衍射型多焦点人工晶状体眼对比敏感度和高阶像差研究

目的 对比研究衍射型多焦点和单焦点人工晶状体眼的对比敏感度和高阶像差.方法 所有患者按照植入的人工晶状体类型分成多焦组和单焦组.多焦组植入衍射型多焦点人工晶状体AcrySofReSTOR(Alton),72例(109只眼);单焦组植入单焦点人工晶状体AcrySofSA60AT(Alcon),88例(130只眼).术后随访6～24月,观察远近视力,脱镜率,对比敏感度,高阶像差.结果 单焦组在明光、暗光、暗光眩光条件下各空间频率对比敏感度均高于多焦组,明光条件下3epd和6cpd(中频)空间频率差异有统计学意义(P＜0.05),暗光眩光条件下中高频率(除1.5cpd外)差异有统计学意义(P＜0.05).术后3阶慧差,4阶球差,总高阶像差均方根(RMS)多焦组略高于单焦组,但差异无统计学意义(P＞0.05).两组间远视力无显著性差异,近视力多焦组101只眼(91.8%)≥J3,单焦组12只眼(9.2%).两组完全脱镜率分别为98只眼(89.1%)和9只眼(6.9%).结论 衍射型多焦点人工晶状体在某些空间频率对比敏感度低于单焦组,没有明显增加高阶像差和视觉干扰;患者具有良好的远近视力和较高的脱镜率.     

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.     

Tritan colour contrast sensitivity function in refractive multifocal intraocular lenses

AIMS: To compare tritan colour contrast sensitivity (CCS), without and with glare, in patients with refractive multifocal intraocular lenses (IOLs) and with monofocal intraocular lenses. METHODS: Tritan CCS was determined (Moorfields Vision System, CH Electronics) in 15 eyes (14 patients, 75.7 (+/-6.6) years) with a refractive multifocal IOL (Allergan SA 40N) and in 11 eyes (10 patients, 73.7 (+/-6.4) years) with a monofocal IOL (Allergan SI 40 NB). Measurements were made monocularly under mesopic conditions at a distance of 2 metres from the monitor with best distance refraction plus 0.5 D at 0.5, 1, 3, 6, 11.4, and 22.8 cycles per degree (cpd). The test was then repeated for the multifocal IOLs, adding minus 2.5 D to the best distance refraction to force the patient to use the near focus. Both lenses were also investigated under glare conditions with the same set-up and using the brightness acuity tester (BAT). RESULTS: The tritan CCS function without glare in multifocal lenses through the distance focus was nearly identical to that through the near focus. The following statistically significant differences were measured: the CCS function without glare for the multifocal lens was worse at 0.5 cpd and 1.0 cpd than that of the monofocal lens. In CCS testing of the multifocal group with glare at 6 cpd, the results through the distance focus were better than the results through the near focus. For the CCS function with glare, the values for the distance focus in the multifocal lens were worse than the values for the monofocal lens at 0.5 cpd and 1 cpd. In CCS testing with glare through the near focus and CCS testing through the monofocal lens, the monofocal lens performed better at 0.5 cpd, 1 cpd, 3 cpd, and 6 cpd. CONCLUSION: Refractive multifocal intraocular lenses influence tritan CCS function compared to monofocal lenses.     

Visual acuity and contrast sensitivity comparison between Tecnis and AcrySof SA60AT intraocular lenses: A multicenter randomized study

PURPOSE: To evaluate best corrected visual acuity (BCVA) and photopic and mesopic contrast sensitivity in pseudophakic patients implanted either with the aspheric intraocular lens (IOL) designed to correct for corneal spherical aberration or with a conventional IOL. SETTING: Three surgical centers participated this prospective randomized masked comparative study. METHODS: Thirty eyes of 30 patients after aspheric lens implantation (Pfizer/Pharmacia Tecnis Z9000) were compared with 30 eyes of 30 age-matched patients after conventional lens implantation (Alcon AcrySof SA60AT). Two to three months after surgery, best spectacle corrected distance visual acuity was measured using the Early Treatment Diabetic Retinopathy Study chart. Contrast sensitivity was measured by sinusoidal grating charts for distance at photopic (85 cd/m(2)) and mesopic (6 cd/m(2)) luminance level with optical correction in place. Tested spatial frequencies were 1.5, 3, 6, 12, and 18 cycles per degree (cpd). RESULTS: The mean BCVA was -0.053 +/- 0.044 logMAR in eyes with the aspheric Tecnis IOL and 0.006 +/- 0.059 logMAR in eyes with the conventional AcrySof IOL (P=.0001). Eyes with the aspheric IOL showed better contrast sensitivity at spatial frequencies of 3 cpd (P<.05) and 6, 12, and 18 cpd (P<.01) in photopic and in mesopic conditions. Peak improvement occurred at 18 cpd and was 36% (0.29 log units) in photopic and 54% (0.27 log units) in mesopic conditions. CONCLUSIONS: The aspheric Tecnis IOL yielded better BCVA and better distance contrast sensitivity than the conventional IOL. The differences were clinically significant for higher spatial frequencies. The results give some suggestions for further studies.     

