非球面人工晶状体植入术后对比敏感度观察

目的:评价白内障超声乳化吸除联合非球面人工晶状体(intraocularlens,IOL)植入术后对比敏感度(contrast sensitivity,CS)的变化。方法:对45例(48眼)老年性白内障患者实施超声乳化吸除联合IOL植入术,24例(25眼)植入Z9001非球面IOL(AIOL);21例(23眼)植入AR40e单焦球面IOL(SI-OL)。术后3mo应用美国Stereo Optical公司产的OPTEC 6500P视功能测试系统的对比敏感度测试包分别在空间频率为1.5,3,6,12,18cpd的昼及夜照明条件下对手术眼进行有眩光和无眩光的对比敏感度检查。所得数据进行t检验。结果:术后3mo,AIOL组在大部分空间频率下CS普遍优于SIOL组,差异有统计学意义(P<0.05),在1.5cpd有眩光昼及夜照明条件,AIOL组的CS与SIOL组无统计学差异。结论:植入Z9001非球面IOL后,提高了患者的对比敏感度,明显改善患者的视觉质量.     

高度近视合并白内障植入不同多焦点人工晶状体视觉质量分析

目的 比较高度近视合并白内障超声乳化吸除分别植入2种不同多焦点人工晶状体(multifocal intraocular lens.MIOL)的视觉质量.方法 回顾性系列病例研究.回顾性分析高度近视合并白内障患者40眼行超声乳化白内障吸除联合人工晶状体(intraocular lens,IOL)植入术后3mo的随访资料.患者分别植入AR40e(SENSAR,AMO)单焦点IOL(monofocal/single-focalintraocularlens,SIOL)20眼、REZOOM(NXG1,AMO)折射型MIOL8眼、TECNISZMA00衍射型MIOL12眼.使用Snellen标准视力表(5m)及Colenbrander Mixed Contrast Card Set视力测试卡(0.4m)分别测量裸眼远近视力、最佳矫正远视力及最佳矫正远视力下近视力.使用iTrace波前像差仪测量5mm瞳孔直径下的眼内像差及调制传递函数(medulation transfer function,MTF)曲线.满足正态分布和方差齐性的行单因素方差分析,采用SNK-q检验进行组间两两比较.不满足的行K-W检验.结果 3组患者术后3个月裸眼远视力,最佳矫正远视力下近视力比较有统计学意义(P<0.05).裸眼近视力,最佳矫正远视力差异无统计学意义(P>0.05).3组患者在瞳孔5mm直径时,眼内球差差异有统计学意义(P<0.05),眼内彗差及三叶草比较无统计学意义(P>0.05);MTF值在5/10/15cpd时差异有统计学意义(P<0.05).结论 高度近视合并白内障患者更适合植入衍射型MIOL.

Abstract：

Objective To compare visual function of patients with cataract and high myopia after phacomulsification and multifocal intraocular lens(MIOL)implantation. Methods Forty high myopia cataract eyes undertaken phacoemulsification and IOL implantation were divided into three groups: monofocal/single-focal intraocular lens(SIOL, SENSAR, AR40e, AMO)with 20 eyes, retractive MIOL(REZOOM, NXG1,AMO)with 8 eyes and diffractive MIOL(TECNIS, ZMA00, AMO)with 12 eyes. Three months after surgery,uncorrected distant visual acuity(UCDVA), uncorrected near visual acuity(UCNVA), best corrected distant visual acuity(BCDVA)and distant corrected near visual acuity(DCNVA)were observed iTrace aberrometer test intraocular aberration and modulation transfer function(MTF)of different cycle per degree(CPD)in a 5 mm pupil. Results UCDVA and DCNVA between the three groups was statistically significant(P <0.05). BCDVA and UCNVA between the three groups was not statistically significant(P >0.05). Spherical aberration of intraocular between the three groups showed statistical significance(P <0.05). Other aberration of intraocular between the three groups showed no statistical significance(P>0.05). Difference of MTF in 5/10/15 cpd was statistically significantly(P <0.05). Conclusions Diffractive MIOL is more suitable for high myopia with cataract patients than refractive MIOL.     

