Diffractive trifocal pseudophakic intraocular lenses in high myopic eyes: 2-year assessment after implantation

Graefe's Archive for Clinical and Experimental Ophthalmology - To assess the visual outcomes and ocular safety when implanting diffractive trifocal intraocular lenses in a population of high...     

三焦点人工晶状体植入术后中期立体视功能及视觉质量研究

目的　评价三焦点非球面衍射型人工晶状体植入术后的双眼立体视功能及视觉质量。方法　非随机同期对照临床研究。对38例76眼单纯性白内障患者行超声乳化吸出联合人工晶状体植入术，依据植入人工晶状体类型不同分为2组:双眼均植入三焦点人工晶状体组18例36眼为三焦组，双眼均植入单焦点人工晶状体组20例40眼为单焦组。随访记录2组患者术后双眼近立体视功能、视力［单眼及双眼裸眼远距离视力（uncorrected distance visual acuity，UDVA）、裸眼中距离视力（uncorrected intermediate visual acuity，UIVA）、裸眼近距离视力（uncorrected near visual acuity，UNVA）、矫正远距离视力（corrected distance visual acuity，CDVA）、矫正远视力基础上的中距离视力（distance-corrected intermediate visual acuity，DCIVA）、矫正远视力基础上的近距离视力（distance-corrected near visual acuity，DCNVA）］和等效球镜度。利用VF-14-CN量表行主观问卷调查，对夜间光晕及老视眼镜依赖与否行问卷并记录；利用双通道视觉质量分析系统测量客观散射指数、调制传递函数截止频率（modulation transfer function，MTF-cutoff）、斯特列尔比值（strehl ratio，SR）及100%、20%、9%对比度视力（contrast visual acuity，CVA）等指标。结果　三焦组术后近立体视功能明显优于单焦组（P=0.001）。三焦组和单焦组所有术眼术后单眼UDVA较术前均明显提高（均为P<0.05）。三焦组单眼UDVA、UIVA、UNVA均明显优于单焦组（均为P<0.05）；三焦组单眼DCDVA与单焦组差异无统计学意义（P>0.05），但DCIVA和DCNVA均明显优于单焦组（均为P<0.01）。三焦组双眼UDVA、UIVA、UNVA均明显优于单焦组（均为P<0.01）；三焦组双眼DCDVA与单焦组比较差异无统计学意义（P>0.05），但DCIVA和DCNVA均明显优于单焦组（均为P<0.01）。两组等效球镜度差异无统计学意义（P=0.437）。VF-14量表评分单焦组明显低于三焦组（P=0.000）。90.0%单焦组患者依赖老视眼镜，5.6%三焦组患者依赖老视眼镜，差异有统计学意义（P=0.000）；两组眩光发生率差异无统计学意义（P=0.437）；两组夜间光晕发生率（单焦组2/20，三焦组7/18）差异有统计学意义（P=0.027）。三焦组和单焦组客观散射指数、斯特列尔比值、调制传递函数截止频率差异均无统计学意义（均为P>0.05）。三焦组100%CVA、20%CVA均好于单焦组（均为P<0.01）；9%CVA两组差异无统计学意义（P>0.05）。结论　双眼植入三焦点人工晶状体患者可获得良好的立体视功能和视觉质量，术后满意度高。     

