非球面人工晶状体与球面人工晶状体临床应用的对比研究

目的比较前表面光学改良的非球面人工晶状体与传统球面人工晶状体对超声乳化白内障吸除人工晶状体植入眼球差和视觉功能的影响。方法将169例（169只眼）拟行超声乳化白内障吸除人工晶状体植入术的老年性白内障患者随机分为2组,分别植入非球面人工晶状体（试验组）和传统球面人工晶状体（对照组）。术后检测人工晶状体眼的球差、矫正远视力、矫正远视力后的近视力、对比敏感度、眩光敏感度和表观调节力;随访时间为3个月。结果术后3个月,瞳孔直径5mm情况下人工晶状体眼的总球差试验组为（0．024±0．076）μm,对照组为（0．217±0．137）μm,差异有统计学意义（P〈0．05）,而两组角膜球差的差异无统计学意义（P〉0．05）。4．0°和2．5°视角的对比敏感度试验组分别为39．18±11．94和28．30±12．07,对照组分别为33．28±11．84和24．50±8．20,差异有统计学意义（P〈0．05）;6．3°、4．0°、2．5°和1．6° 视角的眩光敏感度试验组分别为30．90±9．21、27．09±8．45、19．20±8．71和12．08±4．44,对照组分别为27．08±8．24、23．30±6．24、15．53±4．37和10．04±4．20,差异有统计学意义（P〈0．05）;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（P〉0．05）。结论与传统球面人工晶状体比较,非球面人工品状体可以减少人工晶状体眼的球差,提高视觉对比度,改善白内障患者术后的视觉质母。     

有晶状体眼后房人工晶状体植入矫正超高度近视临床观察

目的观察有晶状体眼后房人工晶状体（ICL）植入超高度近视眼对视功能、眼结构的影响。方法回顾性临床系列研究。对2010年4月至2014年9月通过对-12DS至-23DS（17．25±4．23）DS超高度近视眼植入后房型人工晶状体的临床随访观察（3—27）月、平均（15．8±3．8）月,随访项目包括：术前、术后1天、末次裸眼视力、矫正视力、眼压、屈光度、晶状体透明度、人工晶状体位置、角膜内皮计数、前房深度、眼轴、调节近点。结果术后末次随访裸眼视力0．62±0．15、最好矫正视力0．91±0．16,与术前矫正视力比较,前者差异无统计学意义（t=-0．45、P=0．55）、后者差异有统计学意义（t=-3．16、P=0．006）,术后末次随访屈光度（-1．28±0．96）DS;术后末次随访眼压：（17．96±3．57）mmHg,与术前比较差异无统计学意义（t=-0．54、P=0．59）;术后末次随访角膜内皮计数、前房深度、眼轴、调节近点分别为（2686±361）个／mm^2、（3．52±0．39）mm、（30．98±1．36）mm,（19．00±3．87）cm,与术前比较分别为（t=0．89、P=0．38）、（t=2．48、P=0．03）、（t=-0．23、P：0．81）、（t=-0．21、P=0．90）。UBM示ICL与晶状体无接触、房角大于30度,未见晶状体混浊。结论有晶状体眼后房人工晶状体（ICL）植入超高度近视能有效提高视力,未对眼结构和调节产生明显影响。     

晶状体不全脱位单襻缝线折叠人工晶状体悬吊术

目的 探讨外伤性白内障晶状体不全脱位时,采用单襻缝合固定可折叠人工晶状体悬吊术的效果.方法 前瞻性病例对照研究.对40例（40眼）外伤性白内障晶状体不全脱位范围180°～240°者,随机分为两组：试验组20例行单襻缝合固定可折叠人工晶状体悬吊术,对照组20例行常规人工晶体悬吊术,术后1d、7d、1月、3月观察裸眼视力、最佳矫正视力、角膜散光、眼压、并发症等情况,并进行统计学分析.结果 试验组与对照组间术后各时期裸眼视力比较及术后1d最佳矫正视力比较,差异有统计学意义,试验组优于对照组,两组间术后7d、1月、3月最佳矫正视力比较,差异无统计学意义.两组间术后各时期角膜散光及术后1d眼压比较,差异有统计学意义,试验组优于对照组,两组间术后7d、1月、3月眼压比较,差异无统计学意义.试验组角膜水肿、玻璃体出血浑浊并发症的出现少于对照组.结论 单襻缝合固定可折叠人工晶状体悬吊术是一种安全有效的手术方法.     

