多焦点人工晶状体植入术后视觉质量和阅读能力的研究

目的:研究多焦点人工晶状体(IOL)植入术后白内障患者的视觉质量及阅读能力。方法:前瞻性临床研究。选择2018年6月至2019年10月于重庆医科大学附属第一医院眼科就诊并行双眼白内障手术的患者共75例(150眼),依据患者选择的IOL进行分组,双眼植入Tecnis ZCB00 IOL 25例(50眼)作为单焦组,双眼植入Tecnis ZMB00 IOL 25例(50眼)作为双焦组,双眼植入AT Lisa tri.839MP IOL 25例(50眼)作为三焦组,对比3组患者术后3个月时的祼眼远视力(UDVA)、祼眼中视力(UIVA)、祼眼近视力(UNVA) (LogMAR)及阅读能力。使用NEI-RQL-42量表中文版评价3组患者术后视觉质量的差异。数据采用卡方检验、方差分析、Kruskal-Wallis检验、Mann-Whitney U检验进行统计分析。 结果:共75例(150眼)患者纳入研究。3组间UDVA差异无统计学意义( H=3.187, P=0.203)。三焦组UIVA(0.2±0.1)优于双焦组(0.3±0.2) ( Z=-2.041, P=0.041)和单焦组(0.3±0.3) ( Z=-2.142, P=0.032)。三焦组UNVA(0.3±0.2)和双焦组UNVA(0.3±0.2)优于单焦组(0.4±0.2) ( t=2.332, P=0.017;t=3.014, P=0.036)。3组阅读视力( F=0.421, P=0.658)、阅读速度( F=1.754, P=0.182)、阅读错误率( H=6.347, P=0.052)差异均无统计学意义。三焦组近视力维度得分(92±14)和双焦组近视力维度得分(100±11)均高于单焦组(50±42) ( U=-3.139, P=0.005;U=-3.726, P=0.001);三焦组中视力维度得分(100±12)高于双焦组(75±25)和单焦组(25±75) ( U=-2.758, P=0.017;U=-3.145, P=0.002)。三焦组脱镜率维度得分(100±25)和双焦组脱镜率维度得分(100±40)高于单焦组(30±100) ( U=-3.004, P=0.008;U=-3.766, P=0.001)。 结论:多焦点IOL植入患者可获得与单焦点IOL植入患者配戴老花镜时相同的近距离视觉质量;AT Lisa tri.839MP IOL与Tecnis ZMB00 IOL可提供相同的远近视力及近距离阅读能力,但前者中距离视觉质量更佳。

Visual Quality and Reading Performance after Multifocal Intraocular Lens Implantation in Cataract Patients

Objective: To evaluate the visual quality and reading performance of cataract patients after multifocal intraocular lens implantation. Methods: This was a prospective clinical study. Seventy-five cataract patients (150 eyes) who had cataract surgery in the Department of Ophthalmology, the First Affiliated Hospital of Chongqing Medical University from June 2018 to October 2019 were involved. Twenty-five patients (fifty eyes) were implanted bilaterally with a Tecnis ZCB00 IOL as the monofocal group, 25 patients (fifty eyes) were implanted bilaterally with a Tecnis ZMB00 IOL as the bifocal group and 25 patients (fifty eyes) were implanted bilaterally with an AT Lisa tri.839MP IOL as the trifocal group. The uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), reading performance at 40 cm and the Chinese NEI-RQL-42 scale were assessed 3 months postoperatively. Data were assessed with a Chi-square test, analysis of variance, Mann-Whitney U test and Kruskal-Wallis test. Results: UDVA showed no significant difference among the three groups (H=3.187, P=0.203); the UIVA of the trifocal group (0.2±0.1) was significantly better than the monofocal group (0.3±0.3)(Z=-2.142, P=0.032) and the bifocal group (0.3±0.2)(Z=-2.041, P=0.041). UNVA was significantly better in the bifocal group (0.3±0.2) and trifocal group (0.3±0.2) than in the monofocal group (0.4±0.2)(t=3.014, P=0.036 and t=2.332, P=0.017, respectively). No statistically significant difference was found in reading acuity at 40 cm (F=0.421, P=0.658), reading speed (F=1.754, P=0.182) or reading mistake rates (H=6.347, P=0.052) among the three groups. Near vision: The bifocal group (100±11) and trifocal group (92±14) were better than the monofocal group (50±42)(U=-3.726, P=0.001 and U=-3.139, P=0.005, respectively); Medium vision: The trifocal group (100±12) was better than the monofocal group (25±75)(U=-3.145, P=0.002); and the trifocal group was better than the bifocal group (75±25)(U=-2.758, P=0.017); Spectacle independence rate: The bifocal group (100±40) and trifocal group (100±25) were better than the monofocal group (30±100)(U=-3.766, P=0.001 and U=-3.004, P=0.008, respectively). Conclusions: Reading performance can evaluate the near visual quality of cataract patients. The AT Lisa tri 839MP IOL can provide distance and near visual acuity and reading performance similar to the Tecnis ZMB00 IOL with better medium visual quality