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。     

Estimating the solar ultraviolet radiation exposure to an intraocular lens implant

A study of the stability of ultraviolet radiation (UVR) absorbers in intraocular lenses (IOLs) upon exposure to UVR is necessary to determine efficacy. Ultraviolet stability is conventionally tested by placing the UV-absorbing IOLs in a solar simulator exposure chamber to determine any degradation of the absorber. To interpret any change requires a method of correlating the UVR exposure rate in the test chamber with the UVR exposure of the IOL in vivo. A method is derived that permits a determination of the upper limit of daily UVR exposure of the in-vivo IOL (or, for that matter, the crystalline lens) based upon knowledge of the ambient outdoor UVR exposure to the head and the threshold for photokeratitis.     

白内障术后植入不同人工晶状体视觉质量的对比分析

目的 对比分析白内障手术植入蓝光滤过晶状体(SA60AT)与非球面晶状体(TecnisZg001)术后视觉质量的变化.方法 选择我院2007年5月至2008年2月年龄相关性白内障患者72例.随机分成两组,均行超声乳化吸除联合人工晶状体植入术.对照组(36例)植入蓝光滤过晶状体SA60AT,实验组(36例)植入非球面晶状体TecnisZ9001.于术后1个月和3个月分别进行视力、对比敏感度和波前像差的检查.结果 视力:术后1个月和3个月,两组术后术眼最佳矫正视力差异无统计学意义(P＞0.05).对比敏感度:术后1个月,在无眩光和眩光环境下,对比敏感度6c/d、12c/d、18c/d,对照组均小于实验组,差异有显著性(P＜0.05),术后3个月在无眩光和眩光环境下,对比敏感度6c/d、12c/d、18c/d,对照组均小于实验组,差异有显著性(P＜0.05).波前像差:术后1个月、3个月,两组在瞳孔直径≥5 mm时的三阶彗差、四阶球差、高阶像差的均方根(RMS值)比较,实验组均低于对照组,两组有统计学意义(P＜0.05).结论 非球面晶状体与蓝光滤过晶状体在同时提高患者视力的同时,可以更好的改善术眼对比敏感度和高级像差,提高术眼视觉质量.     

International intraocular lens and implant registry 2003

This is the fifth annual printing of the International Intraocular Lens and Implant Registry. A total of 1498 intraocular lenses (IOLs) and nonoptical implants from 33 manufacturers are available to surgeons in 2003.     

AcrySof ReSTOR多焦点人工晶状体植入术后的视功能观察

目的 探讨年龄相关性白内障患者行超声乳化联合AcrySof ReSTOR多焦点人工晶状体（MIOL）植入术后的视功能及视物满意度.方法 回顾性研究.将20例（40眼）植入AcrySof ReSTOR＋3D MIOL患者（观察组）与20例（40眼）植入AcrySof IQ单焦点人工晶状体患者（对照组）进行对比,观察两组患者术后3个月相同光照条件下远、中、近裸眼及最佳矫正视力和立体视锐度;并对术后视物满意度进行问卷调查.所得数据资料的比较采用秩和检验.结果 观察组的裸眼中距视力、远矫正下的中距视力、裸眼近视力、远矫正下的近视力均显著高于对照组（Z=2.978,P＜0.01;Z=3.040,P＜0.01;Z=3.471,P＜0.01;Z=3.098,P＜0.01）.观察组立体视锐度显著高于对照组（Z=2.264,P＜0.05）.观察组中,中距离、近距离视物满意度（96%、100%）明显好于对照组（77%、50%）.结论 双眼植入AcrySof ReSTOR＋3DMIOL患者拥有良好的全程视力以及近立体视锐度,生活质量得到了提高.     

非球面人工晶状体植入术后视功能的临床研究

目的:评价Canon Staar KS—3Ai非球面人工晶状体(IOL)对提高年龄相关性白内障患者术后视功能的作用。方法:年龄相关性白内障患者98例(126眼)随机分成两组。在白内障超声乳化吸除术后,观察组52例(65眼)植入非球面IOL(Canon Staar KS—3Ai),对照组46例(61眼)植入球面IOL(Allergan Sensor AR40e)。观察患者术后的裸眼视力(uncorrected visual activity,UCVA)、最佳矫正视力(best corrected visual activity,BCVA)、屈光状态、对比敏感度(contrast sensitivity,CS)、波前像差的均方根(root mean square,RMS)值。随访时间为术后6mo。结果:术后6mo两组UCVA、BCVA、屈光状态差异无统计学意义。无眩光环境下12,18c/d空间频率和眩光环境下6,12,18c/d空间频率上观察组CS明显优于对照组。在瞳孔直径6mm时,观察组4阶像差、4阶球差、总高阶像差RMS值低于对照组。在瞳孔直径6mm时3阶像差、5阶像差RMS值及瞳孔直径3mm时两组高阶像差RMS值差异无统计学意义。结论:非球面IOL眼视觉质量明显优于球面IOL眼。     

