ReSTOR SV25T0与ReSTOR SN6AD1多焦点人工晶状体植入术后临床疗效对比

目的　对比观察ＲｅＳＴＯＲＳＶ２５Ｔ０与ＲｅＳＴＯＲＳＮ６ＡＤ１多焦点人工晶状体（ｍｏｌｔｉｆｏｃａｌｉｎｔｒａｏｃｕｌａｒｌｅｎｓ,ＭＩＯＬ）植入术后的临床视觉效果。方法　行白内障超声乳化吸出联合ＭＩＯＬ植入术的白内障患者４１例（４３眼）,根据植入的ＭＩＯＬ不同分为两组:ＳＮ６ＡＤ１组２０例（２２眼）植入ＲｅＳＴＯＲＳＮ６ＡＤ１ＭＩＯＬ,ＳＶ２５Ｔ０组２１例（２１眼）植入ＲｅＳＴＯＲＳＶ２５Ｔ０ＭＩＯＬ,观察两组患者术前及术后３个月裸眼近视力、裸眼中距离视力（５０ｃｍ、７０ｃｍ）及裸眼远视力,绘制离焦曲线,并进行对比敏感度检查、视觉质量及满意度问卷调查。结果　术后３个月两组患者５ｍ裸眼远视力对比差异无统计学意义（Ｐ＞０．０５）;ＳＶ２５Ｔ０组患者５０ｃｍ及７０ｃｍ的裸眼中距离视力分别为（０．１２±０．０７）ｌｏｇＭＡＲ和（０．１７±０．０８）ｌｏｇＭＡＲ,均明显优于ＳＮ６ＡＤ１组患者的（０．１８±０．０８）ｌｏｇＭＡＲ和（０．２４±０．０９）ｌｏｇＭＡＲ（均为Ｐ＜０．０５）,而ＳＮ６ＡＤ１组患者３３ｃｍ的裸眼近距离视力为（０．１１±０．０８）ｌｏｇＭＡＲ,高于ＳＶ２５Ｔ０组患者的（０．１６±０．０８）ｌｏｇＭＡＲ（Ｐ＜０．０５）;ＳＶ２５Ｔ０组术后暗视下３．０ｃ·ｄ－１及６．０ｃ·ｄ－１空间频率的对比敏感度优于ＳＮ６ＡＤ１组,差异均有统计学意义（均为Ｐ＜０．０５）;术后问卷调查示两组患者均未出现明显视觉干扰,ＳＶ２５Ｔ０组患者在近距离视力的视近满意度较ＳＮ６ＡＤ１组低,在中距离和远距离下满意度稍高,但是两组间差异均无统计学意义（均为Ｐ＞０．０５）。结论　ＲｅＳＴＯＲＳＶ２５Ｔ０与ＳＮ６ＡＤ１ＭＩＯＬ均能改善白内障患者术后视力及对比敏感度,ＲｅＳＴＯＲＳＶ２５Ｔ０在中距离视力的表现优于ＲｅＳＴＯＲＳＮ６ＡＤ１。     

超声乳化白内障吸出人工晶状体植入术联合房角分离术治疗闭角型青光眼合并年龄相关性白内障的疗效观察

目的　对比观察超声乳化白内障吸出人工晶状体植入术联合及不联合房角分离术治疗闭角型青光眼合并年龄相关性白内障的疗效。方法　选取８９例（９８眼）闭角型青光眼合并年龄相关性白内障患眼分为两组,Ａ组４９眼采用超声乳化白内障吸出人工晶状体植入术联合房角分离术治疗,Ｂ组４９眼行超声乳化白内障吸出人工晶状体植入术,对比观察两组患者手术前后的眼压、中央前房深度、房角结构等。结果　Ａ组术后１ａ眼压为（１４．３４±３．６４）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）,比术前眼压（３４．６５±６．５３）ｍｍＨｇ明显降低,差异有统计学意义（ｔ＝１９．２８,Ｐ＜０．０５）。Ｂ组术后１ａ眼压为（１６．２６±４．９１）ｍｍＨｇ,比术前（３５．１５±６．２７）ｍｍＨｇ亦明显降低,差异有统计学意义（ｔ＝１６．５５,Ｐ＜０．０５）。术后１ａ两组间眼压对比差异有统计学意义（ｔ＝２．１９,Ｐ＜０．０５）。Ａ组绝对成功３０眼（６１．２２％）,相对成功９眼（１８．３７％）,总成功率７９．５９％。Ｂ组绝对成功２７眼（５５．１０％）,相对成功７眼（１４．２９％）,总成功率６９．３９％。两组间的总成功率差异无统计学意义（Ｚ＝０．８８６,Ｐ＞０．０５）。Ａ组术后１个月中央前房深度（３．２４±０．３８）ｍｍ较术前（２．０４±０．３１）ｍｍ加深,差异有统计学意义（ｔ＝３．１４１,Ｐ＜０．０５）。Ｂ组术后１个月中央前房深度（３．０５±０．３６）ｍｍ较术前（２．０１±０．２９）ｍｍ亦加深,差异有统计学意义（ｔ＝３．０７８,Ｐ＜０．０５）。术后１个月两组比较差异无统计学意义（ｔ＝０．１７５,Ｐ＞０．０５）。术后１个月行房角检查:Ａ组４０眼前房角全部开放,９眼残留小于４５°的锥状或堤坝状粘连。Ｂ组１０眼３个象限残留房角粘连,１９眼２个象限残留房角粘连,２０眼有小于１个象限的房角粘连。两组视力改善率及术后并发症发生率差异均无统计学意义（均为Ｐ＞０．０５）。结论　超声乳化白内障吸出人工晶状体植入术联合房角分离术是治疗闭角型青光眼合并白内障的安全、有效的方法,对眼压、中央前房深度和房角结构都有明显改善。     

