疏水性和肝素修饰亲水性丙烯酸酯人工晶状体的临床应用效果对比

目的比较疏水性丙烯酸酯人工晶状体(intraocular lens,IOL)与肝素修饰的亲水性丙烯酸酯IOL的临床应用效果。方法 121例(152眼)白内障患者接受了白内障超声乳化摘出联合IOL植入术,其中64眼植入疏水性Sensar AR40e丙烯酸酯IOL为Sensar AR40e组,88眼植入肝素修饰的亲水性HQ201hep丙烯酸酯IOL为HQ201hep组。记录并比较2组术后3d裸眼视力、术后2a最佳矫正视力及后囊膜混浊(posterior capsular opacification,PCO)的发生情况。结果 2组间术后3d裸眼视力及术后2a最佳矫正视力的差异均无统计学意义(χ2=1.066、1.912,P=0.785、0.591)。术后2a PCO的发生率,Sensar AR40e组为15.63%(10/64),HQ201hep组为21.59%(19/88);2级和3级PCO的发生率Sensar AR40e组为1.56%(1/64),HQ201hep组为7.95%(7/88),2组间比较差异均无统计学意义(χ2=3.118、3.036,P=0.374、0.081)。进一步分析发现,在2组60岁以上患者的148眼中,Sensar AR40e组的1.56%(1/64)和HQ201hep组的3.57%(3/84)发生了2级或3级PCO,2组比较差异无统计学意义(χ2=0.055,P=0.814);Sensar AR40e组1.56%(1/64)和HQ201hep组2.38%(2/84)接受了Nd:YAG激光后囊膜切开术,2组比较差异无统计学意义(χ2=0.000,P=1.000)。结论疏水性丙烯酸酯IOL与肝素修饰的亲水性丙烯酸酯IOL植入术后的视力和PCO程度无统计学差异。     

Comparison of the long-term clinical results of hydrophilic and hydrophobic acrylic intraocular lenses

This study was performed to compare the incidence of posterior capsular opacity (PCO) and refractive errors between hydrophilic (ACR6D, Corneal) and hydrophobic (MA60BM, AcrySof) acrylic intraocular lenses (IOLs) over a 3-year follow-up after phacoemulsification surgery. The patients with AcrySof implanted in one eye and Corneal in the other eye were categorized as Group 1 (n=28), while those with one or both eyes implanted with IOLs of the same kind were categorized as Group 2 (AcrySof, n=90; Corneal, n=95). Refractive errors were evaluated at 3 months and 3 years postoperatively. The incidence of visually significant PCO was investigated 3 years postoperatively. Postoperative refractive values at 3 months were not significantly different between the two groups. However, refractive values at 3 years were significantly different between two IOLs in both groups [AcrySof -0.37+/-0.43D, Corneal -0.62+/-0.58D in Group 1 (p=0.04); AcrySof -0.38+/-0.52, Corneal -0.68+/-0.54 in Group 2 (p<0.01)]. The incidence of visually significant PCO was 14% and 32% in Group 1, and 13% and 28% in Group 2, for the AcrySof and Corneal implants, respectively. The incidence of visually significant PCO of hydrophilic acrylic IOLs was higher than that of hydrophobic acrylic IOLs in the 3-year follow-up. The postoperative 3-year refractive value of Corneal showed myopic shift.     

肝素表面修饰的亲水性丙烯酸酯人工晶状体在超声乳化联合小梁切除术中的应用

目的比较肝素表面修饰的亲水性丙烯酸酯人工晶状体和非肝素表面修饰的亲水性丙烯酸酯人工晶状体在晶状体超声乳化及人工晶状体植入联合小梁切除手术后的前房炎症反应。方法29例(29眼)施行晶状体超声乳化及后房型人工晶状体植入联合小梁切除手术者分为A组和B组:A组(15例)植入非肝素表面修饰的亲水性丙烯酸酯人工晶状体,B组(14例)植入肝素表面修饰的亲水性丙烯酸酯人工晶状体。于术后1d、7d、1月及3月随访观察。结果术后1d两组的房水闪光值和细胞计数均显著上升,术后7d下降明显,其后逐渐下降,术后3个月基本恢复至术前水平。两组间房水闪光值和细胞计数在术后1d和第7d差异有统计学意义(P<0.05),而术后第1月、3月两组间差异无统计学意义(P>0.05)。术后3个月,两组间最佳矫正视力及眼压的差异均无统计学意义(P>0.05)。结论肝素表面修饰的亲水性丙烯酸酯人工晶状体可改善人工晶状体的生物相容性,较非肝素表面修饰者更能减轻术后炎症反应,尤其有利于白内障联合青光眼术后早期阶段的视力康复。     

Comparison of anterior capsule contraction between hydrophobic and hydrophilic intraocular lens models

Background  

To compare the incidence of anterior capsule contraction syndrome (ACCS) after hydrophobic and hydrophilic intraocular lens (IOLs) implantation.     