高度近视白内障植入不同类型人工晶体的临床观察

目的观察高度近视白内障植入不同类型人工晶体的临床疗效。方法对高度近视白内障患者58例(65眼)行超声乳化及bigbag人工晶体植入术,按类似的眼轴长度及晶体核硬度分级,选择回顾性分析高度近视白内障行超声乳化及ACR6DSE人工晶体植入术患者44例(46眼),分别观察术后视力及矫正视力、屈光度及其与术前估计屈光度的差值、对比敏感度、波前像差、术后并发症等。术后随访时间1～24月。结果(1)bigbag组术后1个月裸眼视力≥0.5者38只眼,占58.3%,3个月裸眼视力≥0.5者39只眼,占59.3%;ACR6DSE组术后1个月裸眼视力≥0.5者25只眼,占56.3%,3个月裸眼视力≥0.5者23只眼,占50%。(2)术后3月,实际屈光度数与术前估计值相差bigbag组≤±1D者43只眼,占66.2%;ACR6DSE组相差≤±1D者22只眼,占47.8%。(3)术后24月,Bigbag组后囊膜混浊者4只眼(6.2%);ACR6DSE组后囊膜混浊者5只眼(10.9%),晶体偏位1只眼(2.2%),黄斑水肿1只眼(2.2%)。两组后发障均未行YAG激光治疗,差异无统计学意义。(4)两组对比敏感曲线均低于正常值,差异无统计学意义。(5)总像差RMS值bigbag组低于ACR6DSE组,p<0.05,差异有统计学意义。结论高度近视白内障植入特殊设计的人工晶体,具有术后预留度数准确、较好术后视觉质量等优点,但能否减少后发障及眼底并发症等,仍需长期大量的临床观察。     

Optical quality of hyperopic and myopic phakic intraocular lenses

Aims:

To assess and compare the optical quality of the myopic and hyperopic implantable collamer lens (ICL) from its wavefront aberrations for different powers and pupil diameters.

Settings and Design:

Prospective study.

Material and Methods:

The wavefront aberrations of two myopic (−3 and −6 diopters (D)) and two hyperopic V4b ICLs (+3 and +6D) were measured in vitro. To assess and compare the optical quality of different powers of ICLs, we analyzed the root mean square (RMS) of total higher order aberrations (HOAs), trefoil, coma, tetrafoil, secondary astigmatism, and spherical aberration at 3- and 4.5-mm pupil. In addition, the point spread functions (PSFs) of each ICL evaluated were calculated from the wavefront aberrations at 3- and 4.5-mm pupil.

Statistical Analysis:

A Student''s t-test for unpaired data was used for comparison between myopic and hyperopic ICLs.

Results:

Myopic ICLs showed negative spherical aberration, in contrast hyperopic ICLs showed positive spherical aberration, which increases when the ICL power increases, due to the innate optical properties of the lens. All ICLs evaluated had negligible amounts of other aberrations. We did not find statistical significant differences in any Zernike coefficient RMS values analyzed between myopic and hyperopic ICLs at 3- and 4.5-mm pupil (P > 0.05).

Conclusions:

Myopic and hyperopic ICLs provide good and comparable optical quality for low to moderate refractive error. The ICLs evaluated showed values of wavefront aberrations clinically negligible to affect the visual quality after implantation.     

Rate of cataract formation in 343 highly myopic eyes after implantation of three types of phakic intraocular lenses

PURPOSE: To assess the feasibility of using phakic intraocular lenses (PIOL) to treat high myopia, and evaluate the incidence of cataract, comparing three different lens types. METHODS: From 1989 to 2002, we implanted three different phakic intraocular lenses (PIOL) in 343 eyes of 232 patients; 231 eyes recieved an Ophtec (Worst-Fechner model, iris-claw), 89 an Adatomed (silicone posterior chamber), and 23 a Staar (posterior chamber, models V2, V3, V4). Average follow-up was 96.2 months for the Ophtec group, 31.5 months for the Adatomed group, and 19.3 months for Staar group. Eyes that subsequently developed cataract were studied for clinical evolution and had PIOL explantation and cataract extraction. RESULTS: Nuclear cataract developed in 7 of 231 eyes (3.04 %) with an Ophtec lens. Anterior subcapsular cataract developed with the two types of posterior PIOLs (Adatomed group: 38/89 eyes, 42.69%; Staar group: 3/23 eyes, 13.04%). Anterior subcapsular cataract in the Adatomed group developed more rapidly compared to the Staar group. We explanted 7 lenses in the Ophtec group, 16 lenses in the Adatomed group, and 2 lenses in the Staar group (models V2 and V3 only). Patient age older than 40 years at implantation of PIOLs and axial length greater than 30 mm were factors significantly related to nuclear cataract formation and the Ophtec lens. However, these two factors had a weaker correlation with the posterior phakic lenses (Adatomed, Staar) for high myopia than with the Ophtec lens. Postoperative best spectacle-corrected visual acuity remained stable after explantation, phacoemulsification, and posterior chamber lens implantation. CONCLUSIONS: Delayed cataract development and cataract type (nuclear) in patients with an Ophtec lens and the variables of patient age (>40 yr) and axial length (>30 mm) may considered prognostic factors. Other factors such as lens design, material, and placement probably influenced cataract formation in patients with the Adatomed and Staar PIOLs. The lens styles used in this study are no longer manufactured.     

