三焦点与单焦点人工晶状体植入术后1年视觉质量比较

目的:比较三焦点与单焦点人工晶状体(IOL)植入术后1年视觉质量。方法:采用队列研究设计,纳入2017年5月至2018年6月在南京大学医学院附属鼓楼医院行超声乳化白内障摘出联合IOL植入术的年龄相关性白内障患者41例41眼,根据患者意愿将其分为三焦点IOL组20例20眼和单焦点IOL组21例21眼,分别植入AT LIS...     

人工晶状体取出和置换的原因

人工晶状体(intraocular lens,IOL)植入术作为医学上一种比较成功的手术,为白内障患者重新带来了光明,已在临床上广泛开展.但IOL植入眼内后,由于各种原因(包括IOL自身因素、术后屈光因素及IOL植入术后并发症等)偶尔需要取出或置换,这在不同的手术发展阶段其原因有所不同.本文就不同阶段IOL取出和置换的...     

晶状体超声乳化术联合空气泡辅助人工晶状体植入术的安全性和有效性评估

目的:评估空气泡辅助人工晶状体(IOL)植入术的安全性及其对角膜内皮细胞的影响。方法:采用非随机对照研究,纳入2019年3—9月在浙江中医药大学附属第一医院拟行晶状体超声乳化联合IOL1期植入术的年龄相关性白内障患者170例170眼,根据IOL植入术中前房注入剂不同将术眼分为2个组,其中采用空气泡辅助IOL植入术者92...     

Verisyse虹膜固定型人工晶状体植入术后10年角膜内皮丢失影响因素分析

目的 观察高度近视患者Verisyse虹膜固定型人工晶状体(IOL)植入术后10年角膜内皮细胞计数(ECD)的变化,分析其丢失影响因素,并应用眼前节相干光层析成像术(AS-0CT)评估IOL在眼内的相对位置.方法 回顾性分析2008年9月至2010年7月在我院行Verisyse IOL植入术的高度近视患者的临床资料.所...     

有晶状体眼人工晶状体植入术治疗高度近视应注意的几个问题

有晶状体眼人工晶状体(IOL)植入术矫正近视眼具有术后良好的视觉质量及屈光稳定性和预测性,是一个很有前景的矫正中、高度近视的手术方法.但必须认识到这类IOL的设计还不完善,植入眼内前后房的不同位置会对眼内组织产生不同的影响,临床医师应密切注意不同类型有晶状体眼IOL植入术的特点、适应证选择和手术的规范性.为减少并发症的发生,术后长期随访也是非常必要的.     

折衍混合型三焦点人工晶状体常数优化的临床研究

目的:比较Alcon Acrysof IQ PanOptix TFNT00 (PanOptix)晶状体常数优化前后对人工晶状体(intraocular lens,IOL)度数计算准确性的影响,以及不同眼轴长度晶状体常数优化的效果。方法:回顾性收集2021年6月—2022年3月在上海爱尔眼科医院行白内障超声乳化手术联合植入PanOptix IOL患者的术前眼球生物学测量参数、植入IOL度数和术后1～3个月的显然验光结果。联合SRK/T、Hoffer Q、Holladay 1、Haigis公式,通过回归法计算优化的晶状体常数A、pACD、SF,通过多元线性回归计算优化的晶状体常数a0、a1和a2。观察晶状体常数优化前后平均绝对预测误差值(mean absolute error,MAE)及中位绝对预测误差值(median absolute error,MedAE),预测误差在±0.25、±0.50、±0.75、±1.00 D以内的百分比的差异,评价晶状体常数优化对IOL计算准确性的影响。随后,按照眼轴长度进行分组(非高度近视组:<26.00 mm;高度近视组:≥26.00 mm),比较...     

新型多焦点人工晶状体临床应用的研究进展

近年来新型多焦点人工晶状体(IOL)如非球面多焦点IOL、Toric多焦点IOL和非球面Toric多焦点IOL等的不断问世及临床应用,更好地改善了白内障患者术后的生活视力、工作视力以及生存质量.对于新型多焦点IOL的适应证应严格掌握,以使患者术后获得最佳效果.     