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。     

先天性白内障术后视功能观察

目的 观察先天性白内障术后视力及立体视恢复情况.探讨视功能变化的影响因素.方法 将33例(56只眼)先天性白内障患儿据手术时年龄3月至2岁,＞2～6岁分为A、B两组,A组21例36只眼,B组12例20只眼,对术后平均随访3年的最佳矫正远视力及远近立体视恢复情况进行分析.结果 术后脱盲率,A组为100%,B组为90%,两组之间的差别无统计学意义(P＞0.05);脱残率,A组为94%,B组为70%,两组之间差别具有统计学意义(P＜0.05);远立体视的获得率A组为58.8%,B组为16.7%,两组之间差异均具有统计学意义(P＜0.05);近立体视获得率A组为70.6%,B组为41.7%,两组之间差异无统计学意义(P＞0.05).结论 先天性白内障患儿视功能恢复与手术年龄有关,手术年龄越小,视功能恢复越好.

Abstract：

Objective To investigate the factors of visual function change after congenital cataract extraction and intraocular lens (IOL) implantation through the observation of visual acuity and stereosis. Methods A total of 33 cases were divided into 2 groups according to operation age, 3 months-2 years old was named group A, 2-6 years old was named group B. To analyze the best corrected distant visual acuity and the near and distance stereo-acuity after cataract extraction with IOL implantation. They were followed up for an average of 3 years. Results After operation, 100% and 90% patients were relieved from blindness in group A and group B respectively, and two groups did not show difference (P ＞0.05); 94% and 70% patients obtained corrected vision ≥ 0.3 in group A and group B, and two groups showed significant difference (P ＜0.05); 70.6% and 41.7%patients gained the near stereo acuity in group A and group B respectively, the recovery rate of the near stereo-acuity did not show difference (P ＞0.05); 58.8% and 16.7% patients acquired the distance stereo acuity in group A and group B respectively, the recovery rate of the distance stereo-acuity showed significant difference between two groups (P ＜0.05). Conclusions The recovery of visual function of child's congenital cataract is related to the operation age. And the children can get better visual function if they accepte surgery earlier.     

蓝光滤过型人工晶状体植入术后的视功能

目的评价白内障患者蓝光滤过型人工晶状体ACRYsoftTM natural IOL植入术后视功能的改变。方法采用临床对照研究,连续收集年龄相关性白内障患者47例(47眼),随机分为两组,均行超声乳化加人工晶状体植入术,观察组植入ACR YsoftTM natural IOL(Alcon,SN60AT),对照组植入非蓝光滤过型人工晶状体ACR YsoftTM Single-PieceI-OL(Alcon,SA60AT)。于术后不同时间点检查视力、波前像差及对比敏感度,随访时间为6个月。结果观察组与对照组术后第3个月和第6个月波前像差差异无显著性;观察组空间对比敏感度在中、低频率上明显高于对照组。结论在白内障术后早期阶段,蓝光滤过型人工晶状体ACR YsoftTM natural IOL与非蓝光滤过型人工晶状体ACR YsoftTM Sin-gle-Piece IOL相比,其可以提高患者空间对比敏感度,而波前像差无明显改变。     

Tecnis人工晶状体植入术后的视功能

目的评价非球面设计的折叠型人工晶状体(in-traocular lens,IOL)Tecnis对提高年龄相关性白内障患者术后视功能的作用。方法采用同期随机对照研究,选取年龄相关性白内障患者57例(61眼),年龄50～75岁,平均(63.5±6.4)岁,随机分为两组,观察组(28例,30眼)植入非球面人工晶状体Tecnis Z9001 IOL(Pharmacia),对照组(29例,31眼)植入传统球面人工晶状体Sensor AR40e IOL(Allergan)。术后第1个月、第3个月检查最佳矫正视力、无眩光及眩光环境下对比敏感度、角膜前表面及全眼球波前像差。结果"!最佳矫正视力:术后第1个月观察组均值为4.93±0.10,对照组为4.91±0.08(P=0.57);术后第3个月观察组均值为4.94±0.10,对照组为4.92±0.09(P=0.56)。观察组未发现超常视力。"#空间对比敏感度:在术后第1个月无眩光环境下,在6c/d(P=0.010)、12c/d(P=0.007)、18c/d(P=0.015)空间频率上差异有显著性;眩光环境下,在6c/d(P=0.001)、18c/d(P=0.000)空间频率上差异有显著性;术后第3个月无眩光环境下,在12c/d(P=0.008)、18c/d(P=0.000)空间频率上差异有显著性,眩光环境下,在12c/d(P=0.030)、18c/d(P=0.001)空间频率上差异亦有显著性。"$角膜像差:术后第1个月及第3个月组间C12、C7、C8差异均无显著性(P>0.05)。"%全眼球像差:术后第1个月及第3个月,5mm分析直径,两组C12差异均有显著性(P=0.000),而C7、C8差异则无显著性(P>0.05)。结论在白内障术后早期,非球面人工晶状体Tecnis Z9001 IOL可有效降低人工晶状体眼球差,改善有或无眩光环境下中高空间频率对比敏感度,提高术眼视功能。     

Posterior dislocation of an intraocular lens implant and its removal.