不同Kappa角眼多焦点人工晶状体植入术后的视觉质量

目的探讨不同Kappa角眼多焦点人工晶状体植入术后视觉质量的差异。方法前瞻性观察研究。选取第三军医大学大坪医院野战外科研究所眼科行白内障超声乳化摘除联合多焦点人工晶状体植入术的年龄相关性白内障患者47例（47眼）,年龄46~81岁。根据术前Kappa角（角膜上视轴和光轴的距离r）的大小将患者分为2组：A组（0＜r≤0.17 mm）24例（24眼）,B组（0.17 mm＜r≤0.40 mm）23例（23眼）。术后随访3个月,记录裸眼远、中、近视力,调制传递函数截止频率（MTF cutoff）,斯特列尔比（SR）和对比敏感度（CS）,是否出现视觉不良症状及是否戴镜。2组样本中裸眼远、中、近视力,MTF cutoff,SR和CS比较采用独立样本t检验,眩光和光晕的发生率比较采用χ2检验。结果B组光晕发生率显著高于A组,差异有统计学意义（χ2=4.997,P<0.05）;术后2组裸眼视力、MTF cutoff、SR、CS及眩光的发生率差异均无统计学意义（P>0.05）。结论Kappa角对多焦点人工晶状体植入术后视觉质量无显著影响,但是对术后视觉不良症状可能有影响。     

两种不同附加度数的多焦点人工晶状体植入术后视觉质量对比研究

目的评价两种具有不同附加度数的AcrySof ReSTOR人工晶状体(SN60D3和SN6AD1)植入术后的视觉质量。方法收集2009年4月至2010年3月在北京同仁医院就诊的白内障患者共69例(80眼),随机植入多焦点人工晶状体AcrySofRe-STORSN60D3(+4D组)35例(40眼)和SN6AD1(+3D组)34例(40眼)。入选患者分别在超声乳化术后植入AcrySofRe-STOR多焦点人工晶状体SN60D3或SN6AD1,观察术后1个月和3个月裸眼远视力(5m)、裸眼近视力(33cm)、裸眼中间视力(40cm、63cm、100cm);术后3个月拟调节力、对比敏感度和眩光敏感度;问卷调查患者术后不良视觉症状的发生率和脱镜率。结果 +3D组裸眼中间视力(63cm)在术后1个月时为0.70±0.27、术后3个月时为0.72±0.15,明显优于+4D组0.43±0.14、0.45±0.14,差异均有统计学意义(均为P<0.05),而术后1个月、3个月裸眼远视力(5m)、裸眼近视力(33cm)、裸眼中间视力(40cm、100cm)差异均无统计学意义(均为P>0.05)。术后3个月+3D组的拟调节力为(5.45±0.56)D,优于+4D组的(4.90±0.38)D,差异有统计学意义(均为P<0.05)。2组视角6.3°、4.0°、2.5°、1.0°、0.7°对比敏感度差异均有统计学意义,+3D组优于+4D组(均为P<0.05)。视角6.3°、4.0°、2.5°、1.6°、0.7°眩光敏感度差异均有统计学意义,+3D组优于+4D组(均为P<0.05)。在调查问卷中两组视觉不良症状的发生率、脱镜率差异均无统计学意义(均为P>0.05)。结论两种不同附加度数的AcrySofReSTOR人工晶状体SN60D3和SN6AD1均可以提供良好的远视力、近视力、较高的术后脱镜率,低度数附加的SN6AD1具有更为理想的全程视力和视觉质量。     