球面与非球面人工晶状体植入的视功能学比较

目的 观察非球面人工晶状体植入视功能学方面的临床效果.方法 55例(60眼)老年性白内障,随机分成两组.试验组植入非球面人工晶状体,对照组植入传统球面人工晶状体,并分别于术后1周、1月、3月检测两组裸眼远、近视力,最佳矫正远视力,最佳矫正远视力后的近视力,对比敏感度,波前像差,立体视觉等.结果 在术后1周、1月,两组裸眼远、近视力,最佳矫正远视力、远视力最佳矫正状态下的近视力比较差异无统计学意义(P>0.05);术后3月,两组裸眼远、近视力,最佳矫正远视力、远视力最佳矫正状态下的近视力比较差异有统计学意义(P<0.05);术后1月、3月,试验组在昼间有无眩光及夜间有无眩光的各频段对比敏感度均明显优于对照组的各频段,差异有统计学意义(P<0.05);术后1月、3月,试验组的四阶球差及高阶像差均低于对照组,差异具有统计学意义(P<0.05);术后1月、3月,两组在最佳矫正视力下的远、近立体视觉的比较,差异无统计学意义(P>0.05).结论 非球面人工晶状体植入能减少球面像差,提高对比敏感度,改善术后的视觉质量.     

人工晶状体Ⅱ期缝线固定术中眼压稳定的意义

目的临床观察复杂外伤性白内障Ⅱ期人工晶状体睫状沟缝线固定术,术中稳定的眼压对手术操作的安全性及术后视觉效果的意义。方法人工晶状体睫状沟缝线固定术的外伤性白内障术后的无晶状体眼连续病例60例（60只眼）,随机分为两组：观察组30例（30只眼）术中经睫状体平坦部置眼内BSS灌注通道控制眼压;对照组30例（30只眼）常规应用黏弹剂及BSS维持前房深度及眼球形态。分别于术后3个月及6个月观察两组患者的裸眼视力及最佳矫正视力、术中及术后并发症（包括角膜水肿、角膜散光、人工晶状体偏心倾斜等）。结果术后3个月,观察组视力优于对照组,两组患者的裸眼视力（t=2．297,P=0．025）,最佳矫正视力（t=2．305,P=0．025）差异有统计学意义;术后6个月,裸眼视力观察组优于对照组（t=2．388,P=0．02）,最佳矫正视力观察组也优于对照组（t=2．70,P=0．009）。观察组术中及术后并发症较对照组少,差异具有统计学意义。结论经平坦部置眼内灌注以保持眼压的稳定,有利于Ⅱ期人工晶状体睫状沟缝线固定术的手术操作,减少手术并发症,恢复良好的视觉功能。     

微切口超声乳化加非球面人工晶状体植入治疗白内障的临床评价

目的:探讨超声乳化联合非球面人工晶状体植入对白内障患者术后视觉质量的影响.方法:年龄相关性白内障患者(50例63眼)随机分为试验组25例33眼和对照组25例30眼,两组患者手术方法相同,试验组植入非球面人工晶状体,对照组植入球面人工晶状体;比较术后裸眼视力、最佳矫正视力,并检查两组患者对比敏感度和像差.结果:术后1wk;1,3mo两组患者裸眼视力相比差异无统计学意义(P＞0.05),术后3mo两组最佳矫正视力相比差异亦无统计学意义(P＞0.05).在非眩光和眩光条件下,两组患者在3.0,6.0,12.0,18.Ocd频段下对比敏感度比较差异无统计学意义(P＞0.05);在1.5cd频段下,试验组对比敏感度值显著高于对照组,组间比较差异具有统计学意义(P＜0.05);术后3 mo试验组球差、彗差均显著低于对照组,两组间比较差异具有统计学意义(P＜0.05).结论:非球面人工晶状体在低频段对比敏感度显著优于球面人工晶状体,并能够降低白内障患者术后的总像差,从而提高白内障患者术后的视觉功能.     