多焦点人工晶状体与非球面人工晶状体植入术后视觉质量的临床研究

目的客观与主观检测结合评价非球面设计的多焦点与单焦点人工晶状体植入术后的视觉质量。方法132例（207只眼）白内障患者分别植入非球面的多焦点人工晶状体AcrySof IQ ReSTOR IOL和单焦点人工晶状体AcrySof IQ IOL。记录患者手术后的裸眼远、近视力,矫正远、近视力。术后3个月检测患者明视、暗视和暗视眩光状态的对比敏感度。采用VF-14（Visual function-14）视功能和生存质量调查问卷评价患者主观的视觉质量。结果术后两组裸眼远视力（t=0．61,P〉0．05）最佳矫正近视力（t=1．877,P〉0．05）差异无统计学意义。非矫正近视力多焦点组优于单焦点组（t=11．38,P〈0．001）,单焦点组在明光、暗光、暗光眩光条件下各空间频率对比敏感度均高于多焦点组,明光条件下3cpd和6cpd空间频率差异有统计学意义（P〈0．05）,暗光眩光条件下中高频率差异有统计学意义（P〈0．05）,两组无患者存在严重的视觉干扰现象。两组术后视远时脱镜率均大于98％,视近时脱镜率多焦点组为78．9％,单焦点组为10．9％。结论与单焦点人工晶状体相比,除了对比敏感度下降,多焦点人工晶状体能提供令人满意的术后视功能和生活质量,患者能获得较高的视觉质量。     

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.     

Distance and near contrast sensitivity function after multifocal intraocular lens implantation

PURPOSE: To evaluate contrast sensitivity at distance and near after multifocal intraocular lens (IOL) implantation. SETTING: Ophthalmologic Institute of Alicante, University Miguel Hernández, Alicante, Spain. METHODS: Contrast sensitivity was measured with the Stereo Optical Functional Acuity Contrast Test at distance and near in 21 patients with a refractive multifocal IOL (Array SA-40N, AMO). A control group with a monofocal IOL (SI-40NB, AMO) was also studied to allow comparison of results. Contrast sensitivity was measured 1, 3, 6, 12, and 18 months after IOL implantation. RESULTS: There was a statistically significant greater reduction in contrast sensitivity at distance at all spatial frequencies in the multifocal group than in the monofocal group during the first month. At 3 months, contrast sensitivity at 12 and 18 cycles per deg remained reduced in the multifocal group; contrast sensitivity at the other frequencies did not differ from that in the monofocal group (P > 0.1). At 6, 12, and 18 months, contrast sensitivity at all spatial frequencies was not significantly different between groups (P > 0.1). There was a statistically significant greater reduction in near contrast sensitivity in the multifocal group than in the monofocal group at all spatial frequencies during the first and third month after surgery (P <.01). No statistically significant differences were found between groups after 6 months (P > 0.1). Contrast sensitivity at distance and near in the multifocal group improved over time (P <.01). CONCLUSIONS: The Array IOL provided contrast sensitivity at distance comparable to that obtained with the monofocal IOL between 3 and 6 months after implantation. Near contrast sensitivity improved over time but was always lower than at distance and in the monofocal near-corrected patients, which is acceptable to avoid near visual function degradation.     