前房型人工晶状体植入治疗高度近视眼

目的探讨前房内植入房角支撑型硬性人工晶状体治疗高度近视眼的预测性、安全性和有效性。方法40例(76只眼)高度近视眼患者,术前屈光度数为-9.50～-26．25 D,平均(-15．89±3.78)D,术前最佳矫正视力0．5～1．0,植入房角支撑型硬性人工晶状体(Phakic 6H型)矫正高度近视眼,平均随访时间为1年。术前术后观察裸眼视力、矫正视力、届光度数、眼压、角膜内皮和眼前节的变化等。结果术后1年,裸眼视力为0．3～1．5,最佳矫正视力0．5～1．5,残余屈光度数为-2.00～+0．50 D,平均(-0．40±0．64)D,屈光度数在≤±1．00 D以内占96．1％。术前和术后1年角膜内皮细胞计数分别为(3174±248)个／mm2和(3067±320)个／mm2,两者比较,差异有统计学意义(P<0．01)。术前和术后1年眼压分别为(16．12±2.32)mm Hg(1mm Hg=0．133 kPa)和(15．29±3．38)mm Hg,两者比较,差异有统计学意义(P<0．05)。4只眼主诉有眩光。2只眼瞳孔呈竖椭圆形,2只眼晶状体下偏约1．0 mm。1例患者双眼在术后8个月时曾出现黄斑区出血。结论有晶状体眼房角支撑型硬性人工晶状体治疗超高度近视眼安全有效,且预测性好,值得进一步临床研究,长期疗效和安全性有待进一步观察。     

Changes in visual performance after implantation of different intraocular lenses

AIM: To evaluate the trending visual performance of different intraocular lenses (IOLs) over time after implantation. METHODS: Ninety-one patients received cataract surgery with implantations of monofocal (Mon) IOLs, segmental refractive (SegRef) IOLs, diffractive (Dif) IOLs, and extended-depth-of-focus (EDoF) IOLs were included. The aberrations and optical quality collected with iTrace and OQAS within postoperative 6mo were followed and compared. RESULTS: Most of the visual parameters improved over the postoperative 6mo. The postoperative visual acuity (POVA) of the Mon IOL, SegRef IOL, and EDoF IOL groups achieved relative stability in earlier states compared with the Dif IOL group. Nevertheless, the overall visual performance of the 3 IOLs continued to upturn in small extents within the postoperative 6mo. The optical quality initially improved in the EDoF IOL group, then in the Mon IOL, SegRef IOL, and Dif IOL groups. POVA and objective visual performance of the Mon IOL and EDoF IOL groups, as well as POVA and visual quality of the Dif IOL group, improved in the postoperative 1mo and stabilized. Within the postoperative 6mo, gradual improvements were observed in the visual acuity and objective visual performance of the SegRef IOL group, as well as in the postoperative optical quality of the Dif IOL group. CONCLUSION: The visual performance is different among eyes implanted with different IOLs. The findings of the current study provide a potential reference for ophthalmologists to choose suitable IOLs for cataract patients in a personalized solution.     