应用Pentacam系统引导个性化非球面人工晶状体植入的可行性分析

目的:探讨个性化植入非球面人工晶状体使全眼球差接近+0.1μm方法的可行性.方法:对行白内障超声乳化人工晶状体植入术的患者74例82眼随机分为试验组和对照组,术前均应用Pentacam测量角膜球差,试验组以术后全眼球差尽量接近+0.1μm为原则植入TecnisZCB00、Hoya60AD、ADAPT-AO三种不同的非球面人工晶状体,对照组均植入ADAPT-AO非球面人工晶状体.术后3mo测量裸眼视力、最佳矫正视力、角膜球差和全眼球差.结果:术后3 mo两组患者间裸眼视力、最佳矫正视力对比差异无统计学意义(t=O.817、0.343,P＞0.05);术前和术后的角膜球差对比两组均无统计学意义(t=0.688、0.592,P＞0.05);试验组和对照组术后3mo全眼球差对比有统计学意义(t=5.408,P＜0.05);试验组不同人工晶状体组间全眼球差术前预测值和术后实际值比较均无统计学意义(t=1.943、2.033、0.032,P＞0.05);全眼球差预测偏差值与术前角膜球差呈正相关(r=0.834,P＜0.05).结论:根据患者的角膜球差个性化地植入非球面人工晶状体可以达到有效降低全眼球差的目的,具有可行性.     

Acri．Smart非球面人工晶状体与球面人工晶状体临床应用的对比研究

目的比较白内障超声乳化吸除植入前表面光学改良的非球面人工晶状体与传统球面人工晶状体对植入眼对比敏感度和视觉质量的影响。方法选择我院2006年4月至2007年8月年龄相关性白内障患者117例（117只眼），随机分为2组，行白内障超声乳化摘除术后，分别植入非球面人工晶状体（Acri．smart 36A）和球面人工晶状体（Aeri．smart 46S）。术后3个月分别检测最佳矫正视力、眩光和无眩光条件下的对比敏感度以及不同瞳孔直径条件下的全眼球像差。结果两组的最佳矫正视力比较，差异无统计学意义（P〉0．05）。植入Acri．smart 36A型人工晶状体眼的对比敏感度在空间频率3、6、12、18c／d时无眩光、有眩光条件下均明显大于植入Acri．smart 46S型人工晶状体眼（P〈0．01）。在全眼球像差方面植入Acri．smart 36A型人工晶状体眼在不同瞳孔直径条件下均明显低于植入Acri．smart 46S型人工晶状体眼（P〈0．01）。结论与球面人工晶状体比较，非球面人工晶状体可降低像差，提高视觉对比敏感度，改善白内障患者术后的视觉质量。     