Glare disability in patients with hydrophilic and hydrophobic acrylic intraocular lens implants

PURPOSE: To compare glare disability test results in patients with hydrophilic and hydrophobic acrylic intraocular lenses (IOL). METHODS: Sixty eyes of 60 patients were studied in three groups of 20. Each eye in Group 1 had a single-piece hydrophilic acrylic (Bioacryl, Biotech, France) IOL implant, and each eye in Group 2 had a three-piece hydrophobic acrylic (AcrySof, Alcon, USA) IOL implant. Group 3 was the control group, and consisted of eyes without cataracts. Glare disability was tested using the Ophthimus glare sensitivity test (Ophthimus, Sweden). For each eye, we determined log contrast sensitivity values without exposure to glare source and with exposure to glare source. The difference between these values was recorded as the threshold contrast increase. An infrared camera was used to measure pupil diameter during glare disability testing, and pupil diameter greater than 4 mm was used as an exclusion criterion to eliminate edge design as a potential contributor to glare disability. RESULTS: The respective mean log contrast sensitivity scores for Groups 1, 2, and 3 in the absence of the glare source were 0.80 +/- 0.03, 0.81 +/- 0.04, and 0.79 +/- 0.08. The corresponding findings with glare source were 0.84 +/- 0.07, 0.89 +/- 0.07, and 0.84 +/- 0.03. The threshold contrast increase in Group 2 (0.070 +/- 0.035) was significantly higher than that in both Group 1 (0.043 +/- 0.040) and the control group (0.045 +/- 0.026) (p < 0.05 for both comparisons). There were no significant differences between Group 1 and the control group regarding log contrast sensitivity values with glare source and threshold contrast increase (p > 0.05 for both comparisons). CONCLUSIONS: The eyes with hydrophilic acrylic IOL showed better glare disability results than those with hydrophobic acrylic IOL. The superior performance of the hydrophilic acrylic IOL could be related to their lower refractive index and equi-convex design.     

Comparison of posterior capsule opacification rates between hydrophilic and hydrophobic single-piece acrylic intraocular lenses

PURPOSE: To determine the effect of intraocular lens (IOL) material on the development of posterior capsule opacification (PCO) at 1 year. SETTING: Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. METHODS: One hundred six eyes of 53 patients with bilateral cataract and no other ocular comorbidity were prospectively randomized to receive a hydrophobic acrylic or hydrophilic acrylic single-piece IOL in the first eye to have surgery. The alternate IOL was implanted in the fellow eye 4 to 6 weeks later. All surgery was performed by a single surgeon. Postoperative follow-up was 1 day, 1 and 6 months, and 1 year. At each visit, the best corrected high- and low-contrast visual acuities were assessed and a high-intensity digital retroillumination photograph was taken. Posterior capsule opacification was assessed from the digital images by a single operator using a dedicated software program and calculated as the percentage area of opacified capsule. RESULTS: One year postoperatively, the median percentage area of PCO was 50.3% in the hydrophilic IOL group and 4.9% in the hydrophobic IOL group (P<.001). The difference in PCO was not accounted for by loss of contact between the capsulorhexis and IOL surface. Further analysis showed that lens epithelial cells tended to invade the posterior capsule at the haptic-optic junction. This was more marked in the hydrophilic IOL group. CONCLUSIONS: The rate of PCO was significantly higher with the hydrophilic IOL. However, the results cannot be attributed to the IOL material alone as they show the importance of both IOL material and design.     

