A prospective comparative study of the AMO ARRAY zonal-progressive multifocal silicone intraocular lens and a monofocal intraocular lens.

OBJECTIVE: To evaluate the safety and effectiveness of a zonal-progressive multifocal silicone intraocular lens (IOL). DESIGN: Prospective, nonrandomized, fellow eye comparative trial. PARTICIPANTS: Four hundred fifty-six subjects were enrolled at 14 investigational sites in the United States; 400 subjects achieved 1-year follow-up. A subset of 123 subjects (102 at 1 year) were enrolled in a monofocal fellow eye control substudy; subjects were implanted with the multifocal IOL in one eye and a comparable monofocal IOL in the fellow eye. METHODS: Cataract extraction and implantation of a zonal-progressive multifocal silicone IOL was performed using the surgeon's standard technique. Subjects were followed at six postoperative examination intervals through 1 year. MAIN OUTCOME MEASURES: The key efficacy measures were mean uncorrected and corrected distance and near visual acuity at 1 year after surgery. RESULTS: In the monofocal fellow eye control substudy, the multifocal eyes showed a mean 2-line increase over monofocal eyes for uncorrected and distance-corrected near visual acuity (P < 0.0001). Mean uncorrected distance visual acuity was similar between multifocal and monofocal eyes (P = 0.116). A significantly higher proportion of bilateral multifocal subjects reported that they could function comfortably without glasses at near (81%, 96 of 118) compared with multifocal/monofocal subjects (56%; 93 of 165; P < 0.001) and unilateral multifocal subjects (58%; 56 of 97; P < 0.001). Low-contrast visual acuity was reduced in multifocal eyes by approximately 1 Snellen line. However, no perceived disadvantages attributable to the reduction in low-contrast acuity were found. Although the perception of halos and glare increased in the multifocal eyes, good visual function remained, and nearly all subjects were satisfied with the results of their surgery. CONCLUSIONS: In a large study that included a subset of subjects with paired eye compared with those with monofocal lenses, this zonal-progressive multifocal lens provided a high level of uncorrected and corrected distance vision, improved uncorrected and distance-corrected near vision, reduced spectacle dependency, and a high level of patient satisfaction despite some loss of low-contrast visual acuity and increased reports of halos and glare.     

Correlation between pupillary size and intraocular lens decentration and visual acuity of a zonal-progressive multifocal lens and a monofocal lens.

OBJECTIVE: To see whether there is a correlation between pupillary area or intraocular lens (IOL) decentration and tilt and the visual acuity (VA) at all distances for eyes with a zonal-progressive multifocal IOL or a monofocal IOL. DESIGN: Comparative, nonrandomized, interventional study. PARTICIPANTS: Fifty-five eyes of 55 patients undergoing five-zone refractive multifocal IOL implantation and 55 eyes of 55 age-matched patients undergoing monofocal IOL implantation. INTERVENTION: All eyes underwent phacoemulsification and IOL implantation. MAIN OUTCOME MEASURES: The VAs from far to near distances were examined using an all-distance vision tester at 1 month after surgery. The pupillary area was also measured using an infrared pupillometer, and the degrees of IOL decentration and tilt were measured using a Scheimpflug videophotography system. Univariate associations between VA and the pupillary area and IOL decentration or tilt were evaluated statistically. RESULTS: The mean intermediate VAs and contrast sensitivities at all spatial frequencies in the multifocal IOL group were worse than those in the monofocal IOL group, whereas near VA was better in the multifocal group. In the multifocal group, smaller pupillary area was associated significantly with worse near logarithm of the minimum angle of resolution (LogMAR) VA (r = 0.636), but not with far or intermediate VAs. When pupil diameter was 4.5 mm or greater, near mean VA reached 20/63. A greater degree of IOL decentration was associated significantly with worse far and intermediate LogMAR VAs (r = 0.460 at 5.0 m and 0.527 at 1.0 m) but not with near VA. When decentration was 0.9 mm or greater, distance mean VA did not reach 20/32. However, the correlation between tilt and VA was not statistically significant. In the monofocal group, no significant correlation was found between pupillary area, IOL decentration, or tilt and the VA. CONCLUSIONS: Smaller pupil size is correlated significantly with worse near VA, whereas greater decentration is correlated with worse distance and intermediate VA in eyes with refractive multifocal IOLs. Specifically, a pupil diameter of less than 4.5 mm cannot provide useful near VA, and decentration of 0.9 mm is the maximum allowable limit for adequate distance VA. However, pupil size and IOL decentration do not influence VA in eyes with monofocal IOLs.     

