. 24 patients with a refractive multifocal IOLs and five patients with a monofocal IOL were asked about their subjective observation of halos and were included in a clinical experiment using a computer program (Glare & Halo, FW Fitzke and C Lohmann, Tomey AG) which simulates a light source of 0.15 square degrees (sq deg) in order to stimulate and measure halos. Halo testing took place monoculary, under mesopic conditions through the distance and the near focus of the multifocal lens and through the focus of the monofocal lens. RESULTS: The halo diameter depends on the pupil diameter, the refractive power of the cornea, and distance focus of the multifocal IOL as well as the additional lens power for the near focus. 23 out of 24 patients with a refractive multifocal IOL described halos at night when looking at a bright light source. Only one patient was disturbed by the appearance of halos. Under test conditions, halos were detected in all patients with a refractive multifocal IOL. The halo area testing through the distance focus was 1.05 sq deg +/- 0.41, through the near focus 1.07 sq deg +/- 0.49 and in the monofocal lens 0.26 sq deg +/- 0.13. CONCLUSIONS: Under high contrast conditions halos can be stimulated in all patients with multifocal intraocular lenses. The halo size using the distance or the near focus is identical.     

Visual outcomes with multifocal intraocular lenses

Multifocal intraocular lenses (IOLs) are increasingly becoming a part of the armamentarium of cataract and refractive surgeons. Reports show that most multifocal IOLs provide excellent visual outcomes. In one major study of a zonal progressive, refractive, multifocal design, more than 80% of patients were able to see 20/40 or better at distance and J3 or better at near, without correction. This study also found that patients' satisfaction ratings of their multifocal vision were consistently high. Although a few patients with multifocal IOLs complain of halo or glare, these symptoms can be minimized by surgical technique and appropriate selection of the multifocal IOL power.     

Optical performance of monofocal and multifocal intraocular lenses in the human eye

PURPOSE: To study the optical performance of intraocular lenses (IOLs) in the human eye to ascertain how multifocality affects the optical performance of refractive and diffractive technologies and the relationship to pupil size. SETTING: Vissum-Instituto de Oftalmológico de Alicante, Alicante, Spain. METHODS: Ten eyes each received the monofocal AcrySof MA60 IOL (Alcon) or 1 of the following multifocal pupil-dependent IOLs: diffractive AcrySof ReSTOR (Alcon) or refractive ReZoom (Advanced Medical Optics). The intraocular optical quality in vivo with 3.0 mm and 5.0 mm pupils was characterized by comparing the means of the difference between the total and corneal optical aberrations 3 months postoperatively. The main outcomes measures were total, higher-order, spherical, and coma aberrations (root-mean-square values); modulation transfer function values; point-spread function; and the Strehl ratio. RESULTS: The ReZoom group had higher in vivo intraocular aberrations than the AcrySof ReSTOR and AcrySof MA60 groups (P = .022). The difference in spherical aberration between the AcrySof ReSTOR and ReZoom groups was statistically significant with 5.0 mm pupils (P = .003) and 3.0 mm pupils (P = .001). The AcrySof ReSTOR group had statistically significant lower coma aberration values with a 5.0 mm pupil (P = .012); there were no differences between IOLs with a 3.0 mm pupil (P = .185). CONCLUSIONS: Multifocal refractive IOLs resulted in higher intraocular aberrations. The hybrid refractive-diffractive IOL was the least affected by pupil diameter in terms of intraocular aberrations and showed significantly less increase in optical aberrations when the pupil was enlarged.     

