Tecnis MF和ReZoom两种人工晶状体的临床对比研究

目的:比较应用Tecnis MF和ReZoom两种多焦点人工晶状体植入术后1mo患者视力及对比敏感度(contrast sensitivity,CS)变化情况。方法:采用同期随机对照研究,选取年龄相关性白内障患者58例(74眼),随机分为两组,ReZoom IOL组(28例,28眼)植入人工晶状体ReZoom,Tecnis MFIOL组(30例,46眼)植入Tecnis MFIOL。术后第1mo检查矫正视力、无眩光及眩光环境下对比敏感度。结果:Tecnis MF近视力优于ReZoom(P<0.05),ReZoom中视力优于Tecnis MF(P<0.05),两者远视力无显著差异。Tecnis MF在空间频率为18c/d和24c/d时对比敏感度优于ReZoom(P<0.05)。两者眩光对比敏感度在各空间频率均无显著差异。结论:Tecnis MF及ReZoom在屈光晶状体手术中,对患者预后的影响各异,因此个性化使用Tecnis MF和ReZoom IOL为影响患者预后的关键环节。     

可调节人工晶状体植入术后的视觉质量及拟调节力

目的:研究Tetraflex可调节人工晶状体(IOL)植入术后视力、调节幅度、对比敏感度及主观视觉功能的临床应用效果。方法:病例对照研究。选择2010-03/2012-12在我院接受白内障超声乳化摘除联合囊袋内IOL植入术的白内障患者48例72眼,其中23例35眼植入Tetraflex可调节IOL(Tetraflex组),25例37眼植入AcrySof SA60AT单焦点IOL(SA60AT组),对比研究两组患者术后1,3,6mo裸眼远视力、最佳矫正远视力、裸眼近视力、最佳矫正近视力、最佳矫正远视力下近视力、拟调节力、脱镜率以及患者满意度情况,采用主观移近法测量调节力。采用SPSS13.0统计软件包进行统计学处理。结果:术后随访期间,两组患者的裸眼远视力、最佳矫正近视力和最佳矫正远视力差异无统计学意义(P>0.05);Tetraflex组患者的裸眼近视力和最佳矫正远视力下近视力与单焦组比较差异有统计学意义(P<0.05)。术后Tetraflex组拟调节力均高于SA60AT组(P<0.05),于术后6mo Tetraflex组拟调节力有所下降,与1,3mo比较差异均有统计学意义(P<0.05),两组间对比敏感度差异无统计学意义。脱镜率及和主观视功能满意度,Tetraflex可调节IOL组均明显优于单焦组,差异有统计学意义(P<0.05)。结论:可调节IOL可提供较好的远近视力,增加拟调节力,有效降低患者术后对老视镜的依赖,改善主观视功能。但其拟调节力仍需要进一步的研究。     

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.     

非球面人工晶状体术后视功能评估

目的 评估植入人工晶状体前表面非球面修饰的TecnisZ9003(AMO)术后视功能是否优于传统的球面人工晶状体(Acrosof Natural,Alcon).方法 随机选择8例白内障手术患者,1只眼植入Z9003 IOL,另眼植入Acrysof Natural SN6OATIOL.术后1周和1月,行对比敏感度检查、眩光检查和像差仪检查,分别评价术后视功能.结果 两组间平均术前和术后球镜、柱镜度及最佳矫正视力无统计学意义.对比敏感度(明亮光下)术后1周没有明显不同,术后1月植入TecnisZ9003 IOL眼在所有空间分辨率下均优于对侧眼,尤其在3,6cpd下差异有统计学意义.眩光检查两组间没有差别.像差仪检查显示术后1周、1月植入TecnisZ9003IOL眼的球差明显小于对侧眼.结论 临床结果证实白内障术后的球差可以通过植入非球面修饰的人工晶状体所消除.这样可以明显提高对比敏感度和功能视力.     