Prospective visual evaluation of apodized diffractive intraocular lenses

PURPOSE: To evaluate distance, intermediate, and near visual performance in patients who had multifocal apodized diffractive intraocular lens (IOL) implantation. SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. METHODS: The best corrected distance visual acuity, best distance-corrected near visual acuity, intermediate visual acuity, distance contrast sensitivity under photopic and mesopic conditions, and patient satisfaction were measured in 325 patients and 335 patients who had bilateral implantation of the model SA60D3 IOL (AcrySof ReSTOR, Alcon) and model SN60D3 IOL (AcrySof Natural ReSTOR), respectively. RESULTS: At the 6-month postoperative visit, binocular best corrected distance acuity with the ReSTOR IOL and the Natural ReSTOR IOL was 0.034 logMAR+/-0.004 (SD) and 0.019+/-0.020 logMAR, respectively (approximately 20/20). Binocular best distance-corrected near acuity was 0.011+/-0.012 logMAR and 0.035+/-0.013 logMAR, respectively (approximately 20/20). Intermediate visual acuity with both IOL models worsened significantly as a function of the distance of the test (P<.01). Photopic contrast sensitivity was within the standard normal range with both IOLs. Under mesopic conditions, contrast sensitivity with both IOLs was comparable to that with monofocal IOLs and lower, particularly at higher spatial frequencies, than under photopic conditions. No statistically significant differences in visual acuity or photopic and mesopic contrast sensitivity were found between the 2 IOL models (P>.1). A patient satisfaction questionnaire showed that both IOLs performed well and were comparable in satisfaction regarding distance, intermediate, and near activities under different lighting conditions. CONCLUSIONS: The AcrySof ReSTOR IOL and AcrySof Natural ReSTOR IOL provided good visual performance at distance and near under photopic and mesopic conditions. Intermediate vision with both models was reduced compared with distance and near vision.     

Improved functional vision with a modified prolate intraocular lens

PURPOSE: To evaluate whether the Tecnis Z9000 intraocular lens (IOL) (Pfizer) with a modified prolate anterior surface provides better quality of vision than a conventional spherical IOL. SETTING: Oregon Eye Institute, Eugene, Oregon, USA. METHODS: Patients presenting for cataract surgery who were randomly assigned to receive a Tecnis Z9000 IOL (Pfizer) or a Sensar OptiEdge AR40e IOL (AMO) in 1 eye were followed for 3 months postoperatively. The patient could elect to have the same type of IOL implanted in the fellow eye. The results of sine-wave grating contrast sensitivity testing under mesopic and photopic conditions were compared interindividually. RESULTS: Monocular comparison was made between the 2 IOL groups, which comprised 15 patients each. The Tecnis IOL provided significantly better contrast sensitivity at 6 cycles per degree (cpd) under photopic conditions and at 1.5 and 3 cpd under mesopic conditions. Seven patients with a Tecnis IOL and 9 patients with an AR40e IOL had subsequent implantation in the fellow eye. In all eyes, including fellow eyes, having IOL implantation, the Tecnis provided significantly better contrast sensitivity at 3 and 6 cpd under photopic conditions and at 1.5, 3, and 6 cpd under mesopic conditions. The mean contrast sensitivity in fellow eyes showed that the Tecnis IOL produced significantly better results at some spatial frequencies. CONCLUSIONS: Results show the Tecnis IOL with a modified prolate anterior surface may produce better contrast sensitivity than a standard spherical IOL under mesopic and photopic conditions. Because contrast sensitivity testing correlates well with functional vision, a goal of future research should be to evaluate patient performance using functional tests such as driving simulation.     

Differences in contrast sensitivity between monofocal,multifocal and accommodating intraocular lenses: long‐term results

Background: To evaluate long‐term contrast sensitivity (CS) and visual acuity following implantation of monofocal, accommodating, refractive and diffractive multifocal intraocular lenses (IOLs) in patients with unilateral cataract Methods: In this prospective non‐randomized clinical trial, 87 patients with unilateral cataract were enrolled in four groups for phacoemulsification and IOL implantation in Ophthalmology Department of Goztepe Training and Research Hospital. Twenty‐four patients had monofocal (Alcon Acrysof; group 1), 21 patients accommodating (Human Optics 1CU; group 2), 22 patients diffractive multifocal (Tecnis ZM900; group 3) and 20 patients refractive multifocal (AMO Rezoom; group 4) IOL implantations. Ages of patients were between 40 and 70. Parameters analysed at the 18th postoperative month were subjective refractions, monocular and binocular distance and near photopic CSs, visual acuities. Results: Near visual acuities were statistically better in group 3 than the other groups (P < 0.05). At low spatial frequencies, mean monocular distance CSs of group 1 and mean monocular near CSs of groups 1 and 2 were statistically higher than those of group 4 (P < 0.05). There was no significant difference between binocular CSs of group 4 and the other groups at low spatial frequencies. At high spatial frequencies, monocular and binocular CSs of groups 1 and 2 were statistically higher than those of groups 3 and 4 (P < 0.05). Near CSs was better in group 3 than group 4. Conclusions: In patients with unilateral cataract, monofocal, accommodating and partially diffractive multifocal IOL provided higher CS scores when compared with refractive multifocal IOL and in multifocal IOL groups binocular CSs were better than monocular CSs when compared with other groups.     