青光眼滤过术后白内障患者行超声乳化联合人工晶状体植入术毕前房注射地塞米松的临床疗效

目的　评价青光眼滤过术后白内障患者行超声乳化联合人工晶状体植入术毕前房注射地塞米松的临床疗效。方法　选取青光眼滤过术后白内障患者９８例（１２０眼）,由同一医师进行白内障超声乳化联合人工晶状体植入术。所有患者随机分组,对照组４８例（６０眼）术毕给予地塞米松注射液０．５ｍＬ（２．５ｍｇ）球结膜下注射;试验组５０例（６０眼）术毕前房内注射０．１ｍＬ（０．５ｍｇ）地塞米松注射液。观察并比较两组患者手术后最佳矫正视力、前房反应、眼压、角膜内皮细胞计数、六角形细胞比率的差异。结果　青光眼滤过术后白内障超声乳化联合人工晶状体植入术后１ｄ、３ｄ最佳矫正视力试验组比对照组效果更好,２组比较差异有统计学意义（Ｐ＜０．０５）,术后１周最佳矫正视力两组间差异无统计学意义（Ｐ＞０．０５）;对照组与试验组术前,术后１ｄ、３ｄ、１周、１个月、３个月眼压组间比较差异均无统计学意义（均为Ｐ＞０．０５）;对照组与试验组术后１ｄ、３ｄ、１周前房炎症反应组间差异有统计学意义（均为Ｐ＜０．０５）,试验组眼前房炎症反应较轻;对照组与试验组术后３ｄ、１周、１个月角膜内皮细胞密度、六角形细胞百分比及变异系数组间比较差异均有统计学意义（均为Ｐ＜０．０５）,对照组较试验组术后细胞密度明显降低,六角形细胞百分比下降,变异系数增高。结论　青光眼滤过术后白内障超声乳化联合人工晶状体植入术毕前房注射地塞米松注射液是安全有效的,对术后短期内获得最佳矫正视力、减轻前房反应、减少角膜内皮细胞的丢失具有积极的临床意义。     

Tetraflex可调节人工晶状体临床应用的初步观察

目的 观察白内障超声乳化联合囊袋内可调节人工晶状体植入术的效果.方法 病例对照研究.全部患者行白内障超声乳化联合囊袋内人工晶状体植入术,根据植入人工晶状体的不同分为试验组:22例(30只眼)植入可调节人工晶状体,对照组:22例(29只眼)植入单焦点人工晶状体.观察并记录术后6个月和12个月时术眼远、近视力,主观调节幅度,应用OCULUS Pentacam三维前段分析仪测量2%毛果芸香碱眼液诱导前后的前房深度变化值.各观察指标数据以均数±标准差表示.使用SPSS13.0软件对数据进行分析.采用两组独立样本t检验比较两组各观察指标,以P<0.05为差异有统计学意义.结果 术后随访期间,试验组患者的裸眼近视力和最佳远视力矫正后的近视力与对照组患者相比,有统计学差异(P=0.000),两组患者的最佳矫正视力差异无统计学意义(P>0.05);术后6个月时,应用主观移近法测得的主观调节幅度,试验组为(1.60±0.57)D,对照组为(1.10±0.70)D.前房深度变化值试验组为(0.50±0.37)mm,对照组为(0.08±0.06)mm.术后12个月时,应用主观移近法测得的主观调节幅度,试验组为(1.38±0.52)D,对照组为(1.06±0.61)D.前房深度变化值试验组为(0.30±0.27)mm,对照组为(0.10±0.09)mm.结论 与传统的单焦点人工晶状体相比,Tetraflex可调节人工晶状体可以为患者提供较好的近视力和主观调节幅度,但远期疗效有下降趋势.     

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.     

可调节人工晶状体植入术的早期疗效观察

目的探讨超声乳化白内障吸除可调节人工晶状体植入术的临床疗效和调节幅度。方法对75例(94只眼)白内障患者行超声乳化白内障吸除1CU型可调节人工晶状体植入术,观察并记录术眼的主观屈光状态、裸眼远视力、裸眼近视力、最佳矫正远视力、30cm处远视力矫正后近视力、30cm处最佳矫正近视力、主观调节幅度(分别采用主观移近法和负镜片法测量)。术后随访时间1～12个月,对术后1周、1个月及3个月的资料进行分析。结果术后1周、1个月及3个月裸眼近视力≥Jr5者分别占81.9%(77/94)、85.1%(80/94)及84.0%(79/94);远视力矫正后近视力≥Jr5者分别占78.7%(74/94)、79.8%(75/94)及74.5%(70/94)。采用主观移近法和负镜片法检查调节幅度,术后1周分别为(1.96±0.63)D(0.75～4.50D)和(1.74±0.59)D(0.75～4.50D),术后1个月分别为(1.89±0.54)D(0.75～3.25D)和(1.68±0.47)D(0.75～3.25D),术后3个月分别为(1.77±0.53)D(0.75～2.75D)和(1.66±0.50)D(0.75～2.75D)。术后1周、1个月及3个月2种方法测量的主观调节幅度比较,差异均无统计学意义(P>0.05)。远视力矫正后近视力和调节幅度之间为正相关(P=0.00)。结论早期观察结果显示1CU型可调节人工晶状体植入术后视功能恢复良好,患者在具有较好远视力的同时,具备良好的视近能力。远期效果有待进一步观察。     