相同直径亲水性和疏水性丙烯酸酯人工晶状体波阵面像差研究

目的利用波阵面像差仪检测探讨白内障患者行超声乳化并植入不同材料的折叠式人工晶状体术后波阵面像差的变化,讨论其相关性,对人工晶状体的材料选择具有指导意义,最大限度消除术后像差的存在,使患者获得最佳视网膜成像质量。方法随机选取自愿接受超声乳化合并人工晶状体植入手术的白内障患者(排除眼科其它疾病及相关全身疾病)共66人70眼,随机分为两组:A组植入光学直径6.0mm疏水性丙烯酸酯(Acrysof SA60AT)人工晶状体32例32眼;B组植入光学直径6.0mm亲水性丙烯酸酯(Isotechnics HP25B)人工晶状体38例38眼;其中4例8眼患者为左右眼自身对比。各组年龄之间具有可比性,由同一术者施行此手术,术后观察患眼波阵面像差及其它相关的变化。结果在瞳孔直径为4.0mm、5.0mm、6.0mm、7.0mm时,A组和B组的高阶像差均方根RMSh无显著性差异(P>0.05);两组RMS3无显著性差异(P>0.05);两组C12值亦无显著性差异(P>0.05)。结论1.人工晶状体眼的高阶像差随瞳孔直径增大而增大;2.在瞳孔直径4.0mm、5.0mm、6.0mm、7.0mm时,亲水性与疏水性丙烯酸酯人工晶状体眼的高阶像差均方根、彗差和球差均无显著性差异。     

Comparison of posterior capsular opacification in heparin-surface-modified hydrophilic acrylic and hydrophobic acrylic intraocular lenses

Purpose  To compare posterior capsular opacification (PCO) in a heparin-surface-modified (HSM) hydrophilic acrylic intraocular lens (IOL) and a hydrophobic acrylic IOL. Methods  Seventy-eight patients with simple cataract were randomized to receive either the BioVue 3 HSM hydrophilic acrylic IOL (Ophthalmic Innovations International, Ontario, CA, USA) (n = 38) or the Sensar AR40e hydrophobic acrylic IOL (AMO, Santa Ana, CA, USA) (n = 40). Another 99 patients with complicated cataract received either the BioVue 3 (n = 49) or the Sensar AR40e IOL (n = 50). Twelve months after surgery, POCOman software was used to analyze digital retroillumination photographs of the PCO. Results  In the simple cataract group, the respective PCO areas, expressed as a percentage and PCO severity scores at 12 months were 6.12% and 0.081 in the BioVue 3 group and 5.91% and 0.075 in the Sensar AR40e group. There was no statistically significant difference in the PCO area or the PCO severity score between the two IOLs (P = 0.631, P = 0.495, respectively). In the complicated cataract group, the respective PCO areas and PCO severity scores were 35.80% and 0.181 in the BioVue 3 group and 27.17% and 0.110 in the Sensar AR40e group. There was no statistically significant difference between the two IOLs (P = 0.147, P = 0.162). Conclusion  There was no difference in the degree or severity of PCO between the HSM hydrophilic acrylic IOL and the hydrophobic acrylic IOL groups.     

儿童先天性白内障摘出肝素化人工晶状体植入

目的　评价儿童先天性白内障摘出联合肝素化人工晶状体植入术的疗效。方法　对46例(62眼) 2～14岁先天性白内障行白内障吸出联合肝素化人工晶状体植入术。随访6月以上,对术后视力变化及并发症进行分析。结果　术后1天、1周和6月矫正视力达0 .3的分别为4眼(6. 45 % )、13眼(2 0 .97% )和40眼(64. 5 2 % )。2 8眼发生后发障。结论　白内障摘出联合肝素化人工晶状体植入术治疗儿童先天性白内障,术后并发症较少,后囊浑浊程度较轻。     

Comparison of a hydrophilic and a hydrophobic apodized diffractive multifocal intraocular lens