Contrast sensitivity and glare disability by halogen light after monofocal and multifocal lens implantation

BACKGROUND: Standard examination of contrast sensitivity under conditions of glare disability is performed with incandescent light. A new halogen glare test that simulates glare as seen with oncoming vehicle headlights was used to measure glare disability in patients implanted with multifocal and monofocal intraocular lenses (IOLs). METHODS: 28 patients with an average age of 69 years (SD 12 years) were implanted with a monofocal IOL (SI-40NB, Allergan) and 28 patients with an average of 66 years (12 years) were implanted with a refractive multifocal IOL (Array-SA-40N, Allergan). All patients were followed for 5 months postoperatively. Contrast sensitivity at four spatial frequencies (3, 6, 12, and 18 cycles per degree, cpd) with and without a glare source were measured using the halogen glare test (CSV-1000 HGT). Statistical analysis was performed using the two sample Wilcoxon test. The local significance level was set at 0.05. RESULTS: When tested at the lowest spatial frequency (3 cpd) without halogen glare, contrast sensitivity was lower in the multifocal group than in the monofocal group (p=0.0292). With additional glare, there was no difference between both groups. At all other spatial frequencies (6, 12, and 18 cpd), when tested without halogen glare (6 cpd, p=0.5250; 12 cpd, p=0.8483; 18 cpd, p=0.9496) and with moderate (3 cpd, p=0.7993; 6 cpd, p=0.4639; 12 cpd, p=0.7456; 18 cpd, p=1.0) and high halogen glare (3 cpd, p=0. 1513; 6 cpd, p=0.2016; 12 cpd, p=0.3069; 18 cpd, p=0.9933), there was no statistically significant difference between groups. Patients in both groups of age 70 or older had reduced contrast sensitivity without halogen glare and with moderate and strong glare. When monofocal and multifocal patients older than 70 years of age were analysed separately, there was no statistically significant difference in contrast sensitivity with and without glare. Astigmatism >1 dioptre had no significant influence on contrast sensitivity and glare disability when monofocal and multifocal eyes were compared. CONCLUSION: Reduced contrast sensitivity was found in the multifocal group only at the lowest spatial frequency without halogen glare. The monofocal and multifocal groups had no statistically significant differences in contrast sensitivity with moderate and strong glare. These results suggest no difference in glare disability induced by halogen light similar to oncoming vehicle headlights for patients implanted with monofocal and multifocal IOLs.     

Multifocal intraocular lens implantation in prepresbyopic patients with unilateral cataract

OBJECTIVE: To evaluate the benefits of implantation of a zonal-progressive multifocal intraocular lens (IOL) in prepresbyopic patients with unilateral cataract. STUDY DESIGN: Prospective, nonrandomized, comparative trial. PARTICIPANTS: Ninety-five eyes of 95 prepresbyopic patients aged between 14 and 40 years with either multifocal or monofocal IOL implantation at two institutions and with more than 6 months follow-up. INTERVENTIONS: Temporal clear corneal phacoemulsification and foldable IOL implantation was performed in all eyes. In 54 patients, a zonal-progressive optic multifocal IOL (Array SA40-N, Allergan, Irvine, CA) was implanted, whereas 41 patients received a monofocal IOL and served as controls. RESULTS: Preoperative patient demographics, mean postoperative spherical equivalent, astigmatism, and uncorrected and best-corrected distance visual acuities were similar in the two groups. Patients with a multifocal IOL achieved a significantly better uncorrected near visual acuity than patients with monofocal IOL (0.18 versus 0.37; P = 0.0001). With distance correction only, mean near visual acuity was 0.17 versus 0.43 (P = 0.0001). Best-corrected near visual acuity was 0.11 for both groups (P = 0.91), with +1.43 diopters (D) for the multifocal group and +2.35 D for the monofocal group (P = 0.0001). Spectacle dependency differed significantly between the two groups, with 21 patients (51%) of the monofocal group commonly requiring an additional plus add for near tasks compared with 5 patients (9%) in the multifocal group (P = 0.001). Stereopsis was superior in the multifocal group (P < 0.001), with 42 (77%) and 33 (61%) patients with a multifocal IOL responding positively to the Lang and Titmus tests, respectively. In the monofocal group; only 20 (48%) and 9 (22%) patients gave correct answers. CONCLUSIONS: Multifocal IOL implantation is a viable alternative to monofocal pseudophakia in prepresbyopic patients with unilateral cataract.     

