衍射型多焦点人工晶状体植入术后临床效果

目的:探讨衍射型多焦点人工晶状体植入术后的临床效果。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AcrySof ReSTOR(Alcon),72例(109眼);单焦组植入单焦点人工晶状体AcrySof SA60AT(Alcon)作为对照,88例(130眼)。术后随访6~24mo,观察瞳孔直径,远近视力,最佳矫正视力,脱镜率,术后屈光状态、夜间视觉干扰现象等指标。结果:两组间在远视力和最佳矫正远近视力方面没有显著性差异,而近视力多焦组达到或超过J3的患者101眼(92.7%),单焦组12眼(9.2%),差异具有显著性(χ2=166.44,P=0.00)。两组完全脱镜率分别为98眼(89.9%)和9眼(6.9%)。多焦组完全脱镜的患者术后平均等效球镜为-0.03±0.45D(-1.0~+0.50D),6例7眼(6.4%)视近远时都需戴镜矫正,术后平均等效球镜+1.14D。结论:衍射型多焦点人工晶状体植入后能够使患者获得理想的远近视力,大大降低了患者对眼镜的依赖性。人工晶状体的屈光力测量精确性是增加术后脱镜率的重要因素,应该尽量避免术后等效球镜大于+0.50D。     

衍射型多焦点人工晶状体临床应用新进展

衍射型多焦点人工晶状体能使白内障患者在超声乳化白内障摘出联合人工晶状体植入术后获得良好的裸眼远视力、裸眼近视力和中间距离视力(30 cm～1 m),并获得良好的视觉效果.本研究将对衍射型多焦点人工晶状体在材料、设计、临床效果、术后不良症状等方面的进展进行综述.     

新型衍射型非球面多焦点人工晶状体的临床应用

目的比较白内障超声乳化联合植入新型衍射型非球面多焦点人工晶状体Tecnis AMO00及非球面单焦点人工晶状体Tecnis的临床效果。方法选择老年性白内障患者,根据植入的晶状体不同分为2组:多焦点组46例62眼,植入Tecnis AMO00新型衍射型非球面多焦点人工晶状体,单焦点组42例68眼,植入Tecnis非球面单焦点人工晶状体。术后1个月和3个月随访,观察术后裸眼远视力、裸眼近视力、最佳矫正远视力、最佳矫正近视力及中间距离视力,术后3个月进行角膜内皮计数及角膜地形图检查,问卷调查了解视觉症状和视觉满意度。结果术后1个月及3个月两组间患者裸眼远视力、最佳矫正远视力和最佳矫正近视力均无显著差异。术后1个月及3个月多焦点组裸眼近视力分别为0.65±0.27和0.68±0.28,中间距离视力分别为0.64±0.22和0.67±0.25,相比单焦点组术后1个月及3个月的裸眼近视力(分别为0.28±0.26和0.30±0.25)和中间距离视力(分别为0.27±0.25和0.29±0.27),具有明显优越性,差异均有统计学意义(均为P<0.05)。两组患者术前、术后的散光状态差异均有统计学意义(均为P<0.01),术前、术后的角膜内皮细胞计数差异亦均有统计学意义(均为P<0.01),两组之间术后角膜内皮细胞丢失率差异无统计学意义(P>0.05)。多焦点组脱镜率(96.77%)明显高于单焦点组(25.00%),差异有统计学意义(P<0.01)。多焦点组4例患者诉轻度光晕、眩光,但在可以忍受范围内。结论新型衍射型非球面多焦点人工晶状体Tecnis AMO00能提供良好的全程视力,有效降低患者对老视镜的依赖,提高白内障患者术后的视觉质量。     