白内障超声乳化术后混浊人工晶状体置换术

目的探讨白内障超声乳化术后人工晶状体(intraocular lens,IOL)混浊的原因与治疗方法 ,研究改良手术方式以减少手术并发症。方法收集2001年8月至2011年1月在我院因超声乳化白内障吸出联合Hydroview H60M IOL植入术后远期IOL发生混浊的患者14例,在表面麻醉下行IOL置换术,比较术前与术后最佳矫正视力。术中采用IOL剪碎法、旋转法等方式将IOL取出,重新植入STAAR公司疏水性KN-X IOL。将取出的IOL在显微镜下进行观察拍照,用钙特异性茜素红染色并进行病理检查,与未使用的Hydroview H60M IOL对比观察。结果所有病例均成功实施IOL置换术,术后视力为0.4~1.0,有10例IOL重新植入囊袋内,有4例置换的IOL植入睫状沟内。术中晶状体后囊膜破裂1例、晶状体襻残留1例、睫状体出血2例、黄斑囊样水肿2例。混浊IOL茜素红染色呈阳性反应,光学部表面有粗糙的着色颗粒,光学部内有细小颗粒所组成的云雾状或团状着色区。结论 IOL混浊与IOL材质、IOL表面钙离子富集有关,IOL置换术是改善IOL混浊患者视力的有效方法 ,术中使用改良技术可以减少手术期并发症的发生。     

人工晶状体悬吊植入术后人工晶状体脱位的原因分析

背景 目前人工晶状体(IOL)悬吊植入术的操作技术逐渐进步,但术后远期IOL位置的稳定性仍不十分理想. 目的 探讨IOL悬吊植入术后发生IOL脱位的原因. 方法 本研究为回顾性系列病例观察研究.纳入1998-2009年于北京爱尔英智眼科医院因无晶状体眼行IOL悬吊植入术者321例321眼,本组中保持有效随访者共263例263眼,其中随访时间在5年以上者共164例164眼.所有患者术后5年以内(含5年)均未出现IOL脱位.对纳入分析的164例患者术后IOL脱位情况进行分析,对术中所用IOL材料、IOL植入位置、IOL植入时间以及术后眼压等与IOL脱位的关系进行统计,分析导致IOL脱位的原因,并对IOL脱位后的处理方法和结果进行分析和总结.结果 本组患者随访期在5年以上的164例164眼中术后发生IOL脱位者共9例9眼,占5.49％,IOL脱位时间在术后7～10年.从脱位IOL复位术中证实IOL脱位的主要原因是无明显诱因的悬吊线断裂,IOL固定于非水平对角位者IOL脱位发生率高于IOL固定于水平位者.IOL脱位的患者中以外伤性视网膜脱离患者比例最高,占33.33％.发生脱位的IOL均为一片式悬吊IOL,三片式折叠IOL植入者均未发生脱位.结论 IOL悬吊植入术中IOL的固定缝线断裂是IOL脱位的主要原因,悬吊线断裂可能与非水平对角位固定IOL时的重力有关,因此建议术中采用3:00 ～9:00位水平固定IOL.     

两种不同类型功能性人工晶状体植入术后视觉质量对比研究

目的 比较Tecnis Symfony连续视程人工晶状体(IOL)与SBL-3区域折射型多焦点人工晶状体(MIOL)植入术后的临床疗效。方法 前瞻性病例对照研究。纳入2022年3～10月在安徽医科大学第一附属医院行超声乳化吸出联合IOL植入术的白内障患者37例(45只眼)。其中21例(25只眼)植入Symfony IOL为Symfony组，16例(20只眼)植入SBL-3为SBL-3组。比较两组术后3个月裸眼远、中、近距离视力、最佳矫正远视力(BCDVA)、客观散射指数(OSI)、调制传递函数截止频率(MTF cut off)、斯特尔比率(SR)、模拟对比度视力(PVA)、全眼总高阶像差(tHOAs)、球差(spherical)、彗差(coma)、三叶草差(trefoil)、二阶散光(secondastigmatism)、VF-14评分、近距离阅读脱镜率、夜间视觉干扰症状及疗效满意度。结果 术后3个月，两组裸眼及BCDVA比较差异无统计学意义(P>0.05);Symfony组裸眼中视力优于SBL-3组，差异有统计学意义(P<0.05);SBL-3组裸眼近视力优于Symfon...     