Contrast sensitivity after LASIK flap creation with a femtosecond laser and a mechanical microkeratome

PURPOSE: To compare the effects on contrast sensitivity of the IntraLase femtosecond laser for flap creation (IntraLASIK) and standard LASIK for myopia. METHODS: Two hundred eyes of 100 consecutive patients underwent LASIK treatment using the VISX S2 laser system. The femtosecond laser (15 kHz IntraLase) was used for flap creation in 100 eyes (50 patients) and a mechanical microkeratome (Carriazo-Barraquer) was used in 100 eyes (50 patients). Best spectacle-corrected contrast sensitivity was measured before and 6 months postoperatively in the IntraLASIK and mechanical LASIK groups. The IntraLASIK and mechanical LASIK-induced changes in contrast sensitivity were compared under photopic (85 cd/m2) and mesopic (5, 2.5, and 0.1 cd/m2) conditions. RESULTS: Contrast sensitivity for eyes after IntraLASIK did not differ from preoperative values at the photopic level (85 cd/m2). However, under mesopic conditions, a statistically significant reduction (P < .01) in contrast sensitivity was found at high spatial frequencies (12 and 18 cpd), although no significant contrast sensitivity differences were observed at low and middle spatial frequencies (P > .01 for 1.5, 3, and 6 cpd). No statistically significant differences were found between IntraLASIK and mechanical LASIK for 1.5, 3, and 6 cpd at any luminance level (P > .01). IntraLASIK showed better contrast sensitivity than mechanical LASIK under mesopic conditions at 12 cpd and photopic and mesopic conditions at 18 cpd (P < .01). CONCLUSIONS: IntraLASIK surgery demonstrated better contrast sensitivity at high spatial frequencies under photopic and mesopic conditions than mechanical LASIK.     

不同类型人工晶状体对白内障术后对比敏感度的影响

目的:研究不同类型人工晶状体植入术后暗视和明视下对比敏感度(contrast sensitivity,CS)的变化,评估患者术后的视觉质量。方法:采用对照研究的方法:实验组为2010-03/10期间于我院行超声乳化白内障吸除联合人工晶状体植入术的老年性白内障患者50例55眼。全部患者分为3组,分别植入Sensar AR40e人工晶状体17眼,Bausch&Lomb LI61SE人工晶状体18眼和Array SA40N多焦点人工晶状体20眼,对照组为年龄相匹配的志愿者12例24眼。SensarAR40e人工晶状体的光学材料为疏水性丙烯酸酯,另外2种人工晶状体的光学材料为硅凝胶。检查患者术后和志愿者的最佳矫正视力后暗视和明视下对比敏感度。结果:Array SA40N组的CS除明视下0.8cpd以外在各空间频率较正常对照组均明显下降;Bausch&Lomb LI61SE组的CS在除0.8cpd以外其余各空间频率较正常对照组均明显下降;Sensar AR40e组在0.8cpd,1.5cpd的CS与正常对照组无明显差异,在其余各空间频率较正常对照组均明显下降。Array SA40N组在12cpd,20cpd的CS较其他两组人工晶状体眼下降。Sensar AR40e组和Bausch&LombLI61SE组各空间频率的CS相比较均无明显差异。结论:人工晶状体眼的CS较同龄正常对照组均明显下降;多焦点人工晶状体眼较单焦点人工晶状体眼的CS在高频区明显下降;疏水性丙烯酸酯与硅凝胶两种材料的人工晶状体对白内障术后CS的影响无明显差异。     

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.     