两种常用衍射型多焦点人工晶状体的视觉评估

目的 比较Tecnis和Restor两种衍射型多焦点人工晶状体(IOL)(简称TMF和Restor)植入术后患者的视觉质量.方法 前瞻性病例系列研究.将2008年3月至8月行超声乳化白内障吸除联合衍射型IOL植入的73例(90只眼)白内障患者采用SPSS Syntax程序随机分为两组,各45只眼,分别植入TMF和Restor,术后3个月时随访患眼的屈光状态、裸眼视力和矫正的远、中、近视力;不同对比度视力;阅读能力;瞳孔大小、像差、球差及对比敏感度;离焦曲线及IOL位置的测定等;进行生活质量调查问卷,并针对整体视觉、脱镜率和光晕眩光等进行评价.对分类变量资料进行x2检验,对计量资料进行非参数Mann-Whitney U检验.结果 TMF和Restor两种IOL远、中、近和不同对比度视力比较,其中裸眼和矫正远视力(Z=-1.006,P=0.315和Z=-0.685,P=0.493);裸眼和远矫正中间距离(60 cm)视力(Z=-0.294,P=0.768和Z=-0.365,P=0.715);裸眼、远矫正和最佳矫正近视力(Z=-1.285,P=0.199;Z=-0.881,P=0.378和Z=-0.142,P=0.887);60%、50%、45%、40%、30%和20%不同对比度视力(Z=-0.335,P=0.737,Z=-0.189,P=0.850,Z=-0.575,P=0.565,Z=-0.394,P=0.693,Z=-1.126,P=0.260和Z=-0.418,P=0.676)差异均无统计学意义.在暗光下,TMF的阅读视力和阅读速度都优于Restor(Z=-2.579,P=0.009;Z=-5.244,P=0.000).焦深曲线提示TMF的50 cm中间距离视力优于Restor(Z=-5.300,P=0.000),而Restor的25cm和28 cm近视力优于TMF(Z=-3.745,P=0.000;Z=-5.691,P=0.000).瞳孔3 mm和5 mm时,TMF的全眼和眼内Z(4,0)明显低于Restor(Z=-8.175,P=0.000;Z=-5.210,P=0.000和Z=-4.453,P=0.000;Z=-3.790,P=0.000),而视觉质量评价的一些指标如点扩散函数Strehl比PSF Strehl Ratio值和调制转移函数面积比A/D值优于Restor(Z=-3.047,P=0.002;Z=-3.672,P=0.008和Z=-2.038,P=0.042;Z=-2.579,P=0.009).生活质量调查问卷分别将两种IOL的总体满意度评分、脱镜率、光晕和眩光的发生率进行了比较,其中远、中、近距离和夜间满意度(Z=-1.282,P=0.200,Z=-1.769,P=0.077和Z=-1.287,P=0.198和Z=-1.512,P=0.131);脱镜率(x2=0.104,P=0.748);光晕(x2=0.741,P=0.389)和眩光(x2=0.051,P=0.822)差异均无统计学意义.结论 两种衍射型多焦点IOL均可提高远、近视力.焦深曲线提示Restor的近视力优于TMF,而在阅读速度和中距离视力方面TMF优于Restor.负球差设计的TMF的部分视觉质量指标优于球面型Restor.     

Drug-induced intraocular lens movement and near visual acuity after AcrySof intraocular lens implantation

PURPOSE: To evaluate the factors influencing AcrySof intraocular lens (IOL) (Alcon Laboratories) movement and near visual acuity after cyclopentolate 1% and pilocarpine 2%. SETTING: Department of Ophthalmology, University of Ankara, Ankara, Turkey. METHODS: Thirty eyes of 22 patients with AcrySof IOL implantation were included in this prospective study. Near visual acuity (Jaeger) at 35 cm through best distance correction without an add and pupil diameter were measured and correlated with anterior chamber depth (ACD) measured with ultrasound biomicroscopy (UBM) after application of cyclopentolate 1% and pilocarpine 2%, respectively. The magnitude of the change in the ACD was correlated with the accommodation amplitude, patient age, time interval between surgery and imaging, preoperative axial length, capsulorhexis diameter, ACD during cycloplegia, IOL diameter, and presence of posterior capsule opacification (PCO). RESULTS: Near visual acuity significantly decreased after application of cyclopentolate 1% and increased after application of pilocarpine 2% (P < .001) in all eyes. The IOL moved anteriorly in 8 (26%) eyes and posteriorly in 22 (74%) eyes after pilocarpine 2%. There was no correlation between the ACD and near visual acuity under cyclopentolate 1% (r = 0.06, P > .05) or pilocarpine 2% (r = 0.04, P > .05). There was a moderate correlation between the anterior IOL movement and accommodation amplitude (P < .05, r = 0.42). There was no correlation between the magnitude of the IOL movement and patient age, time interval between surgery and imaging, the preoperative axial length, capsulorhexis diameter, ACD during cycloplegia, IOL diameter, and the presence of PCO (P > .05). CONCLUSIONS: There was better near visual acuity in all eyes with the AcrySof MAIOL, although most IOLs move slightly backward after of pilocarpine 2%. This points out pseudoaccommodation rather than pseudophakic accommodation. Ultrasound biomicroscopy is useful in determining the ACD and the relation between the IOL and the surrounding tissues after cataract surgery.