Surgical outcome comparisons of multifocal IOLs of Lentis Comfort LS-313 MF15 and Tecnis Eyhance DIB00V

AIM: To compare the surgical outcomes of a multifocal intraocular lens (IOL; Lentis Comfort LS-313 MF15) with those of an enhanced monofocal IOL (Tecnis Eyhance DIB00V). METHODS: This retrospective study included patients who underwent cataract surgery with LS-313 MF15 or Eyhance IOL implantation. Data regarding patient demographics, surgical records, and ophthalmic examination before the cataract surgery and one and three months postoperatively were collected. Visual acuities, refractive values, defocus curves, contrast sensitivities and subjective symptoms were evaluated. RESULTS: Among the 71 eyes (47 patients) included in this study, 32 eyes (20 patients) underwent LS-313 MF15 IOL implantation, and 39 eyes (27 patients) underwent Eyhance IOL implantation. No significant differences were observed in age, axial length, or refractive error between the two groups preoperatively. Furthermore, the distance-corrected and uncorrected distance visual acuities one month postoperatively did not differ between the groups, and both groups had sufficient visual acuities at the distances of 5, 1 m, 70, 50, and 30 cm. Other ophthalmic data, including subjective symptoms based on the 14-item Visual Function Index Questionnaire, monocular defocus curves, contrast sensitivities, and halo and glare, did not differ between the groups three months postoperatively. Moreover, both groups had good outcomes. The spherical equivalent one month postoperatively was significantly myopic in the LS-313 MF15 group compared with that in the Eyhance group (P=0.033); however, this difference was not observed three months postoperatively (P=0.471). CONCLUSION: Comparison of the surgical outcomes of LS-313 MF15 with those of Eyhance with different optical properties reveal that both IOLs show good postoperative outcomes, with no significant differences being noted between the two IOLs.     

Comparative analysis of the visual and refractive outcomes of a refractive segmented multifocal intraocular lens with and without toricity: 1-year results

Purpose

To compare the visual and refractive outcomes up to 1 year postoperatively following implantation of a refractive segmented or a refractive segmented toric multifocal intraocular lens (IOL).

Methods

This retrospective study included 108 eyes of 64 patients who underwent cataract surgery with implantation of a refractive segmented multifocal IOL (Lentis Mplus LS-313 MF30 IOL) (LM group) and 81 eyes of 49 patients with implantation of a refractive segmented toric multifocal IOL (Lentis Mplus LU-313 MF30T IOL) (LMT group). The visual and refractive postoperative outcomes and the rate of additional refractive procedures were evaluated up to 1 year postoperatively.

Results

The uncorrected distance visual acuity (VA) and uncorrected near VA exceeded 1.0 and 0.60 in decimal VA, respectively, and both were stable postoperative groups. The postoperative subjective refractive astigmatism was also stable and the postoperative refraction was near emmetropia in both groups. No significant differences were found in the need for additional surgical refractive procedures.

Conclusion

The outcomes with a refractive segmented toric multifocal IOL were comparable to those with a non-toric model despite higher preoperative corneal astigmatism.

     

连续视程人工晶状体与双焦点、单焦点人工晶状体植入术后患者视力、视觉质量及满意度对比分析

目的 比较连续视程人工晶状体与双焦点、单焦点人工晶状体植入术后患者视力、视觉质量及满意度的差异。方法 选取2020年10月至12月于我院行超声乳化白内障吸除联合人工晶状体植入术的患者61例61眼。依据患者人工晶状体植入情况分为3组,连续视程组16例16眼植入Tecnis Symfony连续视程人工晶状体;双焦点组20例20眼植入Tecnis ZMB00一片式非球面双焦点人工晶状体;单焦点组25例25眼植入Tecnis ZCB00一片式非球面单焦点人工晶状体。术后1个月检测患者裸眼远、近视力,绘制离焦曲线,运用双通道视觉质量分析系统OQASⅡ检测植入不同人工晶状体后,患者单眼客观视觉质量。分析并获得客观散射指数(OSI)、调制传递函数截止频率(MTF_{cut off})、斯特列尔比(SR)、三种对比度(100%、20%、9%)下的模拟对比度视力(OV100%、OV20%、OV9%),通过问卷形式对患者进行满意度调查。结果 术后1个月,三组患者33 cm和40 cm裸眼近视力差异均有统计学意义(均为P<0.01),单焦点组患者33 cm和40 cm裸眼近视力均差于双...     