两焦点与三焦点人工晶状体植入术后视觉质量的比较

目的:比较两焦点(AT LISA 809MP)和三焦点(AT LISA tri 839MP)IOL植入术后的视觉质量。方法:回顾性研究。共收集2018-03/2019-02行超声乳化吸除术联合多焦点IOL植入术的白内障患者28例49眼。两焦点组18例30眼,年龄40~85(平均67.08±10.80)岁。三焦点组10例19眼,年龄38~79(平均62.21±14.50)岁。所有患者均行视觉质量分析系统(OQAS)、离焦曲线等检查。结果:两焦点组近BCVA优于三焦点,三焦点组中UCVA和远BCVA均优于两焦点组(P<0.05)。三焦点组+1.5、-1.0、-1.5、-2.0、-2.5、-3.0D视力显著优于两焦点组。两组间OQAS视觉质量参数两焦点组OV 20%、OV 9%、SR均优于三焦点组(P<0.05)。结论:两焦点和三焦点IOL植入术后均可获得良好的裸眼远和近视力,视觉质量均较高,而三焦点IOL可获得更佳的中间视力。     

The binocular intraocular lens power difference in eyes with different axial lengths

AIM: To investigate the binocular intraocular lens (IOL) power difference in eyes with short, normal, and long axial lengths (AL) using Lenstar LS 900 optical biometry. METHODS: A total of 716 (1432 eyes) participants were included. The groups were categorized into short (group A: AL<22 mm), normal (group B: 22 mm≤AL≤25 mm), and long AL groups (group C: AL>25 mm). The central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), AL, anterior corneal keratometry, white-to-white (WTW), pupil diameter (PD), as well as IOL power calculated using embedded Barrett formula were assessed. Bland-Altman plots were used to test the agreement of the binocular parameters. RESULTS: In group A, the CCT of the right eye was significantly thinner than that of the left eye (P=0.044) with a difference of -2±8 μm [95% limits of agreement (LoA), -17.8 to 13.2 μm]. For group B, the PD and IOL power in the right eye were significantly lower than those of the left eye (P=0.001, <0.001) with a difference of -0.05±0.32 mm (95%LoA, -0.68 to 0.58 mm) and -0.18±1.01 D (95%LoA, -2.2 to 1.8 D). The AL of right eye was longer than that of the left eye (P=0.002) with a difference of 0.04±0.25 mm (95%LoA, -0.45 to 0.52 mm). No significant difference was observed for all the binocular parameters in group C. The percentage of participants with binocular IOL power difference within ±0.5 D were 62% (31/50), 68.3% (339/496), and 38.8% (66/170) in groups A, B, and C, respectively. CONCLUSION: The binocular parameters related to IOL power are in good agreement, but the binocular IOL power difference of more than half of participants with long AL is more than 0.50 D.     

负度数折叠式人工晶状体植入术治疗白内障合并轴性高度近视

目的:探讨超声乳化白内障吸除联合负度数人工晶状体植入术治疗白内障合并高度近视的临床疗效。方法:对30例41眼白内障合并高度近视患者行超声乳化白内障吸除联合负度数折叠式人工晶状体植入术,随访6mo,观察术中和术后并发症、术后视力、眼底情况。结果:术前平均眼轴长度为32.11mm。术后视力<0.1者3眼,0.1～0.5者26眼,>0.5者12眼。术中2眼晶状体后囊膜破裂;1眼角膜水肿,未见视网膜脱离。24眼眼底有明显的高度近视眼底病变。结论:超声乳化白内障吸除联合负度数人工晶状体植入术是治疗白内障合并高度近视眼安全、有效的方法。     

植入不同附加度数ReSTOR多焦点人工晶状体术后视觉质量的比较

目的比较研究植入2种不同附加度数ReSTOR多焦点人工晶状体术后的视觉质量。方法回顾性分析在我科行白内障超声乳化吸出并植入ReSTOR多焦点人工晶状体的病例共62例(92眼),按植入晶状体类别分组,植入SN6AD1MIOL为+3.0D组,植入SN60D3MIOL为+4.0D组。检查2组病例术后3个月的裸眼及矫正的远(5m)、中(70cm、60cm、50cm)、近(40cm、33cm)距离视力;测量双焦曲线,并收集白内障术后患者问卷调查。结果术后3个月,2组远距离视力以及最佳矫正近视力比较,差异均无统计学意义(均为P>0.05),+3.0D组在中距离视力上好于+4.0D组(P<0.05),而33cm裸眼近视力+4.0D组好于+3.0D组,40cm裸眼近视力+3.0D组好于+4.0D组(P<0.05)。2组的双焦曲线(-5.0～5.0D)相似,均形成双峰,+3.0D组远视力峰值在0D、-2.5D,+4.0D组峰值在0D、-3.5D。+4.0D组问卷调查有2例患者抱怨在进行中距离视物时遇到困难(1例不能看清1m远电脑屏幕,另1例看不清60cm远手机屏幕),+3.0D组在各个距离日常视觉活动中未遇困难。2组均无严重的视觉干扰现象。结论本研究中的2种多焦点人工晶状体都能提供良好的全程视力,显著提高患者的生活质量。植入SN6AD1MIOL在中距离视力和40cm裸眼近视力表现较好,而植入SN60D3MIOL则在33cm裸眼近视力上表现较好。     