多焦点人工晶状体植入的研究进展

白内障是导致患者视力下降乃至失明的主要原因之一,手术是治疗白内障确切有效的手段。随着科学技术的进步,传统的复明性白内障手术逐渐过渡到屈光性白内障手术。各种屈光性人工晶状体也应运而生,传统的单焦点人工晶状体(single focus intraocular lens, SIOL)不再是患者的唯一选择,多焦点人工晶状体(multifocal intraocular lens, MIOL)越来越被患者接受和认可。本文对现有的多焦点人工晶状体进行了归纳总结,通过分类列举,简述不同类型多焦点人工晶状体的多种特点及评估患者术后临床效果的方法,以期为眼科医生提供参考。     

折叠式人工晶状体缝线固定术在后囊破裂应用

目的 评价后房型折叠式人工晶状体缝线固定术的疗效.方法 小切口白内障囊外摘除术中后囊破裂患者按随机数字表分为两组:后房型一片式人工晶状体缝线固定术组(对照组)与后房型折叠式人工晶状体缝线固定术组(实验组).对照组11例(11只眼),实验组12例(12只眼).术后随访观察视力、眼压、散光度变化和人工晶状体偏位程度.结果 术后病人裸眼视力均有提高,实验组散光度变化较对照组小,差异有统计学意义(t=3.137;P=0.005).术后实验组人工晶状体偏位程度与对照相近,差异无统计学意义(t=1.083;P=0.291).结论 后房型折叠式人工晶状体缝线固定术治疗效果优于后房型一片式人工晶状体缝线固定术.

Abstract：

Objective To evaluate the therapeutic effect of posterior chamber foldable intraocular lens (IOL) suture fixation. Methods Posterior capsular rupture cases with small incision cataract extraction surgery were randomly divided into two groups: posterior chamber single-piece IOL suture fixation group (the control group) and posterior chamber foldable IOL suture fixation group (the experimental group). The control group included 11 cases ( 11 eyes) and the experimental group included 12 cases ( 12 eyes). Postoperative follow-up observations included visual acuity, intraocular pressure, astigmatism change and IOL deviation. Results Postoperative uncorrected visual acuity improved in all cases. Astigmatism changes in the experimental group were smaller than that in the control group. The difference was statistical significance (t = 3.137, P =0.005). The degree of IOL deviation in the experimental group was similar to that in the control group. The difference had no statistical significance (t= 1.083, P= 0.291). Conclusions The therapeutic effect of posterior chamber foldable IOL suture fixation is better than that of posterior chamber single-piece IOL suture fixation.     

正常瞳孔下非球面与球面人工晶状体眼高阶像差对比观察

目的 探讨正常瞳孔下非球面及球面晶状体眼高阶像差的差别,分析计算非球面与球面晶状体消除球面像差的差值,以客观评价非球面人工晶状体的临床效果.方法 回顾性临床对照研究.选取2010年1～4月在深圳市眼科医院行白内障超声乳化联合人工晶状体植入术的患者50例(66只眼).病人进行随机分组,分别植入非球面人工晶状体(KS-AIN)和球面人工晶状体(KS-X).术后1月正常瞳孔下(3～5mm),由itrace波前像差仪测量高阶像差及i-trace3.1软件模拟瞳孔直径3mm及5mm的调制传递函数值MTF.运用两样本t检验进行比较分析.结果 正常瞳孔下非球面组球面像差小于球面组,其差异具有统计学意义(P<0.05);非球面晶状体与球面晶状体相比较可消除球面像差(0.069 ±0.026)μm(D-Value);非球面组高阶像差均方根小于球面组,但差异无统计学意义(P>0.05);彗差、三叶草比较亦无统计学意义(P>0.05);3mm瞳孔下两组晶状体MTF值的比较仅在空间频率5周/度差异有统计学意义(P<0.05).5mm瞳孔下非球面晶状体眼在各空间频率的MTF值均好于球面晶状体眼,比较有统计学意义(P<0.05).结论 正常瞳孔下非球面人工晶状体眼与球面人工晶状体相比,可以有效减少球面像差,提高部分空间频率的对比敏感度,使患者拥有更好地视觉质量,但其不能体现可以减少术眼高阶像差的优势.

