折射型与衍射型多焦点IOL双眼联合植入后视觉质量的研究

目的:通过超声乳化白内障吸除联合双眼分别植入折射型多焦点人工晶状体(Rezoom NXG1 MIOL)与衍射型多焦点人工晶状体(ReSTOR SA60D3 MIOL),评价个性化搭配模式的术后视觉质量。方法:将拟行超声乳化白内障吸除术的年龄相关性白内障患者分为多焦点人工晶状体(MIOL)组与单焦点人工晶状体(SIOL)组,每组各10例。MIOL组为主视眼植入ReZoom NXGl MIOL,对侧眼植入ReSTOR SA60D3 MIOL;SIOL组为双眼植入Sensar AR40e IOL。术后1mo,观察两组患者远、中、近视力,对比敏感度,焦点深度及问卷调查,并对结果进行分析。结果:术后1mo,MIOL组患者获得满意的远视力,且中、近视力明显优于SIOL组。比较不同空间频率对比敏感度,除了暗光条件下,在3c/d空间频率SIOL组要优于MIOL组外,其余各空间频率两组无明显差别,而在明光条件下5种空间频率均未见明显差别。MIOL组的焦点深度可达5.30D,显著高于SIOL组的2.85D。MIOL组的中、近距离的视觉质量满意度也较SIOL组有明显的提高。结论:个性化搭配IOL能在一定范围内给白内障术后患者提供更好的全程视力,提高白内障患者术后视觉质量。     

Visual outcomes and optical quality after implantation of a diffractive multifocal toric intraocular lens

Background:This study evaluated the visual function after implantation of a multifocal toric intraocular lenses (IOLs).Results:At 6 months postoperatively, uncorrected distance visual acuity (logarithm of the minimum angle of resolution) was 0.09 ± 0.04, corrected distance visual acuity was 0.02 ± 0.11, and uncorrected near visual acuity was 0.12 ± 0.07. The mean SE was −0.095 ± 0.394 D (±0.50 D in 90%). Refractive astigmatism at the 6-month follow-up visit was significantly reduced to 0.35 ± 0.32 D from 1.50 ± 0.41 D presurgery (P < 0.05). The mean IOL axis rotation was 3.20 ± 1.55°. Postoperative CS levels were high. Postoperative total order aberrations (TOAs), lower-order aberrations (LOAs), higher-order aberrations (HOAs), and spherical aberrations were decreased compared with preoperative values (P < 0.05). At 3 months postoperatively, TOAs, LOAs, and HOAs with a 3 mm pupil diameter as well as TOAs, LOAs, and astigmatism aberrations with a 5 mm pupil diameter were statistically lower than those at 1-month post surgery, but without subsequent significant changes (P > 0.05). There was an increase in MTF results between preoperative and postoperative evaluations at all spatial frequencies.Conclusions:The diffractive multifocal toric IOL is able to provide a predictable astigmatic correction with apparently outstanding levels of optical quality after implantation.     

三焦点人工晶状体植入术后的早期临床效果

目的评价白内障超声乳化联合三焦点人工晶状体（IOL）植入术后的早期临床效果。方法前瞻性自身前后对照研究。选择在大庆油田总医院行白内障超声乳化联合三焦点IOL植入术患者24例（26眼）,术后随访3个月,分别观察术前,术后1周、1个月、3个月的裸眼远视力、裸眼中距离视力和裸眼近视力,以及离焦曲线、对比敏感度（CS）和全眼像差。对手术前后各参数进行重复测量的方差分析。结果三焦点IOL植入术后所有患者1周、1个月、3个月时远、中、近距离均可获得0.3 LogMAR以上的较好视力。术后各距离视力较术前显著提高（P＜0.05）。术后3个月时裸眼远视力接近0 LogMAR,且+1.5~-4.0 D离焦下视力均优于0.3 LogMAR;CS可见术后1周时明视眩光分辨率最好,明视、暗视的分辨率较明视眩光差,暗视眩光分辨率最差,差异有统计学意义（P＜0.05）;术后1周、1个月、3个月时总像差、总低阶像差、离焦深度、散光均较术前明显降低,差异有统计学意义（P＜0.05）。结论三焦点IOL提供了远、中、近兼顾的全程视力,术后视觉质量良好。     