Aurium变色人工晶状体植入术后对比敏感度和眩光对比敏感度的研究

目的 研究Aurium变色人工晶状体对术后对比敏感度和眩光对比敏感度的影响.方法 临床病例系列对比研究.选取2010年8月至2011年4月在南昌大学第二附属医院眼科就诊的白内障超声乳化联合人工晶状体植入术后患者,且随访资料完整的病例70例(眼),其中37例为Aurium (model400)变色人工晶状体组,33例为黄色蓝光滤过型IQ (SN60WF)人工晶状体组.观察患者术后3个月时的裸眼视力(UCVA),最佳矫正视力(BCVA),对比敏感度(CS)和眩光对比敏感度(GS).结果 二组患者术后3个月时的裸眼视力和最佳矫正视力差异均无统计学意义(P＞0.05).Aurium组和IQ组在明适应、明适应眩光、暗适应条件下,两组之间的对比敏感度和眩光对比敏感度差异无统计学意义(P＞0.05),在暗适应眩光条件下Aurium组的眩光对比敏感度(空间频率3 cpd、6 cpd)要优于黄色蓝光滤过型IQ组,差异有统计学意义(P＜0.05).结论 植入Aurium变色人工晶状体术后患者的视力与黄色蓝光滤过型IQ人工晶状体的视力差异无统计学意义.Aurium变色人工晶状体在暗适应眩光条件下,空间频率(3 cpd、6 cpd)的眩光对比敏感度要优于黄色蓝光滤过型IQ人工晶状体.     

球面与非球面IOL在不同瞳孔直径时的对比敏感度与眩光对比敏感度

目的比较球面与非球面人工晶状体（intraocularlens,IOL）在环境照度为85cd.m-2时在3种瞳孔直径：2.0-2.5mm、4-5mm、8mm下的对比敏感度（contrast sensitivi-ty,CS）和眩光对比敏感度（glare contrast sensitivity,GS）的差异。方法收集年龄相关性白内障患者48例（60眼）,行白内障超声乳化吸除或小切口手法摘出联合后房型IOL植入术。根据植入IOL的不同将患者分为2组：球面组和非球面组。30例（35眼）植入球面IOL,18例（25眼）植入非球面IOL。术后1个月检查2组患者在3种瞳孔直径下分别在低频3cycle/degree（cpd）、中频（6cpd）、高频（12cpd、18cpd）时的CS和GS。结果球面IOL组：瞳孔2.0-2.5mm时,各个空间频率的CS与GS之间的差异均无统计学意义;瞳孔4-5mm时,在6cpd、12cpd的CS与GS之间的差异有统计学意义;瞳孔8mm时,全部频率的CS与GS之间的差异均具有统计学意义。非球面IOL组：3个瞳孔直径下各个空间频率的CS与GS之间的差异均无显著性意义。球面与非球面IOL的比较：瞳孔直径2.0-2.5mm及5mm时,在高频段球面与非球面IOL的CS之间的差异有统计学意义;瞳孔8mm时,在低频段两者之间的GS差异有统计学意义,在中频段两者的CS及GS之间差异均具有统计学意义。结论在球面IOL组,随着瞳孔直径的增大,CS及GS均下降,且瞳孔越大,附加眩光时引起CS的下降效应越明显。在非球面IOL组,在各个瞳孔直径时附加眩光均不引起CS的明显下降。瞳孔直径越大,非球面IOL补偿正性球差、减少球面像差的作用越明显。     

非球面人工晶体的临床研究

目的客观评价非球面人工晶体、多焦点人工晶体和单焦点人工晶体的临床疗效。方法选择行白内障超声乳化联合人工晶体（IOL）植入术的患者90例,分成三组,植入Tecnis IOL 30例、Array IOL 30例及Sensar IOL 30例。观察患者手术后1w、3m的远、近视力,术后3m三组的对比敏感度、视觉症状和生存质量等变化。结果手术后1w、3m三组间近视力两两进行比较,P值均〈0.05,三组间差异均有统计学意义,其中Array组近视力最好,Tecnis组其次,Sensar组相对较差。术后1w、3m三组间远视力两两进行比较,P值均〉0.05,三组间无统计学意义。术后3m三组间在无眩光背景下对比度值比较,P值均〈0.05,故三组间差异性均有显著性,其中Tecnis组对比度值最小,即对比敏感度最好,Sensar组其次,Array组对比度值最大,即对比敏感度相对较差。术后3m三组间在有眩光背景下对比度值比较,Tecnis组与Array组比较P〈0.05,Tecnis组与Sensar组比较P〈0.05,差异具有显著性;Array组与Sensar组比较P〉0.05,无显著性差异性;故在有眩光背景下Tecnis组对比度值最小,即对比敏感度最好,而Array组与Sensar组两组无明显差异性。术后3m三组间暗适应时间比较,P值均〈0.05,故三组间差异性均有显著性,其中Tecnis组暗适应时间最短,Sensar组其次,Array组暗适应时间最长。术后3m三组间视功能量表分值比较P〉0.05,故三组间视功能质量无显著性差异。结论对于患有老年性白内障施行超声乳化联合IOL植入术的患者来说,无论植入何种IOL,手术后均可大大提高和改善患者的视功能和生存质量。但在IOL的选择上,植入多焦点人工晶体可以使患者获得较好的近视力,但伴有对比敏感度的下降,植入非球面人工晶体可以获得相对较好的对比敏感度,避免了术后眩光、光晕和夜间视力下降等不良现象的发生,提高视觉质量。     