ReSTOR diffractive versus Array 2 zonal-progressive multifocal intraocular lens: a contralateral comparison

PURPOSE: To evaluate near and distance visual performance after implantation of a diffractive multifocal intraocular lens (MIOL) (AcrySof ReSTOR) or a refractive MIOL (Array 2) in bilateral cataract surgery. METHODS: In this prospective, comparative trial, 18 patients with bilateral cataract were selected to have lens surgery with asymmetric MIOL implantation. Eighteen eyes received ReSTOR MIOL and the 18 fellow eyes were implanted with Array 2. Five months after second lens implantation, main postoperative outcomes were uncorrected and distance corrected near visual acuities (VA). Secondary outcomes were distance VA and near acuity with power add, contrast sensitivity with and without glare (Pelly-Robson Contrast Sensitivity Chart, CSV 1000 HGT). Quality of vision was measured by comparing the severity of visual symptoms as referred to a masked interviewer. RESULTS: Patients reported similar postoperative distance visual acuities for both eyes. ReSTORimplanted eyes showed better uncorrected and distance corrected near acuity than eyes with Array 2 (p=0.002 and p=0.003, respectively). Intermediate VA with distance correction was slightly higher with the Array 2 MIOL (p=0.058). No important difference was observed in contrast sensitivity, glare disability, and subjective rating of light sensations. Severe photic phenomena were reported only for one Array 2-implanted eye. CONCLUSIONS: The diffractive MIOL showed better uncorrected and distance corrected near VA. The refractive Array 2 MIOL had a tendency to better value for intermediate distance. Disturbing photic phenomena were observed only in one case with the Array 2 MIOL.     

ARRAY新型多焦点与单焦点人工晶状体的疗效比较

多焦点人工晶状体植入治疗白内障在临床上的应用日益广泛。与单焦点人工晶状体相比它虽有可能出现对比敏感度下降、夜间眩光感等缺点,但能获得满意的远、近及中等距离视力,且有配镜率低等优点。只要手术适应证掌握得当,植入ARRAY新型多焦点人工晶状体患者术后总满意率是较高的。我们对ARRAY新型多焦点人工晶状体与单焦点人工晶状体的临床疗效比较作一综述。     

Prospective randomised double-masked trial of bilateral multifocal,bifocal or monofocal intraocular lenses

AIMS: To evaluate the functional effect of bilateral implantation of two different multifocal intraocular lenses (IOL) compared with the standard monofocal IOL. METHODS: Sixty-nine patients were recruited into a prospective, double-masked, randomised, controlled trial at a single hospital in the United Kingdom. Sixty completed follow-up; 16 implanted with monofocal IOLs, 29 with AMO 'ARRAY' multifocal IOLs and 15 with Storz 'TRUEVISTA' bifocal IOLs. Phacoemulsification and IOL implantation was performed to a standardised technique in both eyes within a 2-month period. The main outcome measures were distance and near visual acuity, depth of field and validated assessment of subjective function (TyPE questionnaire). RESULTS: naided distance acuity was good, and equivalent across the three groups. Corrected distance acuity was significantly lower in the bifocal group. Patients with multifocal and bifocal IOLs could read smaller absolute print size than those in the monofocal group (P = 0.05), but at a closer reading distance such that mean unaided near acuity was equal in the three groups. Corrected near acuity was significantly higher in the monofocal control group (P < 0.05). Depth of field was increased in multifocal (P = 0.06) and bifocal (P = 0.004) groups. Overall visual satisfaction was equal in the three groups, while near visual satisfaction was higher in the multifocal group than the monofocal (P = 0.04). Spectacle independence was not seen in the monofocal group, but was achieved in 28% of multifocal IOL patients and 33% of bifocal patients (P < 0.001). Adverse symptoms such as glare and haloes were significantly more bothersome with multifocal (not bifocal) IOLs than monofocals (P = 0.01). CONCLUSIONS: Multifocal and bifocal IOLs improved unaided near vision performance, with around one in three patients becoming spectacle-independent. The main adverse effect was an increased incidence of subjective glare and haloes in the multifocal IOL group.     