两种非球面衍射多焦点人工晶状体植入术后视觉质量评价

目的:综合评价非球面AcrySof ReSTOR+4D和非球面AcrySof ReSTOR+3D两种多焦点IOL植入术后患者的视觉质量,并探讨其相关影响因素。方法:白内障患者40例80眼,随机分为两组。A组:非球面AcrySof ReSTOR+3D(SN6AD1)IOL植入组;B组:非球面AcrySof ReSTOR+4D(SN6AD3)IOL植入组,其中A组为实验组,B组为对照组。术后1d;1wk;1,3mo行常规检查,并检查术眼裸眼远(UCDVA)、中(UCIVA)、近视力(UCNVA)。术后3mo检查最佳矫正远(BCDVA)、近视力(BCNVA),以及最佳矫正远视力下的近(DCNVA)、中视力(DCIVA);检查对比敏感度及波前像差;绘制离焦曲线,并进行主观问卷调查评分。结果:术后1d;1wk;1,3mo,两组的UCDVA差异均无统计学意义(P>0.05),UCIVA的差异均有统计学意义(P<0.05)。UCNVA在术后第1d,两组间的差异有统计学意义(P<0.05),而在其余时间段,两组间差异无统计学意义(P>0.05)。术后3mo时,两组的BCDVA,BCNVA,DCNVA,DCIVA差异均无统计学意义(P>0.05);两组间总像差、高阶像差、球差间,差异无统计学意义(P>0.05);在各个视角水平有/无眩光下,对比敏感度差异无统计学意义(P>0.05)。离焦曲线显示:B组在+0.0D和-3.0D处形成两个焦点,而A组不仅在+0.0D和-2.5D处形成两个焦点,而且在-2.0～-2.5D之间可形成一个平台期。问卷调查显示:两组患者视远、视近的满意度较高;而视中距离时,A组患者满意度明显高于B组。两组患者术后视觉不良症状发生率,差异无统计学意义(t=-0.87,P>0.05)。结论:非球面AcrySof ReSTOR+3D IOL植入术后,为患者提供了良好的远、中、近全程视力,尤其是中距离视力较非球面AcrySof ReSTOR+4D IOL有了显著的改善,且没有明显的视觉干扰,提高了患者的视觉和生活质量。     

衍射折射型多焦点人工晶状体远期视觉质量观察

目的:测定衍射折射型多焦点人工晶状体眼术后远期的视觉质量。方法:采取随机对照临床试验研究方法,将67例白内障患者分两组,其中30例33眼植入多焦点人工晶状体,37例37眼植入单焦点人工晶状体。术后3mo和1a进行裸眼远视力、中间视力、近视力、矫正远、中、近视力和对比敏感度检查。视功能和生存质量调查问卷评价患者主观的视觉功能。结果:(1)术后多焦点组裸眼近视力优于单焦点组(P<0·05),中间距离视力亦优于单焦点组(P<0.05),两组裸眼和矫正远视力、近视力及最佳矫正远视力下近视力差异无显著性。术后1a和3mo相比,差异无显著性意义。(2)术后两组对比敏感度均低于正常范围,空间分布差异无统计学意义。(3)两组术后多焦点组脱镜率达83%,而单焦点组脱镜率为32%,两组比较差异有显著性(P<0·05)。多焦点组4例有眩光。多焦点组患者对全程视力的满意度高于单焦组患者。结论:多焦点人工晶状体能提供良好的全程视力,但近视力更好,视觉症状轻,脱镜率更高,有效地提高白内障患者术后的视觉质量。     

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.     

区域折射型与衍射型多焦点人工晶状体植入术后视觉质量对比研究

目的　比较区域折射型多焦点人工晶状体（multifocal intraocular lens，MIOL）和衍射型MIOL植入术后的全程视力和视觉质量。方法　采用前瞻性非随机病例对照研究。收集2016年6月至2017年7月在郑州大学第一附属医院眼科行超声乳化白内障摘出联合人工晶状体（intraocular lens，IOL）植入术患者50例60眼，其中行区域折射型MIOL植入术者28例33眼，为折射组，行衍射型MIOL植入术者22例27眼，为衍射组。术后1个月、3个月、6个月定期随访，检查患者视力、离焦曲线、对比敏感度、高阶像差及问卷调查，并对结果进行统计学分析。结果　术后6个月，折射组的裸眼中视力为（0.169±0.184）logMAR，优于衍射组的（0.331±0.145）logMAR （P＜0.05）。两组裸眼远视力、最佳矫正远视力、裸眼近视力比较，差异均无统计学意义（均为P＞0.05）。瞳孔直径为3 mm时折射组的彗差和三叶草分别为(0.13±0.06）μm、(0.21±0.14）μm，分别大于衍射组的(0.06±0.03）μm、(0.06±0.05）μm；而瞳孔直径为5 mm时折射组的彗差和三叶草分别为(0.38±0.17）μm、(0.59±0.21）μm，分别大于衍射组的(0.16±0.09）μm、(0.41±0.33）μm，差异均有统计学意义（均为P＜0.05）。在暗视条件下3 c·d^-1、6 c·d^-1和暗视+眩光条件下各空间频率的对比敏感度折射组优于衍射组，差异均有统计学意义（均为P＜0.05），暗视条件下12 c·d^-1、18 c·d^-1时两组的对比敏感度差异均无统计学意义（均为P＞0.05）。除中视力满意度折射组为100.0%，优于衍射组的74.1%（P＜0.05），在眩光、光晕干扰程度，远、近、夜间、暗处视力和总体满意度方面，两组差异均无统计学意义（均为P＞0.05）。结论　区域折射型MIOL与衍射型MIOL相比，裸眼中视力好，对比敏感度高，而彗差和三叶草差较大。     