Abstract：

Objective To compare the high order aberrations between implantations of aspherical and spherical intraocular lens with normal pupil diameter, calculate and analyze the differences in spherical aberration between the eyes implanted with aspherical and spherical intraocular lens in order to assess the visual quality and investigate the clinical results. Methods Fifty patients(66 eyes)with cataract underwent surgery from Jan 2010 to Apr 2010, and were divided into 2 groups randomly. Group 1: unifocal and aspherical intraocular lens(negative aberration KS-AIN), Group2: unifocal and spherical intraocular lens(KS-X). Sixty-six eyes were included in this study. The aberrations at normal pupil diameter(interval 3mm-5mm)were measured with the i-Trace wavefront aberrometer. Modulation transfer functions were collected at 3mm and 5mm pupil size. Independent-Samples t Test was used to analyze the data. Results No post-operative complication occurred in each group. The average uncorrected visual acuity(UCVA)was ≥ 0.5, and the average best corrected visual acuity(BCVA)was ≥ 0.6. With normal pupil diameter(mean 3.73± 0.49mm), aspheric IOL group showed less spherical aberration than spherical IOL group with statistical significance(P =0.0040.05, t =-3.216), the difference value(D-value)of spherical aberration was 0.069± 0.026?m. Also aspheric IOL group showed less aberration than spherical IOL group in total higher-order root-mean-square(total HOA RMS)values, but with no statistical difference(P >0.05). There were no significant differences in coma and trefoil values between each group(P >0.05). With 3mm pupil diameter, aspheric IOL group provided a statistically better contrast sensitivity only in 5 cycle/degree while a statistically better contrast sensitivity in all spatial frequencies with 5mm pupil diameter. Conclusions The aspheric lens provides the patients better quality of vision at normal pupil size compared to spherical lens because of the decreased spherical aberration and a better contrast sensitivity in part frequencies. However, aspheric lens cannot express its superiority in decreasing total HOA RMS with normal pupil diameter.     

多焦点折叠式人工晶状体植入术的临床观察

我科2005年10月至2006年6月行超声乳化白内障摘出植人多焦点人工晶状体（muhifocal intraocular lens,MIOL）86眼,效果满意。现与植入SN60AT单焦点人工晶状体（single intraocular lens,SIOL）者进行比较,报告如下。     

双眼多焦点人工晶状体眼的远期立体视觉研究

目的比较双眼植入多焦点人工晶状体(MIOL)和单焦点人工晶状体(SIOL)植入术后远期的立体视觉,评价MIOL植入眼远期的立体视觉,进一步完善MIOL植入眼远期视功能的研究。方法观察2000年至2004年在我院接受白内障超声乳化吸除联合人工晶状体植入的患者共29例,其中双眼MIOL16例,双眼SIOL13例,术后随访时间>7m,分别检查术后非矫正近、远视力,矫正近、远视力,屈光,非矫正视力下远、近立体视锐度,矫正视力下远、近立体视锐度,问卷调查术后满意度、视觉症状。结果81.25%的MIOL眼非矫正近视力≥0.5,优于SIOL眼的15.38%(χ2=25.16,P<0.001,差异具有极显著性);非矫正远视力、矫正远视力及矫正近视力MIOL眼与SIOL眼差异无显著性(P>0.05);非矫正近视力下近立体视锐度,68.75%双眼植入MIOL者≤60s,而双眼植入SIOL者则无≤60s,两组间差异极具显著性(χ2=25.294,P<0.001);矫正近视力下近立体视锐度,93.75%的双眼植入MIOI者≤60s,相比双眼植入SIOL者的46.15%差异极具显著性(χ2=9.650,P=0.008,P<0.01);非矫正远视力下及矫正远视力下远立体视锐度,双眼植入MIOL组与双眼植入SIOL组间差异均无显著性;植入MIOL者术后满意度高于植入SIOL者(t=3.512,P=0.001,P<0.01)。结论术后远期,双眼MIOL植入者近立体视觉优于双眼SIOL植入者,植入MIOL患者满意度高于植入SIOL患者。     

两种类型人工晶状体植入术后远期患者视觉质量的研究

目的比较多焦点人工晶状体(multifocalintraocu-larlens,MIOL)和单焦点人工晶状体(monofocalintraocularlens,SIOL)植入术后患者远期视觉质量的改善情况,以进一步完善MIOL植入眼远期视功能的研究。方法观察2000~2004年在我院接受白内障超声乳化吸出联合人工晶状体植入术患者共69例98眼,其中双眼MIOL16例,双眼SIOL13例,单眼MIOL20例,单眼SIOL20例,术后随访时间>7月,分别检查术后非矫正近、远视力,矫正近、远视力,屈光,问卷调查术后满意度、视觉症状并对结果进行统计分析。结果90.38%(47/52)的MIOL眼非矫正近视力≥0.4,优于SIOL眼的21.74%(10/46)(χ2=53.174,P<0.01,差异具有极显著性);植入MIOL眼视近时屈光度明显小于植入SIOL眼(χ2=25.695,P=0.000<0.05,差异具显著性);非矫正远视力、矫正远视力及矫正近视力MIOL眼与SIOL眼差异无显著性(P>0·05);双眼植入MIOL组视近使用眼镜频率明显少于其他3组(t=9.774,P=0·000<0·01),双眼植入MIOL者术后满意度明显高于其他3组(t=3·637,P=0·001<0·01),双眼植入SIOL、单眼植入SIOL及单眼植入MIOL组之间使用眼镜频率及术后满意度之间无显著性差异。结论双眼植入MIOL后远期可获得较SIOL更好的视觉质量,但单眼植入MIOL则没有明显的优势。     