连续视程人工晶状体和区域折射型人工晶状体植入术后视觉质量的对比分析

目的：比较连续视程(Tecnis Symfony)人工晶状体(IOL)和区域折射型(Lentis Comfort LS-313 MF15)IOL植入术后患者的视觉质量。

方法：临床前瞻性研究。收集2021-01/12在我院行白内障超声乳化联合IOL植入术的白内障患者267例(305眼)，按植入IOL类型分为Symfony组(A组，160眼)和MF15组(B组，145眼)，观察两组患者术后3mo裸眼远视力(uncorrected distance visual acuity， UDVA)(5m)、裸眼中视力(uncorrected intermediate visual acuity， UIVA)(80cm)、裸眼近视力(uncorrected near visual acuity， UNVA)(40cm)，离焦曲线，调制传递函数(MTF)和高阶相差(HOAs)，包括彗差、球差、三叶草差，进行视觉质量问卷调查(Quality of Vision questionnaire，QoV)。

结果：两组患者术前各参数差异均无统计学意义(P>0.05)。A组和B组UDVA和UNVA差异无统计学意义(P>0.05)； A组的UIVA高于B组(P<0.05)； A组的MTF值在各个空间频率下均高于B组，差异具有统计学意义(P<0.05)； A组的HOAs低于B组(P<0.05)； 术后3mo绘制离焦曲线显示0D处两组视力相似，-0.5D～-2.5D处A组视力优于B组，且在-1.0D和-2.0D处差异有统计学意义(P<0.05)； A组的Qov分数高于B组(P<0.05)； A组出现光晕，星爆等不良视觉干扰现象的频率要高于B组。

结论：MF15和Symfony均提供了稳定的远，近距离视力； 与MF15相比，Symfony IOL具有较好的中距离视力，较高的对比敏感度以及较低的HOAs； 与Symfony相比，MF15人工晶状具有更少的术后不良视觉干扰现象(光晕，星芒等)。     

Validity of automated refraction after segmented refractive multifocal intraocular lens implantation

AIM: To evaluate the clinical utility of automated refraction (AR) and keratometry (KR) compared with subjective or manifest refraction (MR) after cataract or refractive lens exchange surgery with implantation of Lentis Mplus X (Oculentis GmbH) refractive multifocal intraocular lens (IOL). METHODS: Eighty-six eyes implanted with the Lentis Mplus X multifocal IOL were included. MR was performed in all patients followed by three consecutive AR measurements using the Topcon KR-8000 autorefractor. Assessment of repeatability of consecutive AR before and after dilation with phenylephrine 10%, and comparison of the AR and KR with MR using vector analysis were performed at 3mo follow-up. RESULTS: Analysis showed excellent repeatability of the AR measurements. Linear regression of AR versus MR showed good correlation for sphere and spherical equivalent, whereas the correlation for astigmatism was low. The mean difference AR-MR was -1.28±0.29 diopters (D) for sphere. Astigmatism showed better correlation between KR and MR. CONCLUSION: We suggest AR sphere plus 1.25 D and the KR cylinder as the starting point for MR in eyes with a Lentis Mplus X multifocal IOL. If AR measurements are equal to MR, decentration of the IOL should be suspected.     

Error induced by the estimation of the corneal power and the effective lens position with a rotationally asymmetric refractive multifocal intraocular lens

AIM:To evaluate the prediction error in intraocular lens (IOL) power calculation for a rotationally asymmetric refractive multifocal IOL and the impact on this error of the optimization of the keratometric estimation of the corneal power and the prediction of the effective lens position (ELP).METHODS:Retrospective study including a total of 25 eyes of 13 patients (age, 50 to 83y) with previous cataract surgery with implantation of the Lentis Mplus LS-312 IOL (Oculentis GmbH, Germany). In all cases, an adjusted IOL power (PIOLadj) was calculated based on Gaussian optics using a variable keratometric index value (nkadj) for the estimation of the corneal power (Pkadj) and on a new value for ELP (ELPadj) obtained by multiple regression analysis. This PIOLadj was compared with the IOL power implanted (PIOLReal) and the value proposed by three conventional formulas (Haigis, Hoffer Q and Holladay Ⅰ).RESULTS:PIOLReal was not significantly different than PIOLadj and Holladay IOL power (P>0.05). In the Bland and Altman analysis, PIOLadj showed lower mean difference (-0.07 D) and limits of agreement (of 1.47 and -1.61 D) when compared to PIOLReal than the IOL power value obtained with the Holladay formula. Furthermore, ELPadj was significantly lower than ELP calculated with other conventional formulas (P<0.01) and was found to be dependent on axial length, anterior chamber depth and Pkadj.CONCLUSION:Refractive outcomes after cataract surgery with implantation of the multifocal IOL Lentis Mplus LS-312 can be optimized by minimizing the keratometric error and by estimating ELP using a mathematical expression dependent on anatomical factors.     