后房型有晶状体眼人工晶状体植入术矫正超高度近视的视觉质量研究

目的　探讨后房型有晶状体眼人工矫正晶状体（ｉｎｔｒａｏｃｕｌａｒｃｏｒｒｅｃｔｉｖｅｌｅｎｓ,ＩＣＬ）植入术治疗超高度近视后患者的视觉质量。方法　收集２０１０年２月至２０１２年１２月就诊于我院的－１０．０Ｄ以上的接受后房型有晶状体眼ＩＣＬ植入术治疗高度近视患者３８例（７６眼）为观察组,选取同期就诊于我院的－１０．０Ｄ以上的接受角膜屈光手术的患者３１例（６２眼）作为对照组。术前２组患者最佳矫正视力、对比敏感度、屈光状态等指标比较,差异均无统计学意义（均为Ｐ＞０．０５）。比较２组术前及术后１０ｄ、１个月、３个月、６个月及１２个月裸眼远近视力、最佳矫正视力、屈光度、波阵面相差及对比敏感度等。结果　术后观察组患者各时间点随访的裸眼视力均超过术前最佳矫正视力,术后１个月及３个月２组裸眼视力比较均无统计学差异（均为Ｐ＞００５）,术后１２个月观察组裸眼视力为１．０３±０．１８、对照组裸眼视力为０．９６±０．２４,２组比较差异有统计学意义（ｔ＝２．０４０,Ｐ＝０．０２５）;观察组最佳矫正视力为１．０５±０．１７、对照组最佳矫正视力为１．０６±０．１７,２组差异无统计学意义（ｔ＝－０．３４１,Ｐ＝０９７０）。观察组术后高阶像差为（０．５１５±０．１２２）μｍ,与术前（０．４００±０．０６０）μｍ相比差异无统计学意义（ｔ＝－７．８２５,Ｐ＝０１２８）,对照组术后高阶像差为（０．８１８±０．１５１）μｍ,与术前（０．３９９±００４９）μｍ相比差异有统计学意义（ｔ＝２２．５８０,Ｐ＝００３７）,２组术后高阶像差相比差异有统计学意义（ｔ＝１３．０４９,Ｐ＝０．００５）。观察组术后１个月对比敏感度恢复到术前水平,对照组对比敏感度始终低于术前,各时间点观察组对比敏感度均优于对照组,差异均有显著统计学意义。结论　ＩＣＬ植入术对于超高度近视的矫正较准分子激光原位角膜磨镶术更安全、稳定、有效。     

计算机引导下的飞秒激光辅助白内障手术治疗对患者视力远期预后的影响及其安全性分析

目的　探讨计算机引导下飞秒激光（ｆｅｍｔｏｓｅｃｏｎｄｌａｓｅｒ,ＦＳＬ）辅助白内障手术治疗对患者视力远期预后的影响及其安全性。方法　收集２０１３年１月至６月于我院行手术治疗的白内障患者的临床资料,分为ＦＳＬ组（４５例６０眼）和传统组（４３例６０眼）。ＦＳＬ组采用计算机引导下ＦＳＬ辅助白内障手术治疗,传统组采用传统超声乳化白内障手术治疗。统计两组疗效、散光度、眼压,以及治疗前（Ｔ０）、治疗后１个月（Ｔ１）、６个月（Ｔ２）、１２个月（Ｔ３）和２４个月（Ｔ４）的远视力、近视力、裸眼视力、最佳矫正视力及术后并发症发生情况。结果　ＦＳＬ组总治疗有效率为９０．００％,高于传统组７６．６７％（Ｐ＜０．０５）。两组平均角膜散光度和眼压比较差异均无统计学意义（均为Ｐ＞０．０５）;两组术后眼压均低于术前（均为Ｐ＜０．０５）。与Ｔ０比较,两组Ｔ１、Ｔ２、Ｔ３、Ｔ４的远视力、近视力、裸眼视力、最佳矫正视力均提高（均为Ｐ＜０．０５）;与传统组比较,ＦＳＬ组Ｔ１、Ｔ２、Ｔ３、Ｔ４的远视力、近视力、裸眼视力、最佳矫正视力均提高（均为Ｐ＜０．０５）。ＦＳＬ组术后并发症发生率为８．３３％,低于传统组的２５．００％（Ｐ＜０．０５）。结论　计算机引导下ＦＳＬ辅助手术治疗白内障疗效佳,患者术后近期和远期视力恢复好且并发症发生少,具有良好的可行性和安全性,值得临床推广使用。     