双眼多焦点人工晶状体ReSTOR植入术后视功能观察

目的 通过比较植入单、多焦人工晶状体(IOL)术后双眼视功能情况,以了解国人植入多焦点IOL的有效性及安全性.方法 选择年龄相关性白内障患者43例,按患者意愿植入多焦点或单焦点IOL.单焦点人工晶状体(MoIOL)组:双眼植入AcrysofNatural25例50只眼.多焦点人工晶状体(MIOL)组:双眼植入AcrysofReSTOR 18例36只眼.观察两组组患者术后双眼裸眼远视力(UCDVA)、裸眼近视力(UCNVA)、最佳矫正远视力(BCDVA)、最佳矫正近视力(BCNVA)、远矫正下的近视力(DCNVA),中间距离视力(40、60、80cm),对比敏感度(CS),视觉症状.结果 MIOL组UCNVA、DCNVA、中间距离视力均优于单焦点人工晶状体MoIOL组,差异有统计学意义(P＜0.05).两组之间,CS无明显差异.MIOL组术后视觉症状较轻,脱镜率80%,患者满意度高.结论 双眼植入MIOL能提供更好的近、中距离视力,视觉症状轻,更好地提高白内障患者术后生活质量.     

Early outcomes of vision and objective visual quality analysis after cataract surgery with trifocal intraocular lens implantation

AIM: To investigate the early outcomes of vision, objective visual quality and their correlation after cataract surgery with trifocal intraocular lens implantation. METHODS: The visual examination and objective visual quality analysis using Optical Quality Analysis System (OQAS) at 1mo and 3mo, and defocus curve examination at 3mo were performed in 20 patients (27 eyes) after phacoemulsification combined with trifocal intraocular lens implantation surgery. RESULTS: The uncorrected distant (UD), intermediate and near visual acuity (VA) were significantly improved after surgery (P<0.001). UDVA at 1mo after the surgery was slightly better than that after 3mo (P=0.026). The defocus curve after 3mo indicated that the peak of distant vision was close to 0 logMAR, and UDVA was lower than 0.3 logMAR in the range of -1.5 D to -3.0 D. The modulation transfer function (MTF) cutoff frequency, strehl ratio (SR), Optical Quality Analysis System values (OVs), includes OV100, OV20 and OV9 after the surgery were significantly better than before surgery (P<0.001), but the objective scattering index (OSI) was significantly decreased (P<0.001). UDVA at 3mo after the surgery had correlations with MTF cutoff, OSI, OV100 and OV20 (r=-0.400, 0.431, -0.437, -0.411, P=0.039, 0.025, 0.023, 0.033). The uncorrected intermediate VA after 3mo of the surgery had correlations with OSI and OV100 (r=0.478, -0.411, P=0.012, 0.033). CONCLUSION: Trifocal intraocular lens implantation can provide good distant, intermediate and near VA, and the vision shows a well correlation with objective visual quality during early surgery.     