Multifocal intraocular lens implantation in patients with traumatic cataract

OBJECTIVE: To evaluate the postoperative outcome and complication rate of cataract extraction with implantation of a zonal-progressive multifocal intraocular lens (IOL) for traumatic cataract. DESIGN: Prospective, nonrandomized, comparative trial. PARTICIPANTS: Fifty-one eyes of 51 subjects with traumatic cataract caused by nonpenetrating, penetrating, and perforating ocular trauma at two university institutions with more than 12 months follow-up. INTERVENTIONS: Temporal clear corneal phacoemulsification with foldable IOL implantation was performed in all eyes. In 29 subjects, a zonal-progressive optic multifocal IOL (Array SA40-N Allergan, Irvine, CA) was implanted, whereas 22 subjects received a monofocal IOL and served as controls. RESULTS: Preoperative subjects demographics, mean postoperative spherical equivalent, astigmatism, and uncorrected and best-corrected distance visual acuity were similar in the two groups. Subjects with a multifocal IOL achieved a significantly better uncorrected near visual acuity than subjects with monofocal IOL (0.24 vs. 0.40; P = 0.0001). With distance correction only, mean near visual acuity was 0.21 vs. 0.43 (P = 0.0001). Best-corrected near visual acuity was 0.17 for both groups (P = 0.91), with +1.24 diopters (D) for the multifocal group and +2.45 D for the monofocal group (P = 0.0001). Spectacle dependency differed significantly between the two groups, with 18 (81%) subjects of the monofocal group commonly requiring an additional plus add for near tasks compared with 5 (17%) subjects in the multifocal group (P = 0.001). Stereopsis was superior in the multifocal group (P < 0.001), with 20 (69%) and 16 (55%) patients with a multifocal IOL responding positively to the Lang and Titmus tests, respectively. In the monofocal group, only eight (36%) and five (22%) subjects gave correct answers. CONCLUSIONS: Multifocal IOL implantation is a viable alternative to monofocal pseudophakia in subjects with traumatic cataract.     

Improving quality of vision with an anterior surface modified prolate intraocular lens: A prospective clinical trial

AIM: To compare the optical performance of the anterior surface modified prolate Tecnis Z9000 IOL with the standard 911A IOL in terms of contrast sensitivity outcomes. · METHODS: The Tecnis Z9000 silicone IOL shares the same basic characteristics with the 911A IOL including a 12.0mm overall diameter, 3-piece equiconvex 6.0mm optic and angulated cap C polyvinylidene fluoride haptics. This is a randomized prospective study that involved ten consecutive patients (20 eyes) with bilateral cataracts. Each patient underwent phacoemulsification and received randomly the Tecnis Z9000 IOL in one eye and the control (911A IOL) in the fellow eye within 6 weeks period of one another. Contrast sensitivity was measured after six postoperative weeks. The collected data were analyzed through using Mann Whitney U test. · RESULTS: The mean pre-operative best spectacle corrected Snellen visual acuity in the eyes that were randomly selected to receive the Tecnis IOL was 6/8.5 (0.70) and in the eye selected to receive the 911A IOL was 6/9.4(0.64). Postoperatively all 20 eyes achieved best corrected Snellen visual acuity of 6/6 (1.0). Postoperative contrast sensitivity testing showed statistically significant differences (P <0.05) between the two IOLs at 12 and 18 cpd under photopic, at 1.5 and 3 cpd under mesopic, and at 1.5 and 3 cpd under mesopic with glare conditions. · CONCLUSION: The Tecnis Z9000 IOL proved to have statistically significant superior contrast sensitivity to the 911A IOL at high spatial frequencies under photopic conditions and at low spatial frequencies under mesopic and mesopic with glare conditions.     

人工晶状体前表面非球面化改良能够改善视觉质量

目的:根据对比敏感度结果比较前表面改良的非球面Tecnis Z9000 IOL和标准的911A IOL的光学性能.方法:Tecnis Z9000硅凝胶IOL和911A IOL具有共同的基本特征包括12mm总长度、三片直边双凸6mm的光学直径和成角的聚丙乙烯C襻.对连续10例双侧白内障患者(20眼)进行了随机前瞻研究,所有患者都接受了白内障超声乳化手术并随机于1眼植入Tecnis Z9000IOL,另1眼在术后6wk内植入911A IOL作为对照,术后6wk进行对比敏感度检查,所得数据采用秩和检验进行比较.结果:随机植入Tecnis IOL组的术前平均最佳Snellen矫正视力为6/8.5(0.70),植入911A I0L组为6/9.4(0.64),所有20眼术后最佳矫正视力都达到了6/6(1.0).术后对比敏感度分析发现两组在12和18 cpd(明视)、1.5和3 cpd(暮视)以及1.5和3 cpd(暮视伴眩光)均有统计学差异(P＜0.05)结论:Tecnis Z9000 I0L被证明其对比敏感度在明视高空间频率和暮视低空间频率方面均显著优于911A IOL.     