白内障超声乳化摘出及后房折叠型人工晶状体植入术治疗高度近视合并白内障

目的　评价高度近视合并白内障行超声乳化摘出及后房折叠型人工晶状体植入术的疗效。方法　对４６例（７７眼）高度近视合并白内障患者施行透明角膜切口超声乳化吸出术,通过３．２ｍｍ切口植入后房折叠型人工晶状体。于术后１周、１个月、３个月、６个月随访复查,比较手术前后最佳矫正视力、球镜度数、柱镜度数、角膜曲率、角膜内皮细胞计数和眼轴长度的变化。结果　手术均顺利完成,人工晶状体１００％囊袋内植入。术后１周、１个月、３个月、６个月最佳矫正视力≥０．５者分别有５９眼、６０眼、６５眼和６５眼。术后６个月患者球镜度数、柱镜度数、角膜曲率、眼轴长度、角膜内皮细胞计数分别为（ －１．０４±０．５９）Ｄ、（－０．２３±１．１４）Ｄ、（４３．７２±１．１６）Ｄ、（２８．４６±１．７７）ｍｍ、（２０４１±８２５）个·ｍｍ－２。与术前相比,球镜度数、角膜内皮细胞计数两项差异具有统计学意义（均为Ｐ＜０．０５）。结论　超声乳化摘出及后房折叠型人工晶状体植入术治疗高度近视合并白内障效果良好,术后视力恢复快、屈光状态稳定。     

非甾体类药物预防飞秒激光辅助白内障术中瞳孔缩小的观察与分析

目的　探讨飞秒激光术后眼内前列腺素Ｅ２（ｐｒｏｓｔａｇｌａｎｄｉｎＥ２）浓度的变化与瞳孔缩小的关系,同时比较术前应用两种非甾体类药物（ｎｏｎｓｔｅｒｏｉｄａｌｄｒｕｇｓ,ＮＳＡＩＤｓ）预防飞秒激光辅助白内障术中瞳孔缩小的效果。方法　前瞻性队列研究。研究对象为２０１４年６月至２０１５年３月于天津医科大学眼科医院白内障科行白内障手术的老年性白内障患者１２０例（１２０眼）,根据手术方式及用药分为４组,其中拟行传统超声乳化手术３０例（３０眼）为Ａ组;拟行飞秒激光辅助白内障手术９０例（９０眼）随机分为３组,其中空白对照组为Ｂ组,术前应用１ｇ·Ｌ－１普拉洛芬滴眼液为Ｃ组,术前应用１ｇ·Ｌ－１双氯芬酸钠滴眼液为Ｄ组。收集包括患者年龄、性别、晶状体核分级、术前充分散瞳后以及完成飞秒激光或手工透明角膜切口后瞳孔直径等临床资料,测量所有样本中ＰＧＥ２浓度。结果　Ａ、Ｂ、Ｃ、Ｄ四组中ＰＧＥ２浓度分别为（４８．２５±１０．５２）ｐｇ·ｍＬ－１、（１２４．１４±８．９７）ｐｇ·ｍＬ－１、（１８．２８±３．４９）ｐｇ·ｍＬ－１、（１９．０５±３．１３）ｐｇ·ｍＬ－１;Ｂ组与Ａ、Ｃ、Ｄ组差异均有统计学意义（均为Ｐ＜０．０００１）,Ｃ组与Ｄ组差异无统计学意义（Ｐ＞０．０５）。Ａ、Ｂ、Ｃ、Ｄ四组术中瞳孔缩小的发生率分别为６．６７％（２／３０）、２０．００％（６／３０）、３．３３％（１／３０）、３．３３％（１／３０）;Ｂ组与Ａ、Ｃ、Ｄ组差异均有统计学意义（均为Ｐ＜０．０５）,Ｃ组与Ｄ组差异无统计学意义（χ２＝０．００１,Ｐ＞０．０５）。瞳孔缩小与年龄、性别及晶状体核分级均无相关性（均为Ｐ＞０．０５）。发生瞳孔缩小者与未发生瞳孔缩小者ＰＧＥ２浓度分别为（１３０．７４±８．７６）ｐｇ·ｍＬ－１、（１２０．８６±７．２７）ｐｇ·ｍＬ－１,差异有统计学意义（Ｐ＜０．０５）,瞳孔缩小程度与ＰＧＥ２浓度无相关性（Ｐ＞０．０５）。结论　飞秒激光术后瞳孔缩小可能与房水中ＰＧＥ２浓度升高有关,术前局部应用ＮＳＡＩＤｓ能降低眼内ＰＧＥ２浓度,减少飞秒激光术后瞳孔缩小的发生。     