衍射型多焦点人工晶状体眼拟调节力的初步报告

目的 评价白内障超声乳化摘除联合衍射型多焦点人工晶状体植入术后患者的视力及拟调节力。方法 将40例（46眼）年龄相关性白内障患者随机分为2组，每组各20例（23眼），分别行白内障超声乳化摘除并植入ReSTOR SA60D3衍射型多焦点人工晶状体（多焦组）和Natural SN60AT单焦点人工晶状体（单焦组），观察术后裸眼远、近视力，最佳矫正远、近视力．最佳视远矫正时近视力以及视近拟调节力。结果 两组患者术后裸眼远视力，最佳矫正远视力和最佳矫正近视力差异均无显著性（P〉0．05）；术后第3个月裸眼远视力≥0．5者多焦组和单焦组均达95．65％。多焦组术后裸眼近视力和最佳视远矫正时近视力明显优于单焦组（P〈0．05）；术后第3个月裸眼近视力≥0．5者，多焦组为69．57％，单焦组为4．35％；而最佳视远矫正时近视力≥0．5，多焦组为69．57％，单焦组为13．04％。术后第3个月视近拟调节力多焦组为（-3．54±1．05）D，单焦组为（-1．65±0．68）D，差异有显著性（P〈0．05）。结论 ReSTOR衍射型多焦点人工晶状体能提供良好的远、近视力。拟调节幅度较单焦点人工晶状体大．能有效地提高白内障患者术后的视觉质量．     

Symmetric bilateral implantation of a distance-dominant diffractive bifocal intraocular lens

PURPOSE: To assess visual results after symmetrical bilateral implantation of a distance-dominant bifocal diffractive intraocular lens (IOL). SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. METHODS: Fifty patients had bilateral implantation of a distance-dominant diffractive bifocal 447D IOL (Acri.Tec GmbH) in a prospective study. Monocular and binocular best corrected distance visual acuities and best distance-corrected near visual acuity, binocular best distance-corrected intermediate visual acuity, and distance contrast sensitivity under photopic (85 cd/m(2)) and mesopic (5 cd/m(2)) conditions were determined. RESULTS: At the 6-month postoperative visit, the mean binocular best corrected distance acuity and best corrected distance near acuity were 0.02 +/- 0.04 logMAR and 0.04 +/- 0.03 logMAR, respectively. Binocular best corrected distance intermediate visual acuity worsened significantly as a function of the distance of the test: from 0.04 +/- 0.03 logMAR at 33 cm to 0.21 +/- 0.08 logMAR at 70 cm (P<.01). Contrast sensitivity was within normal limits under photopic and mesopic conditions. Binocular contrast sensitivity was statistically significantly better than monocular contrast sensitivity at all spatial frequencies under both illumination levels (P<.01). CONCLUSION: Bilateral implantation of the distance-dominant bifocal 447D IOL provided good simultaneous distance, near, and intermediate vision with improved contrast sensitivity under photopic and mesopic conditions.     

Visual outcomes and patient satisfaction 1 and 12 months after combined implantation of extended depth of focus and trifocal intraocular lenses

International Ophthalmology - To assess the 1-month and 12-month postoperative visual performance and subjective outcomes following combined implantation of an extended depth of focus (EDOF)...     

渐进衍射型多焦点IOL植入术后视功能和视觉质量的研究

目的：评价渐进衍射型多焦点人工晶状体(multifocal intraocular lens,MIOL)植入术后的临床效果。

方法：采取随机对照临床试验研究方法,将年龄相关性白内障患者72例分为两组,32例32眼植入渐进衍射型MIOL,40例40眼植入单焦点人工晶状体(monofocal intraocular lens, MoIOL)。术后3mo进行裸眼远视力、中间视力、近视力及矫正远、近、中视力及对比敏感度检查,并进行视功能和生存质量问卷调查。

结果：术后3mo,多焦点组裸眼近视力高于单焦点组(P<0.05),中间距离视力(40,60,80cm)均高于单焦点组(P<0.05),两组裸眼远视力、矫正远视力、矫正近视力及最佳矫正远视力下近视力差异无统计学意义(P>0.05)。术后3mo两组对比敏感度相比差异无统计学意义(P>0.05)。术后多焦点组脱镜率高于单焦点组(P<0.05),视近满意度多焦点组好于单焦点组(P<0.05),术后不良视觉症状及视远满意度两组相比差异无统计学意义(P>0.05)。