Early visual results with the 1CU accommodating intraocular lens

PURPOSE: To prospectively assess the clinical outcome after implantation of the 1CU accommodating intraocular lens (IOL) and a foldable acrylic IOL (AcrySof, Alcon). SETTING: Department of Ophthalmology, Tokyo Dental College, Ichikawa Hospital, Ichikawa, and Minami Aoyama Eye Clinics, Tokyo, Yokohama, Japan. METHODS: Twenty-two eyes of 16 patients with cataract had phacoemulsification implantation of 1CU accommodating IOL. Twenty eyes of 10 age-matched and sex-matched patients with cataract had the same surgery but with a foldable acrylic IOL. All patients had assessments of the amplitude of accommodation, refraction, uncorrected and best corrected distance and near visual acuity, and distance corrected near visual acuity before surgery up to 12 months after surgery. Contrast visual acuities were measured 1 year after surgery. Anterior segment photography, intraocular pressure measurements, specular microscopy, and computerized topography were also performed. RESULTS: The final best corrected distance visual acuity was above 20/25 in all eyes with the 1CU and the AcrySof IOLs. The mean distance corrected near visual acuity was significantly higher in the 1CU IOL group than in the acrylic IOL group after 3 months. None of the eyes with the AcrySof IOL implants displayed an accommodative response at any examination. The peak mean amplitude of accommodation with the 1CU IOLs was observed at 3 months and was 0.5 diopters +/- 0.44 (SD). Accommodation amplitude declined after 6 months. CONCLUSION: The 1CU IOL provided additional near acuity postoperatively, but the benefit disappeared at 12 months with a concomitant decrease in accommodation amplitude owing to an increase in anterior and posterior capsular opacities.     

三种单焦点人工晶状体植入术后拟调节力比较

目的：比较三种单焦点人工晶状体植入术后人工晶状体眼的拟调节力大小。 方法：白内障患者78例78眼根据自愿的原则,采用非随机方式分成三组,Ⅰ组23例23眼植入AcrySof Natural人工晶状体;Ⅱ组24例24眼植入Canon staa人工晶状体;Ⅲ组31例31眼植入聚甲基丙烯酸甲酯(PMMA)人工晶状体。术后3mo检测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,以及33cm处在最佳矫正近视力基础上获得的近附加值及拟调节力(PAC)。 结果：三组术后3mo最佳矫正远视力差异无统计学意义(F=0.317,P=0.729);最佳矫正远视力基础上获得的近视力差异有统计学意义(F=3.377,P=0.039);术后3mo,33cm处在最佳矫正近视力基础上获得的近附加值及拟调节力(PAC)比较差异均有统计学意义(F=10094,P=0.000;F=16.806,P=0.000)。 结论：白内障术后植入三种单焦点人工晶状体拟调节力比较,软性推注式折叠晶状体可获得更高的拟调节力及令人满意的近视力。     

Functional vision after cataract removal with multifocal and accommodating intraocular lens implantation: prospective comparative evaluation of Array multifocal and 1CU accommodating lenses

