散光矫正型多焦点人工晶状体植入术后临床效果

目的:评价白内障超声乳化联合散光矫正型多焦点人工晶状体(MIOL)植入术后患者的长期临床效果。方法:前瞻性自身前后对照研究。选择在大庆油田总医院行白内障超声乳化联合散光矫正型多焦点IOL植入术患者50例(82眼),术后随访1年,分别观察术前,术后3个月、6个月、1年的裸眼远中近视力(LogMAR)、最佳矫正远中近视力(LogMAR)、离焦曲线、对比敏感度(CS)、全眼像差、预计残留散光和IOL轴位偏差分析及脱镜率。对手术前后各参数进行重复测量的方差分析,两两比较采用Bonferroni法及t检验。结果:散光矫正型MIOL植入术后,所有患者术后3个月、6个月、1年时远、中、近距离均可获得优于0.3的较好视力。术后3个月、6个月、1年时各距离视力较术前显著提高(远距离:F=26.39,P<0.001;中距离:F=13.68,P<0.001;近距离:F=12.90,P<0.001)。矫正远距离视力较裸眼视力略有提高,但差异无统计学意义,矫正前后近距离视力差异无统计学意义。术后6个月时,所有患者裸眼远视力接近0.0,且-4.0^+1.2D离焦下视力均可优于0.3LogMAR。术后1年时明视带眩光CS最好,明视、暗视的CS比明视眩光有所下降,暗视眩光分辨率最差,而在高频区(18c/d),CS随时间推移有显著提高,差异有统计学意义。术后1年全眼总散光(0.24±0.15)D,与术前(1.56±0.38)D]相比,差异有统计学意义(t=3.31,P=0.023)。术后全眼总散光与术前预计残留散光(0.15±0.07)D]接近,差异无统计学意义(t=2.31,P=0.102)。术后1年,IOL轴位平均偏离(3.12±1.51)°。术后脱镜率为100%。结论:散光矫正型MIOL能为白内障患者提供满意的全程视力、视觉质量和脱镜率,可预测性好,并有良好的旋转稳定性。

Clinical Observation of the Effect of the Multifocal Intraocular Lens with Astigmatism Correction

To evaluate the long-term clinical effect of cataract phacoemulsification combined with astigmatism in patients implanted with AcrySof IQ ReSTOR Toric MIOLs. Methods: This was a prospective analysis. Fifty patients (82 eyes) underwent cataract phacoemulsification combined with astigmatism correction with IOL implants in Oilfield General Hospital of Daqing. The patients were followed up for 1 year to assess uncorrected distance visual acuity (UDVA, LogMAR), uncorrected intermediate visual acuity (UCIVA, LogMAR), uncorrected near visual acuity (UNVA, LogMAR), best corrected distance visual acuity (BCDVA, LogMAR), best corrected intermediate visual acuity (BCIVA,LogMAR), best corrected near visual acuity (BCNVA, LogMAR), defocus curve, contrast sensitivity (CS), total eye aberrations, estimated residual astigmatism and analysis of axis deviation of the artificial IOL, and spectacle independence preoperatively and 3 months, 6 months, and 1 year postoperatively. Data were analyzed by repeated measured analysis of variance. Results: Postoperative vision was better than preoperative vision and the difference was statistically significant (F=26.39, P<0.001; F=13.68, P<0.001; F=12.90, P<0.001). At 6 months after the operation, the uncorrected distance visual acuity was close to 0, and visual acuity with +1.2 - -4.0 D defocus could reach more than 0.3. Under glare conditions, contrast sensitivity was best during the day and was worst at night 1 year after the operation and the difference was statistically significant. Residual astigmatism at 1 year was significantly reduced compared to baseline (0.24±0.15 D vs 1.56±0.38 D, t=3.31, P=0.023), and was not a statistically significant difference from the preoperative anticipated residual astigmatism (t=2.31, P=0.102). At 1 year, the mean IOL axis rotation was 3.12°±1.51°. All the patients independent of spectacle. Conclusions: The AcrySof IQ ReSTOR Toric astigmatic MIOL provides satisfactory full vision, visual quality, predictability, and good rotational stability for cataract patients.