结论：渐进衍射型MIOL能提供良好的全程视力和视觉质量,有效降低术后脱镜率,提高患者术后的生活质量。     

折射型与折射衍射结合型多焦点人工晶状体植入术后的视功能比较

目的 通过比较折射型SA40N Array和折射衍射混合型Acrysof ReSTOR多焦点人工晶状体眼的视功能,了解不同类型多焦点人工晶状体在改善患者术后生活质量的效果.方法 选择合适的老年性白内障患者,Acrysof ReSTR组患者36例45眼;SA40N Array组患者50例60眼.分别植入多焦点人工晶状体,术后3个月观察2组患者术后视力(未矫正远视力、未矫正近视力、最佳矫正远视力、最佳矫正近视力、最佳矫正远视力下的近视力),屈光状态(球镜、柱镜),对比敏感度,中间距离视力(40 cm、60 cm、80 cm),视觉症状.结果 Acrysof ReSTOR组:未矫正近视力为0.64±0.14,最佳矫正远视力下的近视力为0.69±0.16;SA40N Array组:未矫正近视力为0.49±0.07,最佳矫正远视力下的近视力值为0.57±0.07.Acrysof ReSTOR组在未矫正近视力、最佳矫正远视力下的近视力优于SA40N Array组,差异均有统计学意义(均为P＜0.05),其余2组差异均无统计学意义(均为P＞0.05).2组术后屈光状态(球镜、柱镜)比较,差异均无统计学意义(均为P＞0.05).在焦点深度方面,SA40N Array组和Acrysof ReSTOR组比较,差异也无统计学意义(P＞0.05),且波峰、波谷出现的位点基本一致.2组在100cd·mm-2、最佳矫正远视力情况下,各个空间频段比较,差异均无统计学意义(均为P＞0.05).Acrysof ReSTOR组和SA40N Array组植入术后的视觉症状比较,差异无统计学意义(P＞0.05).结论 Acrysof ReSTOR和SA40N Array均能在不损害近视力的前提下,提供良好的远视力,而Acrysof ReSTOR能提供较SA40N Array更好的近视力,患者的满意度较高.     

Clinical outcomes of a new diffractive multifocal intraocular lens

AIM: To evaluate clinical outcomes after implantation of a new diffractive aspheric multifocal intraocular lens (IOL) with +3.00 addition power. METHODS: This is a retrospective, consecutive case series of cataract patients who underwent bilateral implantation of the Optiflex MO/HF D012 (Moss Vision Inc. Ltd, London, UK) multifocal IOL. Patients followed for 6mo were included in the study. Data on distance, intermediate and near visual acuity, refractive error [manifest spherical equivalent (MSE)], contrast sensitivity, adverse events, subjective symptoms, spectacle independence and patient satisfaction [visual function questionnaire (VFQ)-25 questionnaire] were retrieved from electronic medical records and analyzed. RESULTS: Forty eyes of 20 patients with a mean age of 66.7±8.5y (range: 53-82) were included in the study. Mean uncorrected distance, near and intermediate visual acuity remained stable through postoperative visits and was 0.19±0.19 logMAR, Jaeger 4 and Jaeger 3 respectively at the 6mo visit. At the end of postoperative 6mo, MSE was -0.14±0.42 diopters (D) and 98% of the eyes were within 1.00 D of target refraction. Postoperative low contrast (10%) visual acuity remained stable (P=0.54) through follow up visits with a mean of 0.35±0.17 logMAR at the 6mo visit. There were no reported adverse events. None of the patients reported subjective symptoms of halo or glare. Spectacle independence rate was 90%. Mean VFQ-25 questionnaire score was 93.5±6.12. CONCLUSION: The Optiflex MO/HF-DO12 IOL was safely implanted and successfully restored distance, intermediate and near visual acuity without impairing contrast sensitivity. High levels of spectacle independence were achieved at all distances including intermediate distance.