青光眼-白内障联合术后患者屈光误差及其与术前眼球生物学参数的相关性

目的　对比分析原发性急性闭角型青光眼(PAACG)、原发性慢性闭角型青光眼(PCACG)、原发性开角型青光眼(POAG)患者行青光眼-白内障联合手术（青白联合手术）后3个月的屈光状态,评估术前眼球生物学参数对患者术后屈光状态的影响。方法　回顾性临床研究。选择2020年2月至2021年2月于山西省眼科医院行青白联合手术的青光眼合并白内障患者90例（108眼）,其中PAACG组30例（33眼）,PCACG组30例（38眼）,POAG组30例（37眼）。所有患者术前均采用IOLMaster 700测量眼轴长度、中央角膜厚度、角膜曲率、前房深度、晶状体厚度、白到白距离（WTW）,使用仪器自带的SRK-T公式计算人工晶状体度数及预留屈光度。术后3个月对患者进行综合验光,计算术后屈光误差。比较三组患者术后3个月的屈光误差分布,及术前眼球生物学参数与屈光误差的相关性。结果　三组患者间术前中央角膜厚度、角膜曲率、WTW差异均无统计学意义(均为P>0.05)。POAG组较PAACG组和PCACG组患者术前眼轴更长、前房更深、晶状体更薄,差异均有统计学意义(均为P<0.05),PAACG组与PCACG组患者间术前眼轴长度、前房深度、晶状体厚度相比差异均无统计学意义(均为P>0.05)。术后3个月,PAACG组、PCACG组、POAG组患者绝对屈光误差分别为(0.53±0.75)D、(0.51±0.70)D、(0.05±0.47)D。远视误差组患者术前眼轴长度短于近视误差组,术前前房深度浅于近视误差组,术前晶状体厚度厚于近视误差组,两组间相比差异均有统计学意义(均为P<0.05);两组患者间术前中央角膜厚度、角膜曲率与WTW之间差异均无统计学意义(均为P>0.05)。术后屈光误差与术前眼轴长度、前房深度均呈负相关(r=-0.62、-0.48,均为P=0.00),与术前晶状体厚度呈正相关(r=0.54,P=0.00),与术前中央角膜厚度、角膜曲率、WTW均无显著相关性(均为P>0.05)。结论　使用SRK-T公式计算人工晶状体度数时,PAACG、PCACG患者比POAG患者呈现较大的屈光误差,且多为远视误差。术前短眼轴、浅前房及厚晶状体患者青白联合手术后更趋于远视误差。     

晶状体玻璃体切割术联合内窥镜下睫状体光凝术治疗外伤性晶状体脱位继发性青光眼的疗效和安全性

目的 探讨晶状体玻璃体切割术联合内窥镜下睫状体光凝术(ECP)治疗外伤性晶状体脱位继发性青光眼的疗效和安全性。方法 选取2017年3月至2020年7月河北省眼科医院眼外伤科收治的外伤性晶状体脱位继发性青光眼患者55例(55眼)作为研究对象。取其中35例(35眼)患者作为观察组,行晶状体玻璃体切割术联合ECP+Ⅰ期人工晶状体悬吊术进行治疗;另20例(20眼)作为对照组,行晶状体玻璃体切割+人工晶状体悬吊联合其他抗青光眼手术。对照组患者中行晶状体玻璃体切割+人工晶状体悬吊联合小梁切除术10例,联合引流物植入术7例,联合睫状体分离术3例。术后1个月根据眼压降低情况评估手术效果,分析患者手术疗效、眼压、视力和并发症发生情况。结果 术后1个月,观察组完全成功24眼,部分成功8眼,失败3眼,手术成功率为91.43%;对照组完全成功8眼,部分成功6眼,失败6眼,手术成功率为70.00%。观察组手术成功率明显高于对照组(P<0.05)。观察组患眼术后1周、2周、1个月、3个月、6个月、9个月、12个月时眼压均较术前明显降低,差异均有统计学意义(均为P<0.05)。术后1个月,观察组视力进步...     