三焦点与单焦点人工晶状体植入术效果的比较

目的：观察并比较AT LISA tri 839MP三焦点人工晶状体及CT SPHERIS 209M单焦点人工晶状体植入术后白内障患者的视力、对比敏感度和视觉质量。

方法：行白内障超声乳化摘除联合人工晶状体植入术的患者52例52眼,其中三焦点组26例26眼,术中植入AT LISA tri 839MP三焦点人工晶状体; 单焦点组26例26眼,术中植入CT SPHERIS 209M单焦点人工晶状体。术后3mo检查患者的裸眼远距离视力(UCDVA)、裸眼中距离视力(UCIVA)、裸眼近距离视力(UCNVA)、最佳矫正远视力(BCDVA)、远视力矫正下的中距离视力(DCIVA)、远视力矫正下的近距离视力(DCNVA),明、暗环境中不同空间频率(3、6、12、18c/d)下的对比敏感度,并进行脱镜率、不良视觉症状和满意度等问卷调查。

结果：术后3mo三焦点组UCIVA、UCNVA、DCIVA和DCNVA、脱镜率及满意度均优于单焦点组(P<0.05)。在暗环境中的18c/d空间频率,单焦点组的对比敏感度优于三焦点组(P=0.041)。两组均有轻度眩光和光晕不适主诉(P=0.668)。

结论：AT LISA tri 839MP三焦点人工晶状体较CT SPHERIS 209M单焦点人工晶状体为患者提供了更好的中、近视力,脱镜率和满意度均高于单焦点人工晶状体。     

Aberration and contrast sensitivity comparison of aspherical and monofocal and multifocal intraocular lens eyes

BACKGROUND: Higher-order aberrations and contrast sensitivity were evaluated in patients who underwent phacoemulsification cataract extraction followed by implantation of aspherical, monofocal or multifocal intraocular lens (IOL) replacements. METHODS: In this comparative trial, 124 patients with an average age of 66.8+/-5.2 years and their 124 eyes were randomly divided into three surgical implantation groups to receive one of three types of IOLs in replacement of cataract lenses. The patients of group 1 were given an aspherical IOL Z9001 (AMO, Santa Ana, CA, USA) replacement, and group 2 was implanted a monofocal IOL SA60AT (Alcon, Fort Worth, TX, USA) and group 3 the multifocal IOL SA40N (AMO). Post-surgical best-corrected visual acuity, corneal aberrations, total ocular aberrations, pupil diameters, capsulorhexsis sizes and contrast sensitivity were measured and compared. RESULTS: There was no statistical difference for mean best-corrected visual acuity, pupil diameter, curvilinear capsulorhexis size and corneal aberration among the three groups. For the spherical aberration, fourth-order higher-order aberration and total ocular higher-order aberration, the SA40N group was higher than the SA60AT group and the SA60AT group was higher than the Z9001 group, and the differences between the three groups were statistically significant for these measurements. Contrast sensitivity was higher for the Z9001 group than the SA60AT group and the SA60AT group was higher than the SA40N group, and the difference was statistically significant in all the spatial frequencies of 3, 6, 12 and 18. CONCLUSIONS: Although the multifocal IOL can provide near vision, it can increase higher-order aberration and negatively influence contrast sensitivity. However, the aspherical IOL can reduce aberration and improve contrast sensitivity as compared with the monofocal IOL.     

非球面单焦点及多焦点人工晶体眼高阶像差及对比敏感度比较

目的探讨非球面、单焦点及多焦点人工晶体眼的对比敏感度及高阶像差的差别。方法病人进行随机分组,其中一组病人植入非球面人工晶体Z9001,一组植入单焦点人工晶体SA60AT,一组植入多焦点人工晶体SA40N,共124只眼进入本研究。术后由Allegretto Wave Analyzer(Allegretto,Germany)像差仪测量高阶像差,由CSV-1000E(Vector Vision,USA)测量对比敏感度。结果术后的最佳矫正视力,瞳孔直径,撕囊口直径的大小及角膜高阶像差比较,组间差异不具有统计学意义。术后的高阶像差测量,其中球面像差、4阶高阶像差及总体像差比较中SA40N组大于SA60AT组,SA60AT组大于Z9001组。对比敏感度比较,在所有的空间频率3、6、12、18cpd,Z9001组大于SA60AT组,SA60AT组大于SA40N组。结论多焦点人工晶体眼较单焦点人工晶体相比,可以引起眼的高阶像差增加,对比敏感度降低。非球面人工晶体可以减少球面像差、增加对比敏感度。     