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.     

负度数人工晶状体植入术治疗白内障合并超高度近视眼

目的 观察白内障超声乳化联合负度数Sensar AR40e折叠式人工晶状体植入治疗超高度近视合并白内障的临床疗效.方法 对超高度近视合并白内障行超声乳化白内障吸除联合负度数Sensar AR40e人工晶状体植入术的35例(59只眼)患者进行回顾性研究,记录术前眼轴长度,观察手术并发症和术后视力、屈光度数及其与预期屈光度数的偏差值(屈光度数偏差值).术后随访时间为3～12个月.结果 术前平均眼轴长度为31.34mm.术后最佳矫正视力≥0.2共49只眼(83.05%),≥0.5者共26只眼(44.07%).术后屈光度数偏差值＜±1.00 D共31只眼(52.54%),<±2.00 D共52只眼(88.14%).术中仅1只眼晶状体后囊膜破裂;术后6只眼晶状体后囊轻度混浊,随访期间无视网膜和脉络膜脱离.结论 白内障超声乳化联合负度数人工晶状体植入术治疗白内障合并超高度近视眼安全、有效.植入负度数后房型人工晶状体既可以维持眼内组织的稳定性,又可同时进行屈光矫正.     

不同种类人工晶状体植入术后患者的客观视觉质量及视觉相关生活质量的对比研究

目的　比较不同种类的人工晶状体（IOL）植入术后患者的客观视觉质量及视觉相关生活质量。方法　采用非随机对照研究设计，收集2020年7月至2021年12月在天津市眼科医院进行超声乳化白内障吸除联合IOL植入术的年龄相关性白内障患者85例（136眼），其中，双焦点IOL组23例（34眼），景深延长型IOL组21例（33眼），三焦点IOL组17例（30眼），单焦点IOL组24例（39眼）。测量四组患者术后1 d、1周、1个月和3个月裸眼远、中、近视力及矫正远、中、近视力，并绘制四组患者IOL离焦曲线，同时问卷调查四组患者的视觉满意度及脱镜率。结果　同一时间点，四组患者术后裸眼远视力及术后矫正远视力差异均无统计学意义(均为P>0.05)。同一时间点，四组患者术后裸眼中视力、裸眼近视力差异均有统计学意义（均为P<0.05):景深延长型IOL组和三焦点IOL组患者术后裸眼中视力均优于双焦点IOL组和单焦点IOL组（均为P<0.05)，单焦点IOL组与双焦点、三焦点以及景深延长型IOL组患者术后裸眼近视力差异均有统计学意义（均为P<0.05）；景深延长型IOL组与双焦点和三焦点IOL组患者术后裸眼近视力差异均有统计学意义（均为P<0.05）。单焦点和景深延长型IOL组患者术后视觉干扰情况少于双焦点和三焦点IOL组，双焦点和三焦点IOL组患者术后眼部不适症状均少于单焦点和景深延长型IOL组,景深延长型IOL组患者术后眼部不适症状少于单焦点IOL组，双焦点、三焦点和景深延长型IOL组患者术后视力主观感受优于、配戴老视眼镜情况均少于单焦点IOL组，差异均有统计学意义（均为P<0.05）。结论　植入双焦点、三焦点、景深延长型IOL均能有效地提高患者术后的全程视力，植入三焦点IOL和双焦点IOL术后部分患者存在轻度视觉不良现象。     