The cause of dislocation of an intraocular lens is a direct blow or jerk, and dislocation may complicate both iris-supported and capsule-supported lenses. In capsule-supported lenses the implant dislocates towards the anterior chamber but in iris-supported lenses the dislocation is posterior. A technique for removal of a posterity dislocated lens is described.     

儿童人工晶体植入术后双眼视觉

目的　研究儿童人工晶体术后视力和双眼视功能恢复情况 ,探讨其相关因素。方法　对46例 (5 4眼 )儿童人工晶体植入术后远近视力、双眼视功能、眼位、屈光状态等情况进行 6～ 3 6个月随访。结果　术后视力恢复 :矫正远视力 2 6眼 (4 8 1 5 % )≤ 0 3 ,1 7眼 (3 1 48% )≥ 0 6,近视力 44眼 (81 48% )≤ 0 5 ,1 0眼 (1 8 5 2 % ) >0 5。双眼视功能 :2 8例具有不同程度的双眼视功能 ,其中 1 2例具有远立体视 ,7例用Titmus查有近立体视。结论　儿童白内障手术疗效与发病年龄、手术时机选择、术后光学矫正、系统正规的术后管理、弱视及双眼视功能训练有关。光学矫正时适当增加远视度数 ,将有利于视力提高及看近立体视的恢复。     

Long-term visual results of bifocal intraocular lens implantation.

PURPOSE: To evaluate the long-term visual results and variability in contrast sensitivity in patients with heparin-surface-modified (HSM) diffractive bifocal intraocular lenses (IOLs). SETTING: Institute of Ophthalmology, University of Catania, Italy. METHODS: In this prospective study, visual acuity (distance and near) and contrast sensitivity were measured in 35 patients who had phacoemulsification with bifocal diffractive IOL (model 811E, Pharmacia) implantation. Patient satisfaction was also evaluated using a questionnaire. Mean follow-up was 20 months (range 18 to 24 months). RESULTS: At the last examination, mean distance visual acuity was 0.79 +/- 0.2 (SD) without correction and 1.0 +/- 0.15 with best correction. Mean uncorrected near visual acuity was J1.6 +/- J0.77 and with best distance correction, J1.19 +/- J0.49. No statistically significant changes in visual acuity were evident at the last follow-up (Student t test). No changes were found in contrast sensitivity reduction over time, nor were late postoperative complications noted. Overall patient satisfaction was rated as good by 94.3% of patients with best distance correction. CONCLUSIONS: The diffractive bifocal HSM IOL provided good visual performance for distance and near over time. In relation to the low rate of postoperative complications, the slight contrast sensitivity reduction was stable during follow-up.     

Drug-induced intraocular lens movement and near visual acuity after AcrySof intraocular lens implantation

PURPOSE: To evaluate the factors influencing AcrySof intraocular lens (IOL) (Alcon Laboratories) movement and near visual acuity after cyclopentolate 1% and pilocarpine 2%. SETTING: Department of Ophthalmology, University of Ankara, Ankara, Turkey. METHODS: Thirty eyes of 22 patients with AcrySof IOL implantation were included in this prospective study. Near visual acuity (Jaeger) at 35 cm through best distance correction without an add and pupil diameter were measured and correlated with anterior chamber depth (ACD) measured with ultrasound biomicroscopy (UBM) after application of cyclopentolate 1% and pilocarpine 2%, respectively. The magnitude of the change in the ACD was correlated with the accommodation amplitude, patient age, time interval between surgery and imaging, preoperative axial length, capsulorhexis diameter, ACD during cycloplegia, IOL diameter, and presence of posterior capsule opacification (PCO). RESULTS: Near visual acuity significantly decreased after application of cyclopentolate 1% and increased after application of pilocarpine 2% (P < .001) in all eyes. The IOL moved anteriorly in 8 (26%) eyes and posteriorly in 22 (74%) eyes after pilocarpine 2%. There was no correlation between the ACD and near visual acuity under cyclopentolate 1% (r = 0.06, P > .05) or pilocarpine 2% (r = 0.04, P > .05). There was a moderate correlation between the anterior IOL movement and accommodation amplitude (P < .05, r = 0.42). There was no correlation between the magnitude of the IOL movement and patient age, time interval between surgery and imaging, the preoperative axial length, capsulorhexis diameter, ACD during cycloplegia, IOL diameter, and the presence of PCO (P > .05). CONCLUSIONS: There was better near visual acuity in all eyes with the AcrySof MAIOL, although most IOLs move slightly backward after of pilocarpine 2%. This points out pseudoaccommodation rather than pseudophakic accommodation. Ultrasound biomicroscopy is useful in determining the ACD and the relation between the IOL and the surrounding tissues after cataract surgery.