单眼视(monovision)原理应用于高度近视白内障手术的研究

目的 研究单眼视(monovision,MV)原理在高度近视白内障患者中应用的效果.方法 高度近视伴白内障54例,行白内障超声乳化并单焦点人工晶状体植入术,应用单眼视原理,使术后主导眼(优势眼)形成正视,非主导眼保留-1.0D以上的近视,按屈光参差的程度分为3组,检查术后3个月双眼裸眼远视力、近视力、立体视及对比敏感度,并进行人为加镜形成双眼平衡全矫状态加以对照.最后进行视功能损害眼病患者生存质量量表问卷及满意率调查.结果 远视力及立体视3组比较差异无统计学意义(P＞0.05),近视力比较3组单眼视矫正患者均明显优于完全矫正,差异有统计学意义(P＜0.05).在100％对比度明视白背景下,第3组患者(屈光参差≥2.75D)单眼视矫正视力低于完全矫正,差异有统计学意义(P＜0.05).明暗视时,红蓝背景下敏感度检查比较差异无统计学意义(P＞0.05).术后问卷及满意率调查,3组患者间差异无统计学意义(P＞0.05).结论 单眼视原理应用于高度近视伴白内障患者的屈光矫正,可有效提高患者远、近视力,非主导眼宜保留-1.5D以上的近视,具体情况还需根据患者个体差异而定.屈光参差≥2.75D的患者术后需注意夜间眩光现象.     

非球面多焦点散光矫正型人工晶状体植入术后患者的视觉质量

目的　评价非球面多焦点散光矫正型人工晶状体植入术后患者的视觉质量。方法　前瞻性对照研究。选取２０１３年１月至２０１３年１２月在天津医科大学眼科医院行超声乳化白内障吸出术的单纯年龄相关性白内障患者１３０例（１５０眼）分为三组,每组５０眼。其中,术前规则角膜散光０．５～２．５Ｄ患者植入非球面多焦点散光矫正型人工晶状体为试验组（ＡＲＴ组）;术前顺规角膜散光＜１Ｄ,逆规角膜散光＜０．７５Ｄ患者植入非球面多焦点人工晶状体为对照组１（Ｒｅｓｔｏｒ组）;术前规则角膜散光１．０～３．０Ｄ患者植入非球面散光矫正型人工晶状体为对照组２（Ｔｏｒｉｃ组）。术后１ｄ、１周、１个月、３个月用ＯＱＡＳ视觉质量分析仪检查三组患者的ＯＱＡＳ参数、对比敏感度、裸眼远视力、最佳矫正远视力,并进行脱镜率和患者满意度调查,绘制三组患者的离焦曲线;检查ＡＲＴ组和Ｒｅｓｔｏｒ组的最佳近视力、６０ｃｍ中距离视力;检查ＡＲＴ组和Ｔｏｒｉｃ组的轴位旋转度。结果　三组裸眼远视力及最佳矫正远视力差异无统计学意义（Ｆ＝０．６６１,Ｐ＝０．５１８;Ｆ＝０．０１３,Ｐ＝０．９８７）;ＡＲＴ组与Ｒｅｓｔｏｒ组中距离视力及最佳近视力差异均无统计学意义（ｔ＝－０．７９６,Ｐ＝０．４２８;ｔ＝－０．８８５,Ｐ＝０．３７８）;ＯＱＡＳ参数检查发现:三组的客观散射指数、调制传递函数截止频率值、ＯＶ１００％、ＯＶ２０％、ＯＶ９％差异均无统计学意义（均为Ｐ＞０．０５）;三组的斯特列尔比值、对比敏感度结果比较,差异均有统计学意义（均为Ｐ＜０．０５）,其中ＡＲＴ组与Ｒｅｓｔｏｒ组差异均无统计学意义（均为Ｐ＞０．０５）;术后３个月轴位旋转度,ＡＲＴ组与Ｔｏｒｉｃ组差异无统计学意义（ｔ＝１．０３６,Ｐ＝０．３０３）;ＡＲＴ组与Ｒｅｓｔｏｒ组脱镜率分别为９０％和８８％,高于Ｔｏｒ-ｉｃ组的１２％,三组均未发现明显视觉干扰现象。结论　非球面多焦点散光矫正型人工晶状体在有效矫正角膜散光的基础上,可以提供一个良好的全程视力,提高了患者脱镜率。     