Array多焦点人工晶状体植入术20例临床疗效

目的：白内障超声乳化术后植入多焦点（MIOL）或单焦点人工晶状体（SIOL）,评价Array MIOL植入的安全性和有效性。方法：取我院行白内障超声乳化联合人工晶状体植入术的年龄相关性白内障患者39例43眼,分为多焦组20例22眼植入MIOL（AMO公司,Array SA-40N）;单焦组19例21眼植入SIOL（Bausch ＆ Lomb公司,LI61SE）。观察术后1wk裸眼远近视力;术后3mo的远近视力;对比敏感度;焦点深度;并发症的发生率及不良视觉症状的出现率;问卷调查患者术后视功能相关生存质量、满意度及戴镜情况。结果：两组术中术后均无严重并发症发生。术后两组的裸眼远视力及最好矫正远近视力差异均无显著性（P〉0.05）,裸眼近视力及矫正远视力下的近视力多焦组明显优于单焦组（P〈0.05）。术后3mo两组对比敏感度在0.8,1.5,3,6cpd差异无显著性（P〉0.05）,在12和20cpd多焦组低于单焦组（P〈0.05）。多焦组的焦点深度（＋1.50～-3.00D）明显优于单焦组（＋1.00～-1.00D）。术后多焦组视功能相关生存质量得分优于单焦组（P〈0.05）,两组都有较高的满意度。近距离工作时多焦组的眼镜使用率明显低于单焦组。结论：Array MIOL植入安全有效,可明显改善术后近视力,提供更好的焦点深度,降低术后戴镜率,提高患者术后生存质量。     

双眼植入不同类型多焦点人工晶状体术后视功能的临床观察

目的 探讨超声乳化白内障吸除联合双眼分别植入折射型与衍射型多焦点人工晶状体(MIOL)术后的波前像差、对比敏感度(CS)及立体视功能.方法 前瞻性研究.将年龄相关性白内障患者分为MIOL组与单焦点人工晶状体(SIOL)组,每组各15例(30只眼),行超声乳化白内障吸除联合人工晶状体(IOL)植入术.MIOL组为主导眼植入ReZoom NXG1 IOL(即NXG1组),对侧眼植入Tecnis ZM900 IOL(即ZM900组);SIOL组为同期双眼植入Sensar AR40e IOL(即AR40e组).观察患者术后波前像差、CS、眩光敏感度(GS)及近立体视锐度.两组中波前像差和近立体视锐度比较分别采用单因素方差分析,CS和GS比较采用析因设计方差分析,两两比较采用ISD检验.结果 术后1个月观察发现,ReZoom NXG1 IOL眼、Tecnis ZM900 IOL眼的球差明显低于Sensar AR40e IOL眼的球差(F=11.734;P=0.001,0.000),三者之间的总体像差和高阶像差间的差异无统计学意义(F=0.724,0.173;P=0.493.0.842).ReZoom NXG1 IOL眼、Tecnis ZM900 IOL眼和Sensar R40e IOL眼在各视角的CS及CS比较,差异均无统计学意义(CS:F=0.959,0.978,2.779,0.590,0.485,0175; P=0.398,0.388,0.079,0.564,0.625,0.847;GS:F=0.117,0.479,0.806,1.235,0.531,1.144;P=0.902,0.627,0.458,0.309,0.597,0.383).MIOL组患者术后近立体视锐度可达45.6弧秒,与SIOL组比较差异有统计学意义(F=2.923;P=0.010,0.014).结论 双眼联合植入折射型与衍射型IOL,在一定程度上可以使患者获得良好的视功能.     