PURPOSE: To compare the efficacy (functional vision, spectacle dependence) of the Array multifocal intraocular lens (IOL) (Advanced Medical Optics) and the 1CU accommodating IOL (HumanOptics AG). SETTING: Hartswood Hospital, Brentwood, United Kingdom. METHODS: This prospective study comprised patients scheduled to have standard phacoemulsification surgery with IOL implantation. Patients expressing a preference for spectacle independence were allocated to the Array multifocal IOL group. Those expressing no preference received the 1CU accommodating IOL. Efficacy measures included distance and near uncorrected visual acuity (UCVA), dynamic retinoscopy, and patient-reported spectacle independence. RESULTS: Seventeen patients (34 eyes) had bilateral implantation of the Array multifocal IOL, and 5 patients (9 eyes) had implantation of the 1CU accommodating IOL. Six to 18 months after surgery, 82.4% of eyes in the multifocal IOL group and 77.8% in the accommodating IOL group achieved a distance UCVA of 20/20 (Snellen) or better; the difference between groups was not significant. However, a significantly greater proportion in the multifocal IOL group than in the accommodating IOL group (76.5% versus 44.4%) achieved a near UCVA of N5 (Snellen 20/40) or better (P=.0068). Sixteen patients (94.1%) with Array IOLs and 2 patients (50.0%) with 1CU IOLs reported spectacle independence. Dynamic retinoscopy showed that the mean accommodative effect in the 1CU group was 0.44 diopter. CONCLUSIONS: In this single-surgeon single-site study, a greater proportion of Array multifocal IOL recipients than 1CU IOL recipients achieved functional near visual acuity. Only 1 patient with an Array IOL required corrective spectacles at the last visit.     

Tetraflex 可调节人工晶状体的临床应用

目的 评估眼内植入Tetraflex可调节人工晶状体增强远近视力的安全性、有效性.方法 取29例 (30只眼) 老年性白内障患者行超声乳化手术并植入 Tetraflex可调节人工晶状体;另外 26 例 (30只眼) 植入 IQ折叠人工晶状体.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、手术中及术后并发症.结果 术后6个月,两组的裸眼远视力、矫正远、近视力差异无统计学意义(t =1.667、1.458、1.207,P ＞0.05),Tetraflex组的裸眼近视力和最佳矫正远视力下的近视力好于IQ组(t =2.407,8.667,P ＜ 0.01) .视标推进法测得调节幅度 Tetraflex组 (2.79 ±0.33) D 大于IQ 组(1.42 ±0.25) D (t =15.218,P ＜ 0.001) .结论 Tetraflex可调节人工晶状体是安全有效的,能够在改善患者远视力的同时增强近视力使白内障患者术后获得一定的调节力.     

Visual outcomes after accommodating intraocular lens implantation

PURPOSE: To evaluate and compare the visual outcomes and accommodative amplitude in cataract patients after implantation of the Crystalens intraocular lens (IOL) (Eyeonics) versus standard monofocal IOLs. SETTING: Ten clinics in a nationwide multicenter study in the United States. METHODS: A multicenter comparative interventional case series with masked randomized postoperative examination of 224 eyes of 112 patients was performed by a single observer. Patients were divided into 2 groups (56 patients; 112 eyes each) depending on which IOL was implanted (Crystalens or monofocal). Accommodation was measured using 1 objective (dynamic retinoscopy) and 2 subjective methods (defocus and near point of accommodation). Visual acuity measurements were performed under the same conditions with standard visual acuity charts. RESULTS: Uncorrected monocular near vision was significantly better in the Crystalens group than in the standard monofocal group, with 101 of 112 eyes (90%) and 17 of 112 (15%), respectfully, reading J3 or better postoperatively. All 56 Crystalens patients had a binocular uncorrected near visual acuity of J3 or better compared with 16 of 56 (29%) standard monofocal patients. The mean postoperative monocular (0.85 +/- 0.30 [SD] versus 0.70 +/- 0.19, P<.01) and binocular (1.16 +/- 0.17 versus 1.01 +/- 0.14, P<.01) distance uncorrected visual acuities were also better in the Crystalens group than in the control group. All patients in the study achieved a corrected distance visual acuity of 20/20 or better. Measures of accommodation were significantly higher in Crystalens patients than in the monofocal IOL patients (dynamic retinoscopy 2.42 +/- 0.39 diopters [D] versus 0.91 +/- 0.24 D, P<.01; monocular defocus 1.74 +/- 0.48 D versus 0.75 +/- 0.25 D, P<.01; monocular near point of accommodation 9.5 +/- 3.1 inches versus 34.7 +/- 9.8 inches, P<.01). Perceived accommodation (5.79 D) was significantly greater than the measured accommodation (1.96 to 2.42 D) in Crystalens patients (paired t test, P<.01). CONCLUSIONS: The Crystalens IOL provided better uncorrected near and distance visual outcomes than standard monofocal IOLs in all analyses performed. Patients perceived a greater accommodation than measured. Understanding why this occurred could lead to valuable advances in accommodating IOL technology.     