Tetraflex KH-3500型可调节性后房型人工晶状体眼调节力的临床分析

目的 研究植入式Tetraflex KH-3500型可调节性后房型人工晶状体(intraocular lens,IOL)的调节能力.方法 24例(32眼)患者行白内障超声乳化术并植入Tetraflex KH-3500型可调节性后房型IOL做为试验组,26例(32眼)植入AMOSI40NB单焦点IOL做为对照组.观察患者术后的裸眼远、近视力,矫正远、近视力,最佳矫正远视力下的近视力,调节幅度.结果 术后3个月、6个月2组患者的裸眼远视力、矫正远视力、矫正近视力差异均无统计学意义(均为P>0.05),试验组的裸眼近视力和最佳矫正远视力下的近视力高于对照组,差异均具有统计学意义(均为P<0.05).术后3个月移近法测得试验组调节幅度为(1.81±0.19)D,对照组调节幅度为(0.67±0.15)D,2组比较差异有显著统计学意义(P<0.01).术后6个月试验纽调节幅度为(1.64±0.20)D,对照组调节幅度为(0.49±0.15)D,2组比较差异有显著统计学意义(P<0.01).结论 Tetraflex KH-3500型可调节性后房型IOL可明显提高近视力,使白内障患者术后获得一定的调节力,但是在术后6个月时,患者的调节幅度有所下降.     

两种拟调节型人工晶状体植入术后视功能对比分析

目的 比较超声乳化术后植入可调节人工晶状体和多焦点人工晶状体的视功能.方法 30例白内障患者按自愿原则,采用非随机对照方式分成两组,试验组①10例患者(10只眼)植入Tetraflex可调节人工晶状体.试验组②20例患者(30只眼)植入+3.0D ReSTOR多焦点人工晶状体.术后6个月以ETDRS视力表检测患者最佳矫正远视力及在最佳矫正远视力基础上获得的近视力、中距离视力,综合验光仪检测近点及调节幅度.结果 随访期间所有患者均无明显的术后并发症.试验组①最佳矫正远视力为(-0.21±0.06)LogMAR,近视力为J3/40cm,试验组②为(-0.23±0.09)LogMAR,近视力为J1/35cm,两组比较近视力差异有统计学意义(P=0.035).试验组①术后主观近点为(39±10)cm,试验组②为(35±9)cm,两组比较差异无统计学意义(P=0.80).试验组①术后调节幅度为(1.94±0.13)D,试验组②为(2.08±0.63)D,两组比较差异有统计学意义(P=0.048).结论 可调节人工晶状体与多焦点人工晶状体植入术后均可使患者的视近困难得以改善.医生应根据患者情况为其选择合适的人工晶状体.

Abstract：

Objective To compare the visual performance of accommodative IOLS and that of multifocal IOLs implantation after phacoemulsification. Methods A total of 40 eyes from 30 patients undergoing phacoemulsification received intraocular lens based on the principle of voluntary. Ten eyes from 20 patients who had implantation of Tetraflex accommodative intraocular lens were randomized into group 1. Thirty eyes from 20 patients who had implantation of +3.0 aspheric ReSTOR multifocal intraocular lens were randomized into group 2. Main outcome measures included best corrected distance visual acuity, distance corrected near vision, near point, intermediate vision, and the accommodation amplitude. All the clinical data were obtained at 6months postoperatively. Results No patients had undergone any complications. At 6 months postoperatively,best corrected distance visual acuity were similar between the groupl and group2 (-0.23± 0.09LogMAR versus-0.14 ± 0.08LogMAR, P =0.085). Distance corrected near vision were similar between the two groups (J3/40cm versusJ1/35cm, P =0.035). Subjective near point were similar between the two groups [(39± 10) cm versus (35± 9) cm F=0.065, P=0.80]. The accommodation amplitude were similar between the two groups [(1.94± 0.13)D versus (2.08± 0.63)D, P =0.093]. The defocus line showed a double-peak in group 2 and single peak in group 1 which declined at intermediate distance. Conclusions Both accommodative IOLs and multifocal IOLs can correct presbyopia effectively after operation. It is best to prefer the proper IOLs for patients.