Tetraflex可调节IOL植入术后远期视觉质量的临床研究

目的：探讨可调节人工晶状体植入术后远期视力、表观调节力及视觉症状等情况。方法：病例对照研究。选择43例49眼拟行白内障超声乳化摘除联合囊袋内人工晶状体植入术的白内障患者,其中21例25眼植入Tetraflex可调节人工晶状体（Tetraflex组）,22例24眼植入Acrysof SA60AT单焦点人工晶状体（SA60AT组）,对比研究两组患者术后3,6,24mo裸眼远视力、最佳矫正远视力、裸眼近视力、最佳矫正远视力下近视力、等效球镜度、表观调节力、脱镜率以及患者满意度情况。采用SPSS 13.0统计软件包进行统计学处理。结果：术后随访期间,两组患者的裸眼远视力和最佳矫正远视力差异无统计学意义(P>0.05);Tetraflex组患者的裸眼近视力和最佳矫正远视力下近视力与单焦组比较差异有统计学意义(P<0.05)。术后应用负镜片法测得的表观调节力：术后3mo,Tetraflex组为3.56±1.20D,SA60AT组为-0.25±0.20D;术后6mo, Tetraflex组为3.08±1.30D, SA60AT组为-0.20±0.18D;术后24mo, Tetraflex组为285±1.22D, SA60AT组为-0.15±0.16D,差异均有统计学意义(P<0.05)。近距离阅读时戴老视镜情况和对疗效的满意度情况,Tetraflex可调节人工晶状体组均明显优于单焦组,差异有统计学意义(P<0.05)。结论：与传统的单焦点人工晶状体相比,Tetraflex可调节人工晶状体满足了患者视远、视近的要求,并可提供较好的表观调节力,虽远期有下降趋势,但逐渐平稳。     

Tecnis Z9000人工晶状体植入术后的视功能改变

目的:评价非球面人工晶状体(intraocular lens,IOL)TecnisZ9000对提高年龄相关性白内障患者术后视功能的作用。方法:选取年龄相关性白内障患者34例36眼,其中18眼为Tecnis Z9000组,18眼为传统球面人工晶状体组。检查术后3mo最佳矫正远视力,不同亮度环境及有、无散瞳条件下的对比敏感度(contrast sensitivity,CS)。结果:手术后3mo最佳矫正远视力Tecnis Z9000组为0.89±0.17,球面人工晶状体组为0.76±0.16,两组差异有显著性(P<0.05)。正常瞳孔下,两组晶状体在不同空间频率(1.5,3,6,12,18c/d)、不同照明条件下CS无显著差别。散瞳后Tecnis组亮环境(亮度为85cd/m2)下的12,18c/dCS及暗环境(亮度为3cd/m2)下1.5,3c/dCS均分别与同条件下的球面人工晶状体组比较差异有显著性。结论:白内障术后早期,Tecnis Z9000可提高最佳矫正远视力和对比敏感度,改善术眼视功能。     

Visual function with bilateral implantation of monofocal and multifocal intraocular lenses: a prospective, randomized, controlled clinical trial

PURPOSE: To evaluate visual function of three types of multifocal intraocular lenses (IOLs) and one monofocal IOL (as the control group) after cataract surgery. METHODS: One hundred fourteen patients participated in a prospective, randomized, controlled clinical study and received monofocal Tecnis Z9000 (AMO) (n = 24, 48 eyes); symmetric diffractive multifocal Tecnis ZM900 (AMO) (n = 26, 52 eyes); zonal refractive multifocal ReZoom (AMO) (n = 32, 64 eyes); and asymmetric diffractive multifocal TwinSet (Acri.Tec) (n = 32, 64 eyes) IOLs. RESULTS: Mean binocular distance best spectacle-corrected visual acuity (BSCVA) (logMAR) was 0.05 for controls, 0.08 for ZM900, 0.07 for ReZoom, and 0.11 for TwinSet, with mean binocular distance BSCVA at near of 0.49, 0.06, 0.22, and 0.11, respectively. Mean contrast sensitivity was better for the monofocal IOL group than for the multifocal IOLs. Patients assigned to TwinSet had less favorable contrast sensitivity scores. Patients with monofocal IOLs had more frequently recommended near addition (74%) than those with multifocal IOLs. Patients with refractive ReZoom had also recommended near addition more frequently than the two diffractive groups. The percentage of dysphotopsia phenomena was 81% in patients with diffractive multifocal ZM900 compared with 48% in patients with monofocal IOLs, 53% with refractive ReZoom, and 47% with diffractive TwinSet. CONCLUSIONS: The monofocal IOL showed better visual function and lesser photic phenomena than multifocal IOLs but patients were spectacle dependent. ReZoom provided better distance BSCVA than the TwinSet diffractive model. Patients with Tecnis and TwinSet diffractive multifocal IOLs were more spectacle independent than patients with ReZoom. Patients with TwinSet had the worst visual function. Patients implanted with the Tecnis diffractive ZM900 were those reporting more photic phenomena.     

