多焦点人工晶状体在近视合并白内障患者中的远期疗效评价

目的评价近视合并白内障患者在白内障超声乳化联合多焦点人工晶状体（multifocal intraocular lens，MIOL）植入术后的视觉质量。方法近视眼白内障患者行小切口超声乳化术，植入MIOL（Array SA-40N，AMO）14眼，单焦点人工晶状体（monofocal or single-focal intraocular lens，SIOL）（SA60AT，Alcon）20眼。手术后6个月，观察两组的术后视力、对比敏感度及视觉不良症状．使用Hartmann-Shack波前像差仪测定患者术后高阶像差，Pentacam检测两组人工晶状体（intraocular lens，IOL）的居中性（偏心值和倾斜度）。结果MIOL组术后裸眼近视力≥4．7的患者占64．29％，矫正远视度数下的近视力≥4．7的患者占85．71％，MIOL组裸眼近视力及矫正远视力下的近视力明显好于SIOL组（P〈0．05）。MIOL组在低、中、高频段对比敏感度及眩光对比敏感度与SIOL组差异均无统计学意义（P〉0．05）。分析孔径为5mm时，SIOL组球差显著高于MIOL组（P〈0．05），两组总高阶像差、余各阶像差的差异均无统计学意义（P〉0．05）。两组IOL居中性（偏心值和倾斜度）差异无统计学意义（P〉0．05）。结论MIOL植入治疗近视白内障，可为患者提供较好的全程视力和良好的视觉质量，显著减少了术后对于框架眼镜的依赖。其远期的对比敏感度及眩光对比敏感度均在正常范围,球差低于SIOL。

Long-term visual performance of multifocal intraocular lenses in patients with cataract and myopia

Objective To evaluate the visual quality of patients with cataract and myopia after phacoemulsification and muhifocal intraocular lens （MIOL） implantation. Methods This study was comprised of 34 eyes with myopia and cataract that had undergone small-incision phacoemulsification. Fourteen of the 34 eyes received MIOLs （Array SA-40N,AMO） and twenty eyes were implanted with monofocal or sing-focal intraoeular lens （SIOL,SA60AT,Alcon）. Six months after surgeD＂, distance visual acuity, near visual acuity and contrast sensitivity （CS） were measured. High-order aberrations were measured using a Hartmann-Shack aberrometer （WASCA Analyzer,Zeiss）. The decentration and tilt of the IOLs were quantified using a Scheimpnug videophotography system （Pentaeam,Oculus） and image analysis. Results Six months after surgery, 64.29% of the patients in the MIOL group had uncorrected near visual acuity better than 4.7 and 85.71% of the patients had distance corrected near visual acuity better than 4.7, which were significantly better than those in the SIOL group. CS and glare CS values did not differ significantly between the two groups for the low, intermediate and high spatial frequencies tested （P〉0.05）. For a 5 mm aperture diameter, the spherical aberration was significantly lower in the MIOL group than in the monofoeal IOL group （P〈0.05） and other high-order aberrations showed no statistical differences （P〉0.05）. The extent of IOL decentration and tilt did not show significant differences （P〉0.05）. Conclusion For patients with cataract and myopia. MIOLs can provide a full range of vision with good visual quality, thus greater independence from glasses can be achieved. Eyes receiving MIOLs have relatively normal CS and glare CS values and fewer spherical aberrations compared to those implanted with SIOLs.