区域折射型多焦点人工晶状体与非球面单焦点人工晶状体植入术后患者客观视觉质量的短期对比研究

目的对比区域折射型多焦点人工晶状体(MIOL)SBL－3与非球面单焦点人工晶状体Akreos Adapt AO植入术后短期内患者的客观视觉质量。 方法选取2017年6月至2018年1月在北京大学第一医院眼科诊断为单纯老年性白内障,并行白内障超声乳化吸除联合人工晶状体植入术的患者26例(35只眼)为研究对象。其中,植入SBL－3晶状体有15只眼,植入AO晶状体有20只眼。术后1个月检查SBL－3组及AO组患者术眼的裸眼远视力(UDVA)、裸眼中视力(UIVA)、裸眼近视力(UNVA)、矫正远视力(CDVA)、矫正近视力(CNVA)、最佳矫正远视力下的中视力(DCIVA)及最佳矫正远视力下的近视力(DCNVA),并使用视觉质量分析仪评估两组患者瞳孔直径4 mm与6 mm的全眼、角膜及眼内的总高阶像差、球差及点扩散函数。术后1个月,绘制SBL－3组患者术眼的离焦曲线。两组患者术眼的UDVA、CDVA、CNVA、UIVA、UNVA、DCIVA、DCNVA及视觉质量以均数±标准差( ±s)表示,行非参数Mann－Whimey U检验比较。 结果术后1个月时,SBL－3组及AO组患者术眼的UDVA、CDVA及CNVA差异均无统计学意义(Z＝－0.99,0,－1.84;P>0.05);SBL－3组患者术眼的UIVA、UNVA、DCIVA及DCNVA分别为0.32±0.08、0.44±0.18、0.30±0.10及0.33±0.11,均优于AO组的0.25±0.10、0.27±0.09、0.20±0.07及0.21±0.10,差异均有统计学意义(Z＝－2.26,－3.13,－1.84,－2.17;P<0.05)。视觉质量评估显示,瞳孔直径为4 mm的两组患者术眼球差的差异无统计学意义(Z＝－1.50,－1.04,－0.82;P>0.05);瞳孔直径为6 mm的两组患者术眼球差的差异无统计学意义(Z＝－0.12,－1.93,－1.16;P>0.05)。SBL－3组瞳孔直径4 mm与6 mm的全眼总高阶像差分别为0.45±0.12与1.41±0.21,高于AO组的0.26±0.12与0.82±0.13,差异均有统计学意义(Z＝－3.45,－3.24;P<0.05)。SBL－3组患者术眼的点扩散函数为0.05±0.02,低于AO组的0.11±0.07,差异有统计学意义(Z＝－2.60,P<0.05)。SBL－3组患者术眼的离焦曲线显示波峰出现在0 D处,在－1.0 D至－3.0 D范围内的曲线较平稳,下降不明显;在－3.0 D至－5.0 D范围内的曲线快速下降。 结论Adapt AO晶状体术后客观视觉质量优于SBL－3晶状体,但SBL－3晶状体在中、近视力的应用效果优于Adapt AO晶状体。SBL－3晶状体的离焦曲线波峰出现在0 D处,在－1.0 D至－3.0 D范围内的曲线较平稳,下降不明显。本研究还需扩大样本量并长期观察其效果及安全性。     

Visual function with bilateral implantation of monofocal and multifocal intraocular lenses: a prospective, randomized, controlled clinical trial