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。     

Aberration and contrast sensitivity comparison of aspherical and monofocal and multifocal intraocular lens eyes

BACKGROUND: Higher-order aberrations and contrast sensitivity were evaluated in patients who underwent phacoemulsification cataract extraction followed by implantation of aspherical, monofocal or multifocal intraocular lens (IOL) replacements. METHODS: In this comparative trial, 124 patients with an average age of 66.8+/-5.2 years and their 124 eyes were randomly divided into three surgical implantation groups to receive one of three types of IOLs in replacement of cataract lenses. The patients of group 1 were given an aspherical IOL Z9001 (AMO, Santa Ana, CA, USA) replacement, and group 2 was implanted a monofocal IOL SA60AT (Alcon, Fort Worth, TX, USA) and group 3 the multifocal IOL SA40N (AMO). Post-surgical best-corrected visual acuity, corneal aberrations, total ocular aberrations, pupil diameters, capsulorhexsis sizes and contrast sensitivity were measured and compared. RESULTS: There was no statistical difference for mean best-corrected visual acuity, pupil diameter, curvilinear capsulorhexis size and corneal aberration among the three groups. For the spherical aberration, fourth-order higher-order aberration and total ocular higher-order aberration, the SA40N group was higher than the SA60AT group and the SA60AT group was higher than the Z9001 group, and the differences between the three groups were statistically significant for these measurements. Contrast sensitivity was higher for the Z9001 group than the SA60AT group and the SA60AT group was higher than the SA40N group, and the difference was statistically significant in all the spatial frequencies of 3, 6, 12 and 18. CONCLUSIONS: Although the multifocal IOL can provide near vision, it can increase higher-order aberration and negatively influence contrast sensitivity. However, the aspherical IOL can reduce aberration and improve contrast sensitivity as compared with the monofocal IOL.     

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.     

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.     

Contrast sensitivity after implantation of a spherical versus an aspherical intraocular lens in biaxial microincision cataract surgery

PURPOSE: To determine whether implantation of a microincision intraocular lens (IOL) with a modified anterior surface, designed to compensate for the positive spherical aberration of the cornea in eyes of cataract patients, results in improved pseudophakic quality of vision in pseudophakic eyes after biaxial microincision phacoemulsification. SETTING: Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. METHODS: In a nonrandomized parallel cohort investigation, the visual performance of 52 eyes of 52 patients unilaterally implanted with the aspherical Acri.Smart 36 A IOL (Acri.Tec) were compared with those of 25 eyes of 25 age-matched patients unilaterally implanted with the spherical Acri.Smart 46 S IOL (Acri.Tec). Eight weeks after surgery, the following parameters were assessed: uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), pupil size under various illumination conditions, high-contrast and low-contrast visual acuities, photopic and mesopic contrast sensitivities, capsulorhexis size, and wavefront aberration of the cornea and eye. The primary clinical endpoint of the comparison was defined as the area under the cycles per degree (cpd) curve of the contrast sensitivity profile. RESULTS: The aspherical IOL group and the spherical IOL group did not differ in baseline characteristics. The median age was 71 years and 68% were women in the aspherical group versus 69 years and 62% women in the spherical group. The preoperative median UCVA was 20/80 in both groups. The UCVA, BCVA, pupil size, and capsulorhexis size were not statistically different between the 2 groups. Furthermore, no clinically relevant or statistically significant between-group differences were observed in the primary clinical endpoint. The median postoperative low mesopic contrast sensitivity without glare was 73 cpd in the aspherical group and 84 cpd in the spherical group (P = .624); a similar tendency was observed under high mesopic conditions (median 80 cpd and 83 cpd, respectively) (P = 1.000). Implantation of both IOL types resulted in a negative spherical aberration Z(4)(0), which was significantly different between the 2 groups (median -0.09 mum aspherical and -0.29 microm aspherical at a pupil size of 4.5 mm) (P<.001). CONCLUSIONS: No clinically relevant postoperative differences in contrast sensitivity were observed between the aspherical microincision IOL and the spherical equivalent model. The development of microincision IOLs, which fit through corneal incisions smaller than 2.0 mm and improve night-driving conditions (eg, reduction of glare), could optimize modern biaxial cataract surgery.     