儿童基本型间歇性外斜视不同手术方式的疗效比较

目的　比较双眼外直肌后徙术与单眼一退一截术治疗儿童基本型间歇性外斜视的疗效。方法　研究对象为２０１１年８月至２０１４年１０月在南京医科大学附属南京儿童医院眼科被确诊为基本型间歇性外斜视并行手术治疗的患儿９３例１３７眼,行双眼外直肌后徙术（ｂｉｌａｔｅｒａｌｌａｔｅｒａｌｒｅｃｔｕｓｒｅｃｅｓｓｉｏｎ,ＢＬＲ-ｒｅｃ）４４例８８眼,行单眼一退一截术（ｕｎｉｌａｔｅｒａｌｒｅｃｅｓｓ-ｒｅｓｅｃｔｉｏｎ,Ｒ＆Ｒ）术４９例４９眼。采用三棱镜加交替遮盖法测量患儿经１ｈ诊断性遮盖前后注视６ｍ及３３ｃｍ调节性视标第一眼位的斜视度。检查患儿近立体视锐度。依据诊断性遮盖后测量的最大看远斜视度及双眼注视偏爱,行ＢＬＲ-ｒｅｃ或Ｒ＆Ｒ,所有手术均由同一医师完成。术后１ｄ、１个月、６个月检查患儿的斜视度和近立体视功能。结果　术后１～３ｄ及术后１个月,Ｒ＆Ｒ组的整体疗效均优于ＢＬＲ-ｒｅｃ组（χ２＝６．３２４,Ｐ＝０．０４２;χ２ ＝６．７４７,Ｐ＝０．０３４）。ＢＬＲ-ｒｅｃ组欠矫率在术后１～３ｄ及术后１个月均高于Ｒ＆Ｒ组（χ２＝５．９５９,Ｐ＝０．０１５;χ２＝６．４６１,Ｐ＝０．０１１）,正位率及过矫率的差异无统计学意义（均为Ｐ＞０．０５）;术后远期两组疗效差异无统计学意义（均为Ｐ＞０．０５）。术后两组看远及看近斜视度的差异在各时间点均无统计学意义（均为Ｐ＞０．０５）。术后两组获得正常近立体视功能的患儿比例比较,差异无统计学意义（χ２＝０．０７５,Ｐ＝０．７８４）。结论　治疗儿童基本型间歇性外斜视应首选Ｒ＆Ｒ。     

飞秒激光小切口透镜切除术与飞秒LASIK术后角膜后表面高度变化

目的　应用Ｏｒｂｓｃａｎ-Ⅱ眼前节分析系统探讨飞秒激光辅助的准分子激光原位角膜磨镶术（ｆｅｍｔｏｓｅｃｏｎｄｌａｓｅｒｉｎｓｉｔｕｋｅｒ-ａｔｏｍｉｌｅｕｓｉｓ,Ｆｓ-ＬＡＳＩＫ）和飞秒激光小切口透镜切除术（ｓｍａｌｌｉｎｃｉｓｉｏｎｌｅｎｔｉｃｕｌｅｅｘｔｒａｃｔｉｏｎ,ＳＭＩＬＥ）术后角膜后表面高度的变化。方法　前瞻性随机对照研究。选择２０１４年５月至１１月于我院行激光角膜屈光手术的近视患者（等效球镜度数≤ －６．００Ｄ）６０例（１１９眼）,随机分成Ａ、Ｂ两组,每组３０例（Ａ组５９眼,Ｂ组６０眼）。Ａ组施行ＳＭＩＬＥ,Ｂ组施行Ｆｓ-ＬＡＳＩＫ,观察术后视力、屈光度等的变化。采用Ｏｒｂｓｃａｎ-Ⅱ眼前节分析仪,分别于术前、术后１个月对术眼进行眼前节图像采集,记录角膜后表面Ｄｉｆｆ值变化并进行对比。结果　术后１个月两组患者裸眼视力均比术前提高,但两组间相比差异无统计学意义（Ｐ＞０．０５）。术前最佳矫正视力与术后１个月相比差异均无统计学意义（均为Ｐ＞０．０５）,术后最佳矫正视力两组间相比差异亦无统计学意义（Ｐ＞０．０５）。术前及术后１个月Ａ、Ｂ两组屈光度相比差异均无统计学意义（均为Ｐ＞０．０５）。两组后表面Ｄｉｆｆ值均较术前显著增加,其中Ａ组术前、术后分别为（０．０２７±０．００１）ｍｍ和（０．０５９±０．００１）ｍｍ（Ｐ＜０．０５）;Ｂ组术前、术后分别为（０．０２９±０．００１）ｍｍ和（０．０５４±０．００２）ｍｍ（Ｐ＜０．０５）,但Ａ、Ｂ两组术后角膜后表面Ｄｉｆｆ值增加量相比差异无统计学意义（Ｐ＞０．０５）。结论　ＳＭＩＬＥ和Ｆｓ-ＬＡＳＩＫ矫正近视均安全有效,术后１个月角膜后表面高度均部分前移,其远期变化有待进一步探索。     