PURPOSE: To evaluate visual function of three types of multifocal intraocular lenses (IOLs) and one monofocal IOL (as the control group) after cataract surgery. METHODS: One hundred fourteen patients participated in a prospective, randomized, controlled clinical study and received monofocal Tecnis Z9000 (AMO) (n = 24, 48 eyes); symmetric diffractive multifocal Tecnis ZM900 (AMO) (n = 26, 52 eyes); zonal refractive multifocal ReZoom (AMO) (n = 32, 64 eyes); and asymmetric diffractive multifocal TwinSet (Acri.Tec) (n = 32, 64 eyes) IOLs. RESULTS: Mean binocular distance best spectacle-corrected visual acuity (BSCVA) (logMAR) was 0.05 for controls, 0.08 for ZM900, 0.07 for ReZoom, and 0.11 for TwinSet, with mean binocular distance BSCVA at near of 0.49, 0.06, 0.22, and 0.11, respectively. Mean contrast sensitivity was better for the monofocal IOL group than for the multifocal IOLs. Patients assigned to TwinSet had less favorable contrast sensitivity scores. Patients with monofocal IOLs had more frequently recommended near addition (74%) than those with multifocal IOLs. Patients with refractive ReZoom had also recommended near addition more frequently than the two diffractive groups. The percentage of dysphotopsia phenomena was 81% in patients with diffractive multifocal ZM900 compared with 48% in patients with monofocal IOLs, 53% with refractive ReZoom, and 47% with diffractive TwinSet. CONCLUSIONS: The monofocal IOL showed better visual function and lesser photic phenomena than multifocal IOLs but patients were spectacle dependent. ReZoom provided better distance BSCVA than the TwinSet diffractive model. Patients with Tecnis and TwinSet diffractive multifocal IOLs were more spectacle independent than patients with ReZoom. Patients with TwinSet had the worst visual function. Patients implanted with the Tecnis diffractive ZM900 were those reporting more photic phenomena.     

Visual outcome and optical quality after bilateral implantation of aspheric diffractive multifocal, aspheric monofocal and spherical monofocal intraocular lenses:a prospective comparison

AIM:To evaluate the visual function after bilateral implantation of aspheric diffractive multifocal Tecnis ZMA00, aspheric monofocal ZA9003 versus spherical monofocal Akreos Adapt intraocular lenses (IOLs).METHODS:Tecnis ZMA00, Tecnis ZA9003 or Akreos Adapt IOLs were bilaterally implanted in 180 eyes from 90 patients. The following parameters were assessed 3 months postoperatively:monocular and binocular uncorrected visual acuity (UCVA) and distance-corrected visual acuity (DCVA) for distance, intermediate and near, spherical aberration (SA), contrast and glare sensitivity, near point refractive power, uncorrected and best-corrected near stereoscopic acuity (NSA). Patient satisfaction was assessed by a questionnaire.RESULTS:Three months postoperatively, the monocular and binocular UCVA and DCVA at near of Tecnis ZMA00 were significantly better than other two groups. The mean SA for 5.0mm optical zone in Tecnis ZMA00 and Tecnis ZA9003 was significantly lower than that in Akreos Adapt. Mean contrast sensitivity and glare sensitivity were better for Tecnis ZA9003 group than for other two groups. Patients with Tecnis ZMA00 had higher monocular and binocular near point refractive power and uncorrected NSA than monofocal groups. The patients in Tecnis ZMA00 had higher mean values for halo compared with other two groups.CONCLUSION:Tecnis ZMA00 provided better near VA and uncorrected NSA and higher near point refractive power than monofocal IOLs and patients were spectacle independent. The IOLs with Tecnis aspheric design improved contrast and glare sensitivity. Patients with Tecnis ZMA00 reported more disturbances on visual phenomena of halo.     