Objective measurement of intraocular lens movement and dioptric change with a focus shift accommodating intraocular lens

PURPOSE: To objectively measure the shift and refractive change of the 1CU accommodating intraocular lens (IOL) (HumanOptics) and compare them to that of a monofocal AcrySof MA30 IOL (Alcon Laboratories) in the fellow eye. SETTING: Ophthalmology Department, St. Thomas' Hospital, London, United Kingdom. METHODS: Thirty patients who had bilateral cataract surgery 18 to 24 months previously with a 1CU IOL prospectively randomly allocated to 1 eye and an AcrySof MA30 monofocal IOL to the other eye were examined. Distance correction, near vision, reading fluency, near point, and defocus to minus spheres were measured. Intraocular lens shift to an accommodative stimulus following instillation of pilocarpine 4% was measured with the ACMaster. Refractive change between distance and near was measured with the Tracey wavefront analyzer. RESULTS: Of the original 30 patients recruited, complete measurements could only be obtained for 20. There was no significant difference in near visual function with either IOL. A small anterior movement of the 1CU was seen with accommodation 0.010 mm +/- 0.028 (SD). After pilocarpine 4% instillation, a forward movement of 0.220 +/- 0.169 mm was seen with the 1CU compared to a backward movement of 0.028 +/- 0.095 with the MA30. There was no significant correlation between distance corrected near visual acuity and IOL movement. No change in spherical equivalent between distance and near was seen on wavefront analysis of either IOL. CONCLUSIONS: Small forward movement of the 1CU IOL was seen with accommodation and increased following pilocarpine, compared to the posterior movement of the MA30 IOL. The amount of the IOL shift was not sufficient to provide useful near vision, but the difference suggests that the engineering concept behind the 1CU IOL is valid.     

ICU人工晶状体植入术后的早期临床效果

目的:比较白内障超声乳化术联合ICU(德国HumanOptics公司)可调节人工晶状体植入术后效果与传统单焦后房型UV型(日本HOYA公司)人工晶状体植入术后效果之间的差异。方法:所有患者均行白内障超声乳化联合人工晶状体植入术。比较18例(20眼)患者ICU可调节人工晶状体植入及20例(20眼)患者UV型后房型人工晶状体植入术后1wk、1mo时的裸眼远视力、最佳矫正远视力、近视力(35cm)及矫正远视力的近视力(35cm)、主观调节近点、10g/L硝酸毛果芸香碱滴眼30min后利用A型超声波测量前房深度(anterior chamber depth,ACD)变化等多项指标之间的差异。结果:两组数据间比较,除术后远视力及最佳矫正远视力无显著性差异外,其它指标间比较均有非常显著性差异(P<0.01)。结论:ICU可调节人工晶状体相对于传统单焦后房型人工晶状体具有更高调节力、更佳的近视力,同时也具有良好的远视力。但术后调节幅度有限,长期效果如何有待进一步观察、研究。     

Array多焦点人工晶状体的初步观察

目的 初步评估Array多焦点人工晶状体的有效性。方法 从我院住院的白内障患者中选择合适的病例。男4例4眼,女6例7眼,行标准超声乳化白内障摘出术联合Array人工晶状体植入术,观察患者术后的远、近视力,角膜曲率,及视觉症状,结果 术后最好视力平均值：非矫正远视力为0.8,最佳矫正远视力为0.9,非矫正近视力为0.5,用视远的矫正度数矫正的近视力为0.6,最佳矫正近视力为0.9。角膜散光术前及术后无法小于1.5D。1例（9.1%)患者夜间有眩光。结论 Array人工晶状体可以同时提供良好的远视力和近视力,进一步的结论还有待大组病例的长期观察。