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。     

The Quest for Spectacle Independence: A Comparison of Multifocal Intraocular Lens Implants and Pseudophakic Monovision for Patients with Presbyopia

ABSTRACT

We performed a literature review comparing multifocal intraocular lens (IOL) implantation with pseudophakic monovision to treat presbyopia. Multifocal IOLs utilize refractive or diffractive principles to treat both distance and near vision, with a single lens implant. Monovision uses traditional monofocal lens implants to treat the dominant eye for emmotropia, and the non-dominant eye for myopia. This planned anisometropia is designed to enhance intermediate or near vision. Generally, distance vision was similar with both types of lens implantation, near vision was better with multifocal IOLs, and intermediate vision appeared to be better in the monovision group. For patients requiring cataract surgery, both multifocal IOLs and monovision appear to address presbyopia with a high level of patient satisfaction. More patients reported complete spectacle independence with multifocal IOLs, but more glare and halos were reported by multifocal IOL patients as well.     

Visual Outcomes after Bilateral Implantation of an Extended Depth of Focus Intraocular Lens: A Multicenter Study

PurposeTo evaluate visual performance after bilateral implantation of an extended depth of focus (EDOF) intraocular lens (IOL).MethodsThis multicenter, prospective, observational study included 100 patients who underwent bilateral cataract surgery with a toric or non-toric EDOF IOL (Tecnis Symfony), and 96 patients completed the final assessment at 4 to 6 months. Binocular corrected distance visual acuity and uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA), spectacle independence, visual symptoms, and patient satisfaction were evaluated.ResultsMean decimal visual acuity results showed a binocular corrected distance visual acuity of 1.10 ± 0.18, UDVA of 1.04 ± 0.17, UIVA of 0.96 ± 0.16, and UNVA of 0.68 ± 0.18. Binocular UDVA and UIVA were 0.8 (decimal) or better in 98% and 94% of patients, respectively. Binocular UNVA was 0.63 (decimal) or better in 76% of patients. Overall, 76% of the patients achieved spectacle independence across all distances, and more than 85% reported no or mild dysphotoptic phenomena. On a scale of 0 to 10, the median patient satisfaction score was 9 for far, 9.5 for intermediate, and 8 for near vision.ConclusionsThe Symfony EDOF IOL provided excellent distance, intermediate visual outcome, and functional near visual acuity. The visual results were associated with prominent levels of spectacle independence and patient satisfaction.     

景深延长型人工晶状体Symfony ZXR00的视觉质量研究

目的 评价Symfony ZXR00植入术后患者的视觉质量。设计前瞻性非随机对照研究。研究对象2021年6月至2022年1月于解放军总医院第六医学中心行白内障超声乳化摘除联合IOL植入术的患者42例(42眼),其中植入Symfony ZXR00IOL者18例(18眼),单焦点IOL A1-UV 24例(24眼)。方法比较两组术后3个月视力、对比敏感度、离焦曲线,并对光学干扰现象、脱镜率和视物满意度进行调查和分析。主要指标视力(LogMar)、对比敏感度、离焦曲线、光学干扰现象、脱镜率和视物满意度。结果术后3个月,Symfony组的裸眼远视力(-0.04±0.08)、裸眼中视力(-0.03±0.08)、裸眼近视力(0.28±0.16)、矫正近视力(-0.03±0.05)、矫正远视力下的中视力(-0.04±0.07)、矫正远视力下的近视力(0.27±0.13)显著优于单焦点A1-UV组(0.03±0.10、0.32±0.09、0.39±0.17、-0.01±0.02、0.30±0.11、0.48±0.19),P均<0.05;矫正远视力差异无统计学意义。Symfony组在-2.50 D...     