单眼白内障患者植入多焦点人工晶状体与单焦点人工晶状体后的双眼视功能比较

目的比较单眼白内障患者植入多焦点人工晶状体（IOL）或单焦点IOL后的双眼视功能。方法前瞻性非随机对照研究。2013年6月至2014年12月期间,在我院行白内障超声乳化联合IOL植入术的单眼白内障患者80例（80眼）,根据植入的IOL类型分为2组,各40例（40眼）。观察组植入多焦点IOL,对照组植入单焦点IOL。术后随访3个月,观察指标包括术眼单眼及双眼远（5 m）、中（70 cm）、近（40 cm）视力,双眼对比敏感度,近立体视,脱镜率,视觉干扰现象及患者满意度。术后视力及对比敏感度比较采用独立样本t检验;脱镜率及光干扰现象发生率的比较采用χ²检验;近立体视、视力满意度评分比较采用Mann-Whitney U检验。结果观察组双眼裸眼远、中、近视力分别为0.03±0.04、0.17±0.07、0.15±0.06,对照组双眼裸眼远、中、近视力分别为0.05±0.05、0.27±0.08、0.31±0.09,观察组双眼裸眼中视力和近视力优于对照组（t=3.925、3.429,P＜0.01）,而2组间双眼裸眼远视力差异无统计学意义（t=0.356,P＞0.05）。双眼在空间频率为3、6、12、18 c/d时,观察组无眩光对比敏感度和有眩光对比敏感度均低于对照组（无眩光：t=3.463、3.361、2.198、2.574,P＜0.05;有眩光：t=3.105、2.432、2.758、3.207,P＜0.05）。观察组近立体视优于对照组（Z=2.578,P＜0.05）,脱镜率（88%）高于对照组（28%）（χ²=8.240,P＜0.05）,2组间视远满意度评分差异无统计学意义（Z=0.598,P＞0.05）,而观察组视中和视近满意度评分均高于对照组（Z=2.314、3.137,P＜0.05）。2组间视觉干扰眩光现象差异无统计学意义（χ²=0.602,P＞0.05）,而观察组光晕现象多于对照组（χ²=8.807,P＜0.05）。结论单眼白内障患者植入多焦点IOL相比单焦点IOL能提供更好的双眼中、近视力,双眼立体视,脱镜率及患者满意度,但对比敏感度有所降低。     

Diffractive multifocal intraocular lens implantation in patients with monofocal intraocular lens in the contralateral eye

AIM:To evaluate clinical outcomes of unilateral implantation of a diffractive multifocal intraocular lens(IOL)in patients with contralateral monofocal IOL.METHODS:Twenty-two patients who already had implantation of a monofocal IOL in unilateral eye underwent implantation of a diffractive multifocal IOL in contralateral eye were enrolled.After 1,6,and 12 mo,uncorrected and distant corrected distant visual acuity(UCDVA and DCDVA),uncorrected and distant corrected intermediate-visual acuity(UCIVA and DCIVA),uncorrected and distant corrected near visual acuity(UCNVA and DCNVA),and contrast sensitivity were obtained.Halo/glare symptoms,spectacle dependence,and patient satisfaction were also evaluated.RESULTS:The mean age was 67.86±7.25 y and the average interval between two IOL implantations was 645.82±878.44 d.At 1 mo,binocular UCDVA was lower than 0.20 logMAR in 76%of patients(mean 0.12±0.13 logMAR),which increased to 90%by 6 and 12 mo.The binocular UCDVA was significantly better than the monocular results(P<0.05)at 1,6,and 12 mo.Additionally,UCNVA was lower than 0.40 logMAR in 82%of patients,increasing to 90%by 6 and 12 mo.Mean UCNVA in the multifocal IOL implanted eye was statistically significantly better than that in the monofocal IOL implanted eye(P<0.05)at 1,6,and 12 mo.About 5%of patients at 1 and 6 mo,reported"severe glare or halo".Patient satisfaction rates were 95%and 91%at 6 and 12 mo,respectively.CONCLUSION:Unilateral implantation of multifocal IOL in patients with a contralateral,monofocal IOL implantation results in high patient satisfaction rate,with low severe glare or halo rate during follow-up.It can represent a good option for patients who have previously had a monofocal IOL implantation regardless of two year interval duration between two IOL implantations.     

多焦点和单焦点人工晶状体植入的对比研究

目的：通过对多焦点和单焦点人工晶状体植入术后视力；拟调节力及视觉症状的对比研究，探讨Array SA-40NB^TM多焦点人工晶状体植入术临床应用的有效性和安全性。方法：2002-08／2004-08施行白内障超声乳化人工晶状体植入术984眼，排除合并有其他眼病及伴有可能影响视力的全身疾病者后，分为S组术中植入单焦点人工晶状体；M组术中植入多焦点人工晶状体。观察两组术后远、近视力；拟调节力及视觉症状；采用SPSS10．0软件对术后远、近视力和拟调节力进行统计学处理。结果：M组和S组比较，术后远视力无明显差异；而术后近视力和拟调节力差异有显著性意义，M组明显优于S组。结论：多焦点人工晶状体植入术可以获得等同于单焦点人工晶状体植入术的术后远视力，但是其术后拟调节力较大，术后裸眼近视力显著高于单焦点人工晶状体植入术的患眼，是一种安全的、能有效改善患者视觉功能的手术，值得临床应用和推广。     

Objective and subjective evaluation of photic phenomena after monofocal and multifocal intraocular lens implantation.