双眼单焦点与多焦点人工晶状体混搭植入术后视觉质量评估

目的：比较主视眼植入单焦点人工晶状体(SIOL)、对侧非主视眼植入多焦点人工晶状体(MIOL)和双眼均植入SIOL的临床疗效。

方法：选取2019-01/2021-01于成都爱尔眼科医院行白内障超声乳化联合IOL植入术的年龄相关性白内障患者60例120眼,主视眼均已植入SIOL,根据对侧非主视眼植入IOL的类型分为三组,其中A组患者18例36眼非主视眼植入MIOL(SBL-3); B组患者19例38眼非主视眼植入MIOL(SN6AD1); 对照组23例46眼双眼均植入SIOL。术后3mo,评估并比较三组患者双眼视力及视觉质量。

结果：术后3mo,三组患者双眼裸眼和矫正远视力、裸眼中视力及矫正近视力均无差异(P>0.05),A组和B组患者双眼裸眼近视力和矫正中视力均显著优于对照组(P<0.05)。Catquest 9SF-CN量表评分显示,A组和B组患者(11.11±1.323、11.89±1.883分)视觉质量均优于对照组(14.65±1.722分,均P<0.05)。A组、B组和对照组患者脱镜率分别为88.9%、84.2%、39.1%,A组患者脱镜率显著高于对照组(P<0.0167)。

结论：白内障患者主视眼植入SIOL、对侧非主视眼植入MIOL(SBL-3/SN6AD1)可获得较双眼均植入SIOL更优的全程视力,术后不良视觉症状少,脱镜率及满意度高。     

多焦点人工晶状体的临床评价

评价目前在临床应用较为广泛的几种多焦点人工晶状体.相对于单焦点人工晶状体,多焦点人工晶状体可提供较好的全程视力,减轻患者术后对眼镜的依赖程度,但可增加视觉干扰的发生.如何减少术后视觉干扰,提高患者的视觉、视力效果等问题仍有待进一步改进.     

折射型多焦点人工晶状体与衍射型非球面多焦点人工晶状体术后视觉质量的临床分析

目的通过分别植入折射型多焦点人工晶状体（Rezoom MIOL）和衍射型非球面多焦点人工晶状体（Tecnis ZM900 MIOL）,观察植入术后的视力、对比敏感度、焦点深度及问卷调查,比较植入Rezoom MIOL和植入Tecnis ZM900 MIOL术后视觉质量。方法将52例（58只眼）拟行白内障超声乳化吸除术按照患者植入人工晶状体的不同分为两组：Rezoom组25例（28只眼）植入Rezoom MIOL,Tecnis组27例（30只眼）植入Tecnis ZM900 MI-OL,术后3个月,随访观察两组裸眼远视力、最佳矫正远视力、裸眼近视力、中间视力;并检查暗光条件下对比敏感度、焦点深度测量及问卷调查;对结果进行分析。结果术后3个月,两组最佳矫正远视力、裸眼远视力比较,差异无统计学意义（P〉0.05）;近视力比较,Tecnis组优于Rezoom组,差异有统计学意义（P〈0.05）;63 cm中距离视力比较,Rezoom组优于Tecnis组,差异有统计学意义（P〈0.05）;暗光（3 cd/m2）背景光线;1.5、3、6、12、18 c/d五种空间频率对比敏感度比较,Tecnis组优于Rezoom组,差异有统计学意义（P〈0.05）。术后3个月Rezoom组的焦点深度为4.56 D,Tecnis组焦点深度为5.10 D;Tecnis组与ReZoom组比较,差异无统计学意义（P〉0.05）。结论 Rezoom MIOL能提供较好的远、中距离视力;Tecnis ZM900 MIOL能提供较好的远、近视力。个性化的选择人工晶状体才能更好地提高术后视觉质量。     

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。     

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.     

All-distance visual acuity in eyes with a nontinted or a yellow-tinted diffractive multifocal intraocular lens

Purpose  To compare all-distance visual acuity (VA) between eyes with a nontinted diffractive multifocal intraocular lens (IOL), a yellow-tinted multifocal IOL, and a nontinted monofocal IOL. Methods  Thirty-four patients underwent bilateral implantation of a nontinted multifocal IOL (Alcon ReSTOR), 30 received a yellow-tinted multifocal IOL (ReSTOR Natural), and 17 a monofocal IOL. All-distance VA was measured with an all-distance vision tester at 12 months postoperatively. The relationships between pupillary diameter and IOL decentration and tilt with VA were determined. Results  Both uncorrected and best distance-corrected near VA in the multifocal groups were significantly better than those in the monofocal group, whereas no significant differences were found in far-to-intermediate VAs. There was no significant difference in all-distance VA between the nontinted and yellow-tinted multifocal groups. In the multifocal groups, a larger pupillary diameter was associated with better near VA, whereas there was no correlation between VA and IOL decentration and tilt. Conclusions  Near VA with a diffractive multifocal IOL was better than that with a monofocal IOL, although far-to-intermediate VAs were similar. All-distance VA with the nontinted multifocal IOL was similar to that with the yellow-tinted multifocal IOL. Larger pupillary diameter was associated with better near VA with the multifocal IOL.     

