高度近视合并白内障植入Symfony与ZMB00 IOL视觉质量比较

目的：对比高度近视合并白内障患者植入tecnis Symfony人工晶状体(IOL)与tecnis ZMB00多焦点IOL的术后视觉质量。

方法：采用前瞻性非随机对照研究，纳入2020-06/2021-07在包头医学院第一附属医院行超声乳化吸除联合IOL植入术的高度近视合并白内障患者。依据患者所选IOL不同，分为Symfony组32例32眼和ZMB00组31例31眼。术后随访3mo，主要观察指标：比较术后1、3mo等效球镜，裸眼、最佳矫正远视力(5m)，裸眼、最佳矫正远视力下中(80、60cm)、近(33cm)距离视力，术后3mo离焦曲线、对比敏感度、IOL偏心量及倾斜度。次要指标：术后3mo残余散光耐受度(90°、180°轴位，正、负柱镜)、视觉质量问卷。

结果：术后1、3mo两组裸眼、最佳矫正远视力、等效球镜比较均无差异(P>0.05)，Symfony组裸眼、最佳矫正远视力下中视力优于ZMB00组，ZMB00组裸眼、最佳矫正远视力下近视力高于Symfony组(均P<0.05)。术后3mo Symfony组在+1.0～-3.0D跨度上，离焦曲线形成缓慢下降的平台期、视力优于0.3LogMAR，且在-1.0～-2.5D跨度上优于ZMB00组(均P<0.05)； ZMB00组离焦曲线呈双峰状、在0、-3.00D上为波峰，-3.0～-3.5D跨度上优于Symfony组(P<0.05)。暗环境空间频率(3、6、12、18c/d)对比敏感度(CS)，Symfony组优于ZMB00组(均P<0.05)。术后3mo两组IOL偏心量、倾斜度及视觉质量评分比较均无差异(P>0.05)。残余散光耐受度ZMB00组在+0.75D和-1.00D，Symfony组在+1.00D和-1.50D上表现出不适及视力低于0.3LogMAR(均P<0.05)。术后两组均不同程度出现眩光、光晕等不适，但随时间的推移症状大部分适应或消失。

结论：在高度近视合并白内障术后，两种IOL都有良好的囊袋稳定性及居中性，均能提供优秀的视觉质量。Symfony IOL可提供有效的连续视程、中视力更有优势、近视力表现略有不足，而ZMB00 IOL更适合对近距离视力有高要求者，Symfony IOL表现出更好的术后残余散光耐受度。

Evaluation of visual quality of Symphony and ZMB00 intraocular lens implantation in high myopia with cataract

AIM: To compare the visual quality of patients with high myopia and cataract after the implantation of tecnis Symfony intraocular lens(IOL)and tecnis ZMB00 multifocal IOL.

METHODS: A prospective nonrandomized controlled study was conducted on the patients with high myopia and cataract who underwent phacoemulsification combined with IOL implantation in the First Affiliated Hospital of Baotou Medical College from June 2020 to July 2021. According to the selected IOL, the patients were divided into 32 cases(32 eyes)in Symfony group and 31 cases(31 eyes)in ZMB00 group. The patients were followed up for 3mo after operation. Main outcome measures: comparison of spherical equivalent, naked eye and best corrected far vision(5m), middle(80, 60cm)and near(33cm)vision under naked eye, the best corrected far vision at 1 and 3mo after surgery and the defocusing curve, contrast sensitivity, IOL eccentricity and inclination at 3mo after surgery. Secondary outcome measures: residual astigmatism tolerance(90°, 180° axial position, positive and negative cylindrical mirror)and visual quality questionnaire at 3mo after surgery.

RESULTS: There was no significant difference between the two groups in the comparison of naked eye, best corrected far vision and spherical equivalent at 1 and 3mo after operation(P>0.05). The middle vision under naked eye and best corrected far vision in Symfony group was better than that in ZMB00 group; Compared with the near vision under the naked eye and the best corrected far vision, the ZMB00 group was higher than that in the Symfony group(all P<0.05); In the span of +1.0- -3.0D, the defocusing curve of Symfony group formed a plateau period of slow decline at 3mo after operation, and the visual acuity was better than 0.3LogMAR. And in the span of -1.0- -2.5D, the Symfony group was better than ZMB00 group(all P<0.05); The defocusing curve of ZMB00 group was bimodal, with peaks at 0 and -3.00D, and it was better than that of Symfony group in the span of -3.0- -3.5D(P<0.05). The contrast sensitivity(CS)of dark environment spatial frequency(3, 6, 12 and 18c/d)in Symfony group was better than that in ZMB00 group(all P<0.05). There was no significant difference in IOL eccentricity, inclination and visual quality scores between the two groups at 3mo after operation(P>0.05). Residual astigmatism tolerance showed discomfort at +0.75D and -1.00D in the ZMB00 group and at +1.00D and -1.50D in the Symfony group, and the visual acuity was lower than 0.3LogMAR(all P<0.05). Postoperative discomfort such as glare and halo occurred in both groups to varying degrees, but most of the symptoms adapted or disappeared over time.

CONCLUSION: After cataract surgery for high myopia, both IOL have good capsular bag stability and centricity, and can provide excellent visual quality. With more advantages in middle vision and slightly insufficient performance in near vision, Symfony IOL can provide effective continuous visual range, while ZMB00 IOL is more suitable for those who have high requirements for near vision, and Symfony IOL shows better postoperative residual astigmatism tolerance.