OBJECTIVE: To objectively measure and compare halo, flicker, and glare disability in pseudophakic eyes with monofocal (MONO) and multifocal (MULTI) intraocular lenses (IOLs) with respect to the influence of corneal surface quality, astigmatism, and age. DESIGN: Prospective case series. PARTICIPANTS: This clinical trial involved 28 eyes of 28 patients after small-incision cataract surgery with a MONO silicone IOL and 28 eyes of 28 patients with zonal-progressive silicone IOL. INTERVENTION: A computer program objectively determined halo, glare, and flicker. Corneal surface quality and astigmatism were measured using computerized videokeratography. Ray-tracing analysis was performed based on the videokeratography data to calculate retinal peak distance and distortion index. A questionnaire was sent to all patients to evaluate the incidence of subjective photic phenomena. RESULTS: Mean halo size (square degrees +/- standard deviation) valued 6.1 (+/- 1.3) in the MONO group and 7.2 (+/- 2.3) in the MULTI group with no statistically significant difference between MONO and MULTI. Flicker (in % contrast to add) was -0.7 (+/- 2.9) in the MONO group and -1.0 (+/- 4.2) in the MULTI group with no statistical differences. Glare (in % contrast to add) was 5.5 (+/- 16.5) in the MONO group and 6.5 (+/- 18.0) in the MULTI group with no statistical differences. Patients in the MONO group older than 70 years of age had significantly more glare than those younger than 70 years (P = 0.017). In the MULTI group, patients with corneal shape irregularities (peak distance > 6.0 microm) or astigmatism (> 1 diopter) had statistically significant greater halos than did patients with regular corneal shape (peak distance < or = 6.0 microm) or astigmatism (< or = 1 diopter) (P < 0.005). Three of 27 MONO patients and 9 of 28 MULTI patients noticed light sensations (mainly halos) after surgery that were not present before surgery, with the majority not being bothered by these at all. CONCLUSION: In monofocal as well as in multifocal eyes, halo and glare disability occurred. Patient age, corneal surface quality, and IOL design played an important role in these photic phenomena. Because these photic phenomena may be more prevalent in night driving conditions, the authors' study suggests that night driving ability, especially in the elderly patient with pseudophakia, should be examined carefully.     

Contrast sensitivity and depth of focus with aspheric multifocal versus conventional monofocal intraocular lens.

BACKGROUND: Laboratoires Domilens, Lyon, France, has introduced a new aspheric multifocal intraocular lens (IOL), the Progress 3. The central portion, measuring 4.7 mm in diameter, has an anterior surface of progressively increasing power, such that there is a central add of +5.00 dioptres. We compared contrast sensitivity and depth of focus in patients who received the Progress 3 and in those who received a conventional monofocal IOL. METHODS: Prospective study. Forty patients with age-related cataract were randomly divided into two groups: 20 patients received the Progress 3 aspheric multifocal IOL, and 20 patients received a conventional monofocal IOL of similar design. Contrast sensitivity was measured with the Pelli-Robson letter-based chart. Depth of focus was determined by dialling a series of overcorrections over the patient's manifest refraction until the patient read 6/12 clearly. The depth of focus was defined as the range over which 6/12 or better acuity was achieved. Quality of vision was evaluated by patient questionnaire. RESULTS: Mean contrast sensitivity was significantly lower in the patients with a multifocal IOL than in those with a monofocal IOL (1.38 vs. 1.56 log units) (p < 0.001). The mean depth of focus values for the two groups were 3.10 D and 1.65 D respectively (p < 0.001). The prevalence of subjective problems was similar in the two groups. INTERPRETATION: In our opinion, aspheric multifocal IOLs should be reserved for patients who are willing to trade increased depth of focus for reduced contrast sensitivity postoperatively.