Monovision pseudophakia

PURPOSE: To evaluate distance and near binocular visual acuities and patient acceptability after sequential posterior chamber intraocular lens (PC IOL) implantation for pseudophakic monovision correction. SETTING: Private practice and the Manhattan Eye Ear and Throat Hospital, New York, New York, USA. METHODS: This study comprised 140 binocular patients with less than 2.00 diopters (D) of astigmatism. Preoperatively, all patients expressed a desire to be independent of optical correction; 120 presented for removal of visually significant cataract and 20, for correction of high ametropia (+8.00 to -14.00 D). Phacoemulsification and implantation of a PC IOL calculated to achieve emmetropia were performed in the dominant eye. Ocular dominance was confirmed on multiple preoperative visits using a sighting technique. Implantation of a PC IOL calculated to yield a spherical equivalent of -2.75 D was performed in the nondominant eye. Seven postoperative examinations were performed during the 1-year follow-up, with 96 patients completing all evaluations. At each examination, interviews were conducted on patient acceptance and ability to perform near and distance tasks without correction. RESULTS: In the entire study group, 129 patients (92%) achieved 20/30 or better uncorrected distance acuity, J1 or better uncorrected near acuity, or both. One hundred ten patients (91%) in the cataract group and 19 (95%) in the clear lens group achieved this level. Patient acceptance was 90% in the cataract group and 100% in the clear lens group. CONCLUSIONS: In a diverse group of self-selected patients from 1 metropolitan-area ophthalmology practice who were motivated to be free of spectacles, pseudophakic monovision provided a high level of satisfaction. No morbidity was associated with monovision as those who were dissatisfied with their uncorrected state did well with spectacle or contact lens correction.     

Functional vision with bilateral ReZoom and ReSTOR intraocular lenses 6 months after cataract surgery

PURPOSE: To compare the visual outcomes in patients with bilateral implantation of AcrySof ReSTOR multifocal intraocular lenses (IOLs) (Alcon Laboratories) or ReZoom multifocal IOLs (Advanced Medical Optics) 6 months after cataract surgery. SETTING: Orsett and Southend Hospital, Essex, United Kingdom. METHODS: This study comprised patients who had uneventful bilateral cataract extraction with implantation of ReZoom (n = 50) or ReSTOR (n = 50) multifocal IOLs. Parameters analyzed included binocular uncorrected distance, intermediate, and near acuities; spectacle independence; subjective visual symptoms; and patient satisfaction. All parameters were evaluated 6 months after second-eye surgery. RESULTS: All patients had binocular uncorrected distance visual acuity of 20/32 or better; there was no statistically significant difference between the 2 groups. The mean binocular uncorrected near acuity was 20/26 (J1.22) in the ReSTOR group and 20/34 (J2.34) in the ReZoom group (P<.0001). The mean binocular uncorrected intermediate visual acuity was 20/42 and 20/34, respectively (P = .003). Patients in the ReZoom group reported greater satisfaction with intermediate vision (P = .04). No statistically significant difference was found in satisfaction with near vision. Eighty-six percent of ReSTOR patients and 70% of ReZoom patients did not wear glasses for daily activities; the overall satisfaction was not statistically significantly different between groups. There was no significant difference between groups in photic phenomena. CONCLUSIONS: The ReSTOR IOL provided better near vision and the ReZoom IOL better intermediate vision. Both multifocal IOLs gave excellent distance vision. Photic phenomena were comparable and clinically acceptable. ReSTOR patients had greater spectacle independence for near vision and ReZoom patients for intermediate vision. Overall spectacle independence was not statistically significantly different.     

Reading ability and stereoacuity with combined implantation of refractive and diffractive multifocal intraocular lenses

Purpose: To evaluate reading ability and stereoscopic vision with combined implantation of refractive and diffractive multifocal intraocular lenses (IOLs). Methods: Thirty‐one cataract patients (62 eyes) were assigned to receive either a ReZoom NXG1 IOL in the dominant eye and a Tecnis ZM900 IOL in the fellow eye (MIOL group), or Sensar AR40e IOLs bilaterally (SIOL group). The uncorrected visual acuity (UCVA) at 500 cm, best spectacle‐corrected visual acuity (BSCVA) at 500 cm, reading acuity, reading speed, near stereoacuity and questionnaire were assessed 3 months postoperatively. Results: Three months postoperatively, monocular and binocular UCVA and BSCVA at 500 cm showed no significant differences in both groups. The uncorrected reading acuity and reading speed in the MIOL group were significantly better than those in the SIOL group and were similar to that with correction in the SIOL group. The uncorrected mean near stereoacuity in the MIOL group was significantly better than that in the SIOL group (69 ± 50 seconds of arc in the MIOL group versus 180 ± 160 seconds of arc in the SIOL group). Patients in the MIOL group had a high level of satisfaction and more than 80% of them had an increased independence from spectacles for brief reading. Conclusion: The combined implantation of refractive and diffractive multifocal IOLs was effective in improving reading ability and near stereoacuity with a good visual quality.     