连续视程与三焦点人工晶状体植入术后视觉质量的比较

目的：比较Tecnis Symfony连续视程人工晶状体与Zeiss三焦点人工晶状体(At Lisa tri 839MP)植入术后患者视觉质量的差异。

方法：选取2019-01/2020-12于我院行白内障超声乳化吸除联合人工晶状体植入术的患者42例53眼,其中A组22例29眼植入Tecnis Symfony连续视程人工晶状体,B组20例24眼植入Zeiss三焦点人工晶状体。观察两组患者术后3mo时远中近视力,绘制离焦曲线,并评估生活质量,记录并发症发生情况。

结果：术后3mo,两组患者视力均明显改善,两组患者裸眼远(5m)、中(80cm)距离视力及最佳矫正远距离视力(5m)无差异(均P>0.05),但B组患者裸眼中(60cm)、近(40cm)距离视力优于A组(均P<0.05)。术后3mo绘制离焦曲线示A组在+1.0～-2.0D段跨度平稳形成平台期; B组在0、-2.5D处形成两个波峰; 0D处两组远视力无显著差异(P>0.05),-2.5、-3.5D处B组近视力显著优于A组(均P<0.01)。两组患者术后脱镜率均在90%以上,均出现不同程度眩光、光晕等光学现象,但生活质量总体满意度较高,A组阅读速度明显高于B组,且夜间视物满意度较高(均P<0.05)。

结论：两种类型人工晶状体植入术后脱镜率均在90%以上,可为患者提供兼顾远、中、近的全程视力,Symfony连续视程人工晶状体植入术后流畅阅读及夜间视物满意度较高; Zeiss三焦点人工晶状体植入术后近距离视力更好,更适合近距离工作者。     

高度近视眼早期视野平均缺损监测的研究

目的以视野平均缺损(mean deviation,MD)值对高度近视眼早期状况进行定量分级。方法 运用Humphrey视野计测量10~30岁的高度近视眼患者65例(128眼)静态中心视野,检查结果以MD值分为4组:Ⅰ组(不超过-5.0dB)、Ⅱ组(-5.1~-8.0dB)、Ⅲ组(-8.1~-12.0dB)及Ⅳ组(-12.1dB以上);并了解各组的视野形态、年龄、屈光度、最佳矫正视力以及眼底改变情况。同时以同年龄段的低中度近视眼患者11例(20眼)作为对照。结果 高度近视眼Ⅰ组的MD和最佳矫正视力平均值分别为(-2.65±1.18)dB和0.98±0.01,与对照组的(-2.14±0.84)dB和1.0相比,差异均无统计学意义(均为P>0.05);高度近视眼4组的年龄、屈光度和最佳矫正视力:Ⅰ组分别为(15.69±2.72)岁、(-9.76±2.83)D、0.98±0.01,Ⅱ组分别为(15.60±3.48)岁、(-11.98±2.95)D、0.91±0.15,Ⅲ组分别为(19.05±4.20)岁、(-14.68±3.33)D、0.80±0.14,Ⅳ组分别为(22.31±4.46)岁、(-19.76±4.98)D、0.57±0.21;Ⅰ组和Ⅱ组相比,年龄、屈光度和最佳矫正视力差异均无统计学意义(均为P>0.05);Ⅲ组和Ⅳ组相比及与前2组比较,差异均有统计学意义(均为P<0.05),且眼底改变逐渐加重。高度近视眼视野中心相对暗点出现早于检眼镜下黄斑部病变(χ2=16.90,P<0.05)。结论 高度近视眼患者的视野改变早于检眼镜下的眼底病变,应用视野MD值对高度近视眼早期视功能状况进行定量分级,可以为高度近视眼早期全面诊断和治疗提供参考。