衍射型非球面多焦点人工晶状体眼视功能的初步观察

目的:初步观察植入TecnisZM900衍射型非球面多焦点人工晶状体眼视功能,以评价TecnisZM900衍射型非球面多焦人工晶状体植入的有效性及安全性。方法:共21例(30眼)行白内障超声乳化术患者植入Tec-nisZM900衍射型非球面多焦点人工晶状体,观察患者术后远、近视力,角膜散光度数,对比敏感度,手术并发症,问卷形式调查脱镜率、视觉不良症状和满意度,随访时间为术后3～12mo。结果:植入TecnisZM900MIOL患者术后3mo裸眼远、近视力分别为1.00±0.20,0.86±0.27;术前与术后3mo角膜散光度数比较,差异无显著意义(P>0.05);对比敏感度在低、中空间频率段均位于正常范围内,高空间频率段则有部分病例稍下降;脱镜率为86%(18/21)。结论:TecnisZM900衍射型非球面多焦点人工晶状体可为患者提供良好的远、近视力,86%的患者可摘掉眼镜。     

两衍射多焦点人工晶状体的光学性能与视觉质量对比研究

目的 比较白内障手术患者植入Tecnis ZMB00及AcrySof ReSTOR SN6AD1多焦点人工晶状体(multifocal intraocular lens,MIOL)后光学性能与视觉质量.方法 选取2012年3月至2015年7月于我院眼科择期进行白内障手术治疗的患者120例(130眼).所有患者均采用MIOL植入,并根据MIOL类型分为A组(Tecnis ZMB00组)、B组(AcrySof ReSTOR SN6AD1组),测定患者手术前后裸眼远视力(uncorrect distant visual acuity,UCDVA)、裸眼近视力(uncorrect near visual acuity,UCNVA)、裸眼中距离视力(uncorrecta intermediate vision,UCIVA)、最佳矫正远视力(best correct distant visual acuity,BCDVA)、最佳矫正近视力(best correct near visual acuity,BCNVA),均绘制离焦曲线,作对比敏感度分析,并采用术后视功能与生存质量调查表(VF-14)评定患者术后视觉质量.结果 术后1周、1个月、3个月A组UCNVA、UCIVA、BCNVA恢复情况均优于B组(均为P＜0.05),术后1周、3个月A组UCDVA恢复情况均优于B组,术后3个月等效球镜屈光度低于B组(P＜0.05).A组暗视、明视炫光、暗视炫光不同频率下对比敏感度均高于B组(均为P ＜0.05);A组术后3个月VF-14评分低于B组(P＜0.05);A组在0.0D与-2.5D形成2个波峰,-2.0～-2.5 D形成平台期,B组仅在0.0D与-3.0D形成2个波峰.结论 白内障手术患者植入Tecnis ZMB00 MIOL可改善患者术眼裸眼视力,提升对比敏感度,改善患者术后视功能及生活质量.     

Assessing the optical performance of multifocal (diffractive) intraocular lenses

BACKGROUND AND PURPOSE: While the optical performance of monofocal refractive lenses can be measured quite easily, more efforts are required to assess the performance of multifocal lenses, due to imaging to several foci. The purpose of this study was to develop a rugged test setup for evaluation of the optical properties of intraocular lenses (IOLs) in conformity to the International Standard ISO 11979. METHODS: We built a test setup in order to measure the point spread function and to determine the modulation transfer function (MTF) of IOLs. We measured three multifocal IOLs with (1) a diffraction limited model cornea and (2) an individualized aspheric model cornea which shows a significant amount of spherical aberration. RESULTS: All the three IOL samples tested showed a different impact of spherical aberration on the MTF. The bispheric lenses (Alcon and Dr Schmidt) showed a degradation of the MTF and Strehl ratio with model (2) compared to model (1). In contrast, the MTF of the Tecnis lens, which has a prolate aspheric front surface, improved dramatically in combination with model (2). CONCLUSION: We demonstrated the functional capability of our measurement system by presentation of a set of working examples. Two different model corneas were used to study the influence of spherical aberration on the MTF of our working examples. An aspheric model cornea, which had already been shown to be suitable for testing monofocal aspherics, was shown to be well suited for testing aspheric multifocal lenses.     

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.