白内障手术植入球面和非球面人工晶状体后视觉质量的比较

目的 评估白内障手术植入负球差设计的非球面折叠式人工晶状体(Intraocularlen,IOL)后的视觉质量.方法 取112例(152只眼)白内障超声乳化手术患者按数字表法被分为三组,第一组植入TecnisZ9003IOL(美国 AMO 公司),第二组植入AcrysofIQIOL(美国Alcon公司),第三组植入HQIOL(法国Hexavision公司).于术后一周、一月、三月分别检测裸眼视力、最佳矫正视力,无眩光及有眩光环境下的白天夜晚对比敏感度,同时检测全眼的球差、第三、第四、第五阶像差均方根(root mean square,RMS)、总高阶像差(higher-order aberration,HOA)RMS以及总像差(total ocular aberration,TOA)RMS.结果 术后三次随访三组患者的裸眼视力和最佳矫正视力差异均没有统计学意义.术后一周、一月时三组白天对比敏感度未见显著差异,术后一月、三月时TecnisZ9003组和AcrysofIQ组的夜间对比敏感度在中、低空间频率上明显好于HQ组,同时术后三月时该两组的白天对比敏感度亦好于HQ组,差异均具有统计学意义(P＜0.05).另外,术后三次随访TecnisZ9003组和AcrysofIQ组全眼的球差、RMS4均低于HQ组,在术后一月、三月时HOA较HQ组低,同时术后三次随访在瞳孔直径6mm大小时TOA亦较低,差异均有统计学意义(P＜0.05).结论 植入负球差设计的非球面人工晶状体可提高白内障患者术后对比敏感度,降低球差和高阶像差,获得更好的视觉质量.     

三种非球面单焦点丙烯酸酯IOL植入术后暗视下视觉质量的观察

目的: 研究三种非球面丙烯酸酯人工晶状体(intraocularlens,IOL)植入术后患者在最佳矫正视力及暗视下(3cd/m2)对比敏感度(contrast sensitivity,CS)的变化,评价白内障超声乳化联合单焦点非球面丙烯酸酯IOL植入术后患者的视觉质量。方法: 选取符合条件的年龄相关性白内障患者77例90眼,2011-12/2012-11于我院行白内障超声乳化吸除联合IOL植入术,术前将患者随机分成三组,1组(25例30眼)植入疏水性染黄色丙烯酸酯IOL(HOYA),2组(28例30眼)植入亲水性丙烯酸酯IOL(Rayner)及3组(24例30眼)植入亲水性丙烯酸酯表面肝素处理IOL(XO)。所有患者于术后1,3mo均行最佳矫正视力(标准对数视力表)检查及暗视无眩光状态下的CS检查,所得结果进行统计学分析。结果: 患者术后1,3mo时,各组之间最佳矫正视力无明显统计学差异(P>0.05);患者1,3mo暗视无眩光状态下CS结果(标准化后的CS值:lgCS),三组患者之间CS值并无统计学差异(各组之间P>0.05),但HOYA组患者CS结果略下降。结论: 三组患者之间,术后1,3mo时最佳矫正视力及对暗视无眩光状态下CS结果无明显差异(P>0.05)。由于蓝光滤过型IOL对视网膜的潜在保护作用,因此植入染黄色滤过蓝光的IOL是可取的,特别是对儿童及青年白内障患者是必要的。