三焦点人工晶状体植入术后中期立体视功能及视觉质量研究

目的评价三焦点非球面衍射型人工晶状体植入术后的双眼立体视功能及视觉质量。方法非随机同期对照临床研究。对38例76眼单纯性白内障患者行超声乳化吸出联合人工晶状体植入术,依据植入人工晶状体类型不同分为2组:双眼均植入三焦点人工晶状体组18例36眼为三焦组,双眼均植入单焦点人工晶状体组20例40眼为单焦组。随访记录2组患者术后双眼近立体视功能、视力单眼及双眼裸眼远距离视力(uncorrected distance visual acuity,UDVA)、裸眼中距离视力(uncorrected intermediate visual acuity,UIVA)、裸眼近距离视力(uncorrected near visual acuity,UNVA)、矫正远距离视力(corrected distance visual acuity,CDVA)、矫正远视力基础上的中距离视力(distance-corrected intermediate visual acuity,DCIVA)、矫正远视力基础上的近距离视力(distance-corrected near visual acuity,DCNVA)]和等效球镜度。利用VF-14-CN量表行主观问卷调查,对夜间光晕及老视眼镜依赖与否行问卷并记录;利用双通道视觉质量分析系统测量客观散射指数、调制传递函数截止频率(modulation transfer function,MTF-cutoff)、斯特列尔比值(strehl ratio,SR)及100%、20%、9%对比度视力(contrast visual acuity,CVA)等指标。结果三焦组术后近立体视功能明显优于单焦组(P=0.001)。三焦组和单焦组所有术眼术后单眼UDVA较术前均明显提高(均为P<0.05)。三焦组单眼UDVA、UIVA、UNVA均明显优于单焦组(均为P<0.05);三焦组单眼DCDVA与单焦组差异无统计学意义(P>0.05),但DCIVA和DCNVA均明显优于单焦组(均为P<0.01)。三焦组双眼UDVA、UIVA、UNVA均明显优于单焦组(均为P<0.01);三焦组双眼DCDVA与单焦组比较差异无统计学意义(P>0.05),但DCIVA和DCNVA均明显优于单焦组(均为P<0.01)。两组等效球镜度差异无统计学意义(P=0.437)。VF-14量表评分单焦组明显低于三焦组(P=0.000)。90.0%单焦组患者依赖老视眼镜,5.6%三焦组患者依赖老视眼镜,差异有统计学意义(P=0.000);两组眩光发生率差异无统计学意义(P=0.437);两组夜间光晕发生率(单焦组2/20,三焦组7/18)差异有统计学意义(P=0.027)。三焦组和单焦组客观散射指数、斯特列尔比值、调制传递函数截止频率差异均无统计学意义(均为P>0.05)。三焦组100%CVA、20%CVA均好于单焦组(均为P<0.01);9%CVA两组差异无统计学意义(P>0.05)。结论双眼植入三焦点人工晶状体患者可获得良好的立体视功能和视觉质量,术后满意度高。

Mid-term stereopsis vision and visual quality after implantation of trifocal intraocular lenses

Objective　To evaluate the mid-term stereopsis vision and visual quality after implantation of a trifocal diffractive intraocular lens.Methods　Non-randomized concurrent controlled clinical trial.Totally 38 patients of 76 eyes with simple cataract underwent phacoemulsification combined with intraocular lens implantation.According to the type of implanted intraocular lens,the patients were divided into two groups:18 patients of 36 eyes receiving a trifocal diffractive intraocular lens (trifocal group) and 20 patients of 40 eyes being implanted with monofocal intraocular lens (monofocal group).The stereopsis vision,monocular and binocular uncorrected distance visual acuity (UDVA),uncorrected intermediate visual acuity （UIVA），uncorrected near visual acuity (UNVA),corrected distance visual acuity (CDVA),distance-corrected intermediate visual acuity (DCIVA),distance-corrected near visual acuity (DCNVA) and spherical equivalent (SE) were measured for all patients.The VF-14-CN scale was used to conduct subjective questionnaire surveys for recording nighttime glow and presbyopic glasses.Double-pass visual quality analysis system was used to evaluate the visual quality,including the objective scatter index (OSI),modulation transfer function (MTF-cutoff),strehl ratio (SR),100%,20%,9% contrast visual acuity (CVA).Results　Trifocal group had a better stereopsis vision than monofocal group（P=0.001）.Postoperative single-eye UDVA of all patients in both groups were improved dramatically (all P<0.05).UDVA,UIVA and UNVA of trifocal group was better than those in the monofocal group in both single and binocular eyes (all P＜0.05).No significant statistical difference in DCDVA was found between trifocal group and monofocal group no matter single and binocular eyes (all P＞0.05),but DCIVA and DCNVA were significantly better than those in the monofocal group for both single and binocular eyes (all P<0.01).There was no significance in SE between the two groups (P=0.437).In terms of VF-14 scale score,the trifocal group was significantly higher than that of the monofocal group (P=0.000).Moreover,90.0% of patients in the monofocal group were dependent on presbyopic glasses,and 5.6% in the trifocal group were dependent on presbyopic glasses,and the difference was statistically significant (P=0.000);there was no significant difference in the incidence of glare between the two groups (P=0.437).The incidence of nocturnal halos in the two groups (2/20 in the monofocal group and 7/18 in the trifocal group) was statistically significant (P=0.027).There were no significant differences in OSI,SR and MTF-cutoff between the trifocal and monofocal groups (all P>0.05).100% CVA and 20% CVA in the trifocal group were better than those in the monofocal group (both P<0.01),but there was no significant difference in 9% CVA between the two groups (P>0.05).Conclusion　Compare to the traditional mono-focal intraocular lens,the trifocal diffractive intraocular lens can provide a better full range of clear vision and visual quality,which may help to achieve good postoperative satisfaction.