白内障摘除手术单眼视设计度数对白内障患者预后视觉质量的影响

目的：探讨白内障摘除手术单眼视设计中不同的近附加度数对白内障患者预后视觉质量的影响。

方法：选取2016-02/2017-02在我院进行白内障摘除手术的白内障患者84例168眼进行前瞻性研究,根据单眼视设计中近附加度数的不同,将入选患者分为低近附加度数组(1.25～1.75D)和高近附加度数组(2.25～2.75D)每组各42例84眼。比较两组患者的术后6mo双眼裸眼近视力、中距离视力、远视力及立体视,以及治疗前后的视功能生存质量评分。

结果：低近附加度数组患者的双眼裸眼中、远视力分别为0.27±0.20、0.09±0.08,高近附加度数组患者的双眼裸眼中、远视力分别为0.29±0.25、0.10±0.07,两组相比差异均无统计学意义(P>0.05)。高近附加度数组患者的双眼裸眼近视力为0.03±0.06,显著优于低近附加度数组0.07±0.04,差异具有统计学意义(P<0.05)。治疗前两组患者视功能指数量表(VF-14)评分分别为27.93±4.52、28.24±4.91分,治疗后两组患者视功能指数量表(VF-14)评分分别为82.04±14.31、81.22±13.70分,差异均无统计学意义(P>0.05)。与治疗前相比,两组患者治疗后VF-14评分均显著增加,差异具有统计学意义(P<0.05)。低近附加度数组患者正常立体视、周边立体视及黄斑立体视所占百分比分别为47.6%、31.0%、21.4%,高近附加度数组正常立体视、周边立体视及黄斑立体视所占百分比分别为42.9%、23.8%、33.3%,两组相比差异均无统计学意义(P>0.05)。

结论：白内障患者的两种近附加度数对提高单眼视设计白内障摘除手术后患者的裸眼视力、视功能生存质量及立体视均有相似的优越性。     

改良单眼视LASIK手术矫正老视的疗效

目的 评价Custom-Q引导的改良单眼视准分子激光角膜磨镶术(LASIK)治疗患有近视、散光的老视患者的疗效.方法 前瞻性系列病例研究.收集2009年6月至2010年2月在华西医院近视中心实施改良单眼视LASIK手术的老视患者10例,主视眼屈光度全矫,实施传统LASIK切削;非主视眼保留-1.50 D球镜度数,实施“Custom-Q”引导的非球面性切削,实现改良的单眼视,分别于术后1周、1个月、3个月、6个月及1年进行随访,观察非主视眼和双眼的远、近视力,通过问卷调查,评估患者手术前后用眼舒适度、眼镜的依赖程度及术后满意度.分别对结果进行单因索方差分析、配对t检验和Wilcoxon秩和检验.结果 ①视力:与术前相比,术后非主视眼单眼的裸眼远、近视力差异均有统计学意义(P＜0.01),双眼同时视的裸眼远、近视力差异均有统计学意义(P均＜0.01).②稳定性:非主视眼的单眼和双眼裸眼视力在术后各时间点,差异均无统计学意义.③安全性:术中、术后无严重并发症发生,非主视眼最佳矫正视力术后较术前差异无统计学意义.④满意度:术后主观评分8.40±0.88,问卷调查显示用眼舒适度和眼镜依赖度评分术前和术后差异具有统计学意义(Z=-2.527、-2.609,P＜0.05).结论 运用Custom-Q改良的高级单眼视可用于矫正患有近视、散光的老视人群,可同时获得较好的远、近视力,患者满意度较高.     

单眼视设计的人工晶状体眼视功能临床研究

目的 探讨应用单眼视原理设计双眼白内障超声乳化联合植入单焦点人工晶状体术后的视功能情况.方法 对双眼年龄相关性白内障患者42例(84只眼),分为常规组21例(42只眼)及单眼视组21例(42只眼).常规行白内障超声乳化联合折叠式人工晶状体植入术.分别记录术前最佳矫正视力及术后1周单眼裸眼远、近视力及双眼裸眼远、近视力.采用SAS8.2统计软件对结果进行统计学分析.结果 (1)术前平均最佳矫正视力常规组4.44,单眼视组4.47(P ＞0.05),患者平均年龄常规组71岁,单眼视组69.5岁(P ＞0.05),差异无统计学意义.(2)术后1周单眼裸眼远视力常规组4.90,单眼视组:优势眼4.94(P ＞0.05),与常规组比较差异无统计学意义;非优势眼4.71(P < 0.05),与常规组比较差异有统计学意义.术后1周单眼近视力常规组4.36,单眼视组:优势眼4.37(P＞0.05),与常规组比较差异无统计学意义;非优势眼4.78(P < 0.05),与常规组比较差异有统计学意义.(3)术后1周双眼裸眼远视力常规组4.91,单眼视组4.91(P ＞0.05),与常规组比较差异无统计学意义;术后1周双眼近视力常规组4.42,单眼视组4.78(P < 0.05),与常规组比较差异有统计学意义.结论 单眼视设计的人工晶状体眼术后双眼远视力与常规设计人工晶状体眼相同,但近视力明显好于常规设计.按照单眼视原理设计人工晶状体可以较好的临床应用.