Comparative analysis of visual quality between unilateral implantation of a trifocal intraocular lens and a rotationally asymmetric refractive multifocal intraocular lens

AIM: To compare visual quality after unilateral cataract surgery with implantation of trifocal intraocular lens (IOL) and asymmetric refractive multifocal IOL. METHODS: The prospective nonrandom, comparative study consisted of 60 eyes of 60 patients suffering unilateral cataract surgery with implantation of two different IOLs: AT LISA tri 839MP (30 eyes; Carl Zeiss Meditec, Germany) and LS-313 MF30 (30 eyes; Oculentis GmbH, Germany). Visual acuity, refractive outcome, contrast sensitivity, defocus curves, quality of vision, and optical phenomena were evaluated at 3mo postoperatively. RESULTS: There were no statistical differences between groups in uncorrected distance visual acuity (P=0.13) and uncorrected near visual acuity (P=0.54). In contrast, uncorrected intermediate visual acuity was better in trifocal group compared to the refractive multifocal group (P=0.02). No significant statistical between-group difference was detected in cylinder (P=0.43). Compared to trifocal group, spherical refraction and spherical equivalent in refractive multi focal group were more myopic (P<0.01). Under photopic conditions, no significant statistical differences were found between groups in contrast sensitivity at 3 and 6 cycles per degree (cpd). The refractive multifocal group performed better at 12 and 18 cpd than the trifocal group (P=0.01, P=0.034, respectively). The questionnaires of quality of vision and optical phenomena showed no differences between groups. CONCLUSION: Trifocal IOL is superior to refractive multifocal IOL in intermediate visual acuity. Rotationally asymmetric refractive multifocal IOL is more myopic in automated refraction and significantly better for the photopic contrast sensitivity at high frequency.     

Symfony与两种不同附加度数双焦点人工晶状体植入术后患者视觉质量的对比研究

目的　比较三种多焦点人工晶状体植入术后患者的视力、屈光度、对比敏感度、视觉质量的差异。方法　前瞻性非随机对照研究。选择2016年6月至2019年9月在我院行白内障手术并植入人工晶状体的患者89例（89眼）,按植入的晶状体类型不同分为三组: Restor+3.0 D双焦点人工晶状体组（Restor+3.0 D组32例）、Restor+2.5 D组（30例）、Symfony 组（27例）。观察三组患者术后3个月的视力、屈光度、对比敏感度、脱镜率、眩光现象、视物满意度。结果　Symfony组患者的远视力优于Restor+3.0 D组（P<0.05）,Restor+3.0 D组获得了最佳的近视力（P<0.05)。Restor +2.5 D组和Symfony组提供了比Restor+3.0 D组更好的中视力（均为P<0.05）,特别在离焦-1.5 D处Restor +2.5 D组和Symfony组视力均明显好于Restor+3.0 D组（均为P<0.05)。Symfony组在任何空间频率下对比敏感度均显著优于Restor+3.0 D组和Restor+2.5 D组,差异均有统计学意义(均为P<0.05)。Restor +2.5 D组相比Symfony组 和Restor +3.0 D组有更高的脱镜率(均为P<0.05)。眩光和光晕现象三组患者间差异无统计学意义 (P=0.248)。视远满意度评分三组间差异无统计学意义(P>0.05);视中满意度评分Symfony组和Restor+2.5 D组均显著高于Restor+3.0 D组,差异均有统计学意义(均为P<0.05);视近满意度评分Restor+3.0 D组均显著高于Symfony组和Restor+2.5 D组,差异均有统计学意义(均为P<0.05), Symfony组高于Restor+2.5 D组,差异有统计学意义（P<0.05)。结论　白内障术后植入Symfony连续视程人工晶状体和Restor+2.5 D双焦点人工晶状体相比Restor +3.0 D双焦点人工晶状体都可以提供更好的中距离视力,但是植入Symfony连续视程人工晶状体可以获得更好的视觉质量。