To compare outcomes between a new design apodized diffractive hydrophilic multifocal intraocular lens (IOL) (Seelens MF; study group), and a well-known apodized diffractive hydrophobic multifocal IOL (SN6AD1; control group). A comparative case series comparing refractive and visual outcomes at distance and near. Patient satisfaction with a validated questionnaire, dysphotopsia and straylight measurement scores were recorded at 3 months post-operatively. The study group comprised 48 eyes and the control group 37 eyes. At 3 months post-operatively the mean uncorrected distance visual acuity (UDVA) was not statistically significant different between the study group and the control group (0.02 ± 0.07 logMAR [SD] vs 0.04 ± 0.09 logMAR). Corrected distance visual acuity (CDVA) was statistically significantly better with the study lens (?0.04 ± 0.05 logMAR vs ?0.01 ± 0.04 logMAR (p < 0.019). There was no clinical or statistical significant difference at the 40 cm distance (0.09 ± 0.12 logMAR vs 0.08 ± 0.09 logMAR). The study group had statistically significant better uncorrected near acuity at 50 and 60 cm distances (p < 0.03 and p < 0.007, respectively). In terms of satisfaction the lenses performed equally. Halos were seen less often with the study lens. Straylight, as a parameter for visual quality, was significantly less with the study lens. Conclusion: The Seelens MF performs equally as well as the well-known SN6AD1 for UCDA and CDVA. The Seelens MF performs better at intermediate distance, and seems to allow for better depth of focus, and increased visual quality. More study is needed to corroborate the last finding.     

肝素表面修饰可折叠亲水性丙烯酸酯人工晶状体对白内障术后炎症反应影响的评测

目的：：调查使用激光房水闪光细胞仪评测肝素表面修饰的和无肝素表面修饰的可折叠亲水性丙烯酸酯人工晶状体对前房炎症反应的影响。方法：研究组22例22眼被植入肝素表面修饰的可折叠亲水性丙烯酸酯人工晶状体,对照组21例21眼被植入无肝素表面修饰的的可折叠亲水性丙烯酸酯人工晶状体。分别在术后1、7和28d,使用激光房水闪光细胞仪检测其前房房水细胞密度和闪光数值。结果：在术后1,7d,肝素表面修饰的可折叠亲水性丙烯酸酯人工晶状体组的患者前房房水的细胞密度数值和闪光数值显著低于无肝素表面修饰人工晶状体组患者的检测数值。在术后28d,两者间细胞密度数值和闪光数值无明显差别。结论：肝素表面修饰的可折叠亲水性丙烯酸酯人工晶状体与无肝素表面修饰人工晶状体相比,可以降低白内障术后早期炎症反应。激光房水闪光细胞仪可以安全、客观地评测前房炎症反应。     

Reversible opacification of a hydrophilic acrylic intraocular lens

A 56-year-old woman with diabetic retinopathy and chronic myelogenous leukemia had phacoemulsification cataract removal and hydrophilic acrylic intraocular lens (IOL) (Akreos MI-60) implantation in both eyes. One month after surgery, significant IOL opacity and severe cystoid macular edema were observed in both eyes. After bilateral intravitreal injection of bevacizumab (Avastin) to control macular edema, central clearing of the IOL opacity was observed in both eyes. Two months after the injection, the IOL opacity had almost disappeared from both eyes. To our knowledge, this is the first case of early postoperative bilateral IOL opacity in a hydrophilic acrylic IOL cleared after anti-vascular endothelial growth factor (VEGF) intravitreal injection. The role of anti-VEGF therapy in clearing IOL opacification requires further investigation.     

In-the-bag dislocation of a hydrophilic acrylic intraocular lens

We report a case of a dislocated hydrophilic acrylic intraocular lens (IOL) inducing astigmatism and causing chronic pain and cystoid macular edema as a result of a folded haptics, which mechanically irritated the iris. Scanning electron micrographs of the explanted IOL, including the capsular bag, showed a folded IOL haptic incarcerated in the capsular bag.     

新一代疏水性丙烯酸人工晶状体临床应用观察

目的:观察和评估新一代疏水性丙烯酸人工晶状体SensarAR40e的临床应用疗效及与硅胶人工晶状体的比较。方法:对46例(92眼)白内障患者行超声乳化吸除人工晶状体植入手术,1眼植入SensarAR40e人工晶状体,另1眼植入新型硅胶人工晶状体。观察SensarAR40e人工晶状体的植入性能、术中并发症、术后视力、术后前房反应、人工晶状体位置、后发障及以上指标与硅胶人工晶状体的对比情况。随访时间为6mo。结果:术后1wk,平均裸眼远视力为0.57±0.20,术后1,3,6mo,平均最佳矫正远视力分别为0.81±0.16,0.77±0.19,0.71±0.25;术后前房反应轻微;术后3,6mo,SensarAR40e人工晶状体眼后发障眼分别为2,4,硅胶眼则为4,12;未发现人工晶状体明显移位者。结论:SensarAR40e人工晶状体具有良好的植入性能、光学中心定位性能,术后反应轻,后发障发生率低,手术疗效满意。