ReSTOR多焦点人工晶状体植入术后全程立体视觉质量分析

目的 比较双眼植入ReSTOR＋3D多焦点人工晶状体（MIOL）与单焦点人工晶状体（SIOL）术后的近、中、远视力和立体视觉质量.方法 前瞻性对照研究.选择接受白内障超声乳化吸除联合人工晶状体植入术的患者共46例（92眼）,年龄45～67岁.按植入人工晶状体的不同分为两组：ReSTOR＋3D（AcrySof ReSTOR SN6AD1）MIOL组23例（46眼）,AcrySof IQ（AcrySof IQ SN60WF）SIOL组23例（46眼）,均非同期手术.患者分别于第二只眼术后3个月时检查裸眼及配戴最佳远距离矫正眼镜时的近、中、远视力和立体视锐度,并对术后患者主观立体视觉质量进行问卷调查.样本均数的比较采用配对t检验,样本率之间比较采用x2检验.结果 术后3个月,裸眼近、中视力及最佳矫正近、中距离视力比较,MIOL组明显优于SIOL组,差异均有统计学意义（x2分别为26.2、23.7、29.3、25.0,P均＜0.05） 裸眼远视力及最佳矫正远视力比较,两组差异均无统计学意义（P＞0.05）.裸眼及最佳矫正下的立体视锐度比较：MIOL组的近立体视锐度明显优于SIOL组,差异均有统计学意义（x2分别为26.3和23.5,P均＜0.05） MIOL组的中距离立体视锐度亦优于SIOL组,差异有统计学意义（x2分别为15.2和12.6,P均＜0.05） 而两组的远立体视锐度比较,差异均无统计学意义（P＞0.05）.MIOL组对近、中距离立体视觉质量的满意度为4.05±0.25和4.25±0.25,均高于SIOL组,差异有统计学意义（t分别为5.4和5.1,P均＜0.05） 而两组对远距离立体视觉质量的满意度差异无统计学意义（P＞0.05）.结论 ReSTOR＋3D MIOL的近、中距离视力和立体视锐度明显优于SIOL,可为患者提供更好的立体视觉质量,患者术后对近、中距离立体视觉质量的满意度更高.

Clinical evaluation of stereovision at different distances after the implantation of ReSTOR multifocal intraocular lenses

Objective To evaluate the near, intermediate and distance stereovision with bilateral implantation of ReSTOR+3.0 diopters (D) multifocal intraocular lens (MIOL). Methods This was a prospective controlled trial. Ninety-two eyes of 46 patients were enrolled in this retrospective study. The patients were between 45 and 67 years old. Twenty-three were bilaterally implanted with AcrySof ReSTOR+3D MIOL and 23 were bilaterally implanted with AcrySof IQ monofocal intraocular lens (SIOL). Both uncorrected and corrected binocular distance visual acuity,intermediate visual acuity and near visual acuity were evaluated. Distance stereovision, intermediate stereovision and near stereovision were measured under uncorrected and distance corrected visual acuity conditions 3 months after the fellow eyes were implanted with IOL. Subjective visual performance after surgery was evaluated by a questionnaire. The data were analyzed with t test or x2 test. Results Uncorrected and distance corrected near and intermediate visual acuity were statistically better in the MIOL group than in the SIOL group (x2=26.2, 23.7, 29.3, 25.0, P＜0.05). There was no significant difference in corrected and uncorrected distance visual acuity between the two groups (P＞0.05). Uncorrected and distance corrected near stereovision were statistically better in the MIOL group than in the SIOL group (x2 =26.3, 23.5, P＜0.05). Uncorrected and distance corrected intermediate stereovision were statistically better in the MIOL group than in the SIOL group (x2=15.2,12.6, P＜0.05). There was no difference in uncorrected or corrected distance stereovision between the two groups. Satisfaction scores for the MIOL group were higher than for the SIOL group (t=5.4, 5.1,P＜0.05). Conclusion Compared with the SIOL, bilateral implantation with the ReSTOR+3D MIOL could provide a satisfactory full range of stereovision and result in better visual performance.