Ocular aberrations and contrast sensitivity after cataract surgery with AcrySof IQ intraocular lens implantation Clinical comparative study

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified posterior aspherical surface (AcrySof IQ, Alcon Surgical Laboratories) results in reduced ocular aberrations (spherical aberration) and improved contrast sensitivity after cataract surgery. SETTING: Brasilia Ophthalmologic Hospital, Brasilia, and Sao Geraldo Eye Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil. METHODS: In an intraindividual randomized prospective study of 25 patients with bilateral cataract, an IOL with a modified posterior surface (AcrySof IQ) was compared with a biconvex IOL with spherical surfaces (AcrySof Natural, Alcon). Ocular aberrations with a 5.0 mm and 6.0 mm pupil were measured with a Hartmann-Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. All patients were followed for 3 months. RESULTS: There were no statistically significant differences between eyes in postoperative uncorrected and best corrected distance visual acuities after a follow-up of 1 month and 3 months. Postoperatively, there was a statistically significant between-group difference in contrast sensitivity under photopic conditions without glare at 18 cycles per degree (cpd) (P = .04) and under mesopic conditions without glare at all spatial frequencies (3 cpd, 6 cpd, 12 cpd, and 18 cpd; P = .03, P = .009, P = .003, and P = .003, respectively) and with glare at 3 cpd and 6 cpd (P = .001 and P = .02, respectively). The difference in higher-order aberration (HOA) values between groups was statistically significant with a 5.0 mm and 6.0 mm pupil, with the AcrySof IQ IOL inducing less HOA than the AcrySof Natural IOL. Eyes with an AcrySof IQ IOL also had statistically significant less spherical aberration than eyes with an AcrySof Natural IOL with both pupil diameters (P<.001). CONCLUSIONS: The AcrySof IQ IOL with a modified posterior surface induced significantly less HOA and spherical aberration than the AcrySof Natural IOL. Contrast sensitivity was better under mesopic conditions with the AcrySof IQ IOL.     

Contrast sensitivity and glare disability after implantation of AcrySof IQ Natural aspherical intraocular lens: prospective randomized masked clinical trial

PURPOSE: To evaluate contrast sensitivity and glare disability after implantation of an AcrySof IQ Natural SN60WF aspherical intraocular lens (IOL) (Alcon Laboratories). SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: One hundred twenty consecutive patients who had phacoemulsification in a prospective triple-masked trial were randomized to receive an AcrySof SA60AT IOL (40 eyes), AcrySof Natural SN60AT IOL (40 eyes), or AcrySof IQ SN60WF IOL (40 eyes). At 3 months, contrast sensitivity was measured using the CSV-1000E contrast sensitivity chart test face (Vector Vision) at 3, 6, 12, and 18 cycles per degrees (cpd) under photopic conditions (85 cd/m(2)) and mesopic conditions (2.7 cd/m(2)) with 4.0 mm and 6.0 mm fixed central apertures, with and without glare. The Kruskal-Wallis test was used and a pair-wise comparison performed. The main outcome measure was the difference in contrast sensitivity between IOLs at each spatial frequency. RESULTS: The best corrected visual acuity was similar between the 3 IOL groups (P = .6). The AcrySof IQ group had significantly higher contrast sensitivity at 18 cpd under photopic conditions (P = .008); at 3, 6, 12, and 18 cpd during mesopic testing with a 4.0 mm aperture without glare (P = .018, P = .011, P = .007, and P = .0001, respectively) and with glare (P = .003, P = .006, P = .005, and P = .004, respectively); and at all spatial frequencies during mesopic testing with a 6.0 mm aperture without glare (P = .018, P = .006, P = .009, and P = .0001, respectively) and with glare (P = .019, P = .002, P = .01, and P = .017, respectively). CONCLUSION: Eyes with the AcrySof IQ SN60WF IOL had significantly higher contrast sensitivity than eyes with an AcrySof SA60AT or AcrySof Natural SN60AT IOL at all spatial frequencies during mesopic testing (with and without glare) with 4.0 and 6.0 mm artificial pupil.