可调节人工晶状体植入术的早期疗效观察

Accommodation in pseudophakic eyes with the 1CU accommodative intraocular lens

目的探讨超声乳化白内障吸除可调节人工晶状体植入术的临床疗效和调节幅度。方法对75例(94只眼)白内障患者行超声乳化白内障吸除1CU型可调节人工晶状体植入术,观察并记录术眼的主观屈光状态、裸眼远视力、裸眼近视力、最佳矫正远视力、30cm处远视力矫正后近视力、30cm处最佳矫正近视力、主观调节幅度(分别采用主观移近法和负镜片法测量)。术后随访时间1～12个月,对术后1周、1个月及3个月的资料进行分析。结果术后1周、1个月及3个月裸眼近视力≥Jr5者分别占81.9%(77/94)、85.1%(80/94)及84.0%(79/94);远视力矫正后近视力≥Jr5者分别占78.7%(74/94)、79.8%(75/94)及74.5%(70/94)。采用主观移近法和负镜片法检查调节幅度,术后1周分别为(1.96±0.63)D(0.75～4.50D)和(1.74±0.59)D(0.75～4.50D),术后1个月分别为(1.89±0.54)D(0.75～3.25D)和(1.68±0.47)D(0.75～3.25D),术后3个月分别为(1.77±0.53)D(0.75～2.75D)和(1.66±0.50)D(0.75～2.75D)。术后1周、1个月及3个月2种方法测量的主观调节幅度比较,差异均无统计学意义(P>0.05)。远视力矫正后近视力和调节幅度之间为正相关(P=0.00)。结论早期观察结果显示1CU型可调节人工晶状体植入术后视功能恢复良好,患者在具有较好远视力的同时,具备良好的视近能力。远期效果有待进一步观察。

Objective To investigate the clinical effect of accommodating intraocular lens（IOL） on the accommodation of patients with IOL implantation. Methods 75 cases （94 eyes ） had phacoemulsification and implantation of Human-Optics accommodating 1CU intraocular lens. The main outcome measures were subjective refraction, uncorrected distance vision acuity, spectacle-free near visual acuity, best corrected distance vision acuity, distance corrected near vision acuity at 30 cm, best corrected near vision acuity at 30 cm, and amplitude of accommodation with subjective techniques of pushing-up test （near point） and defocusing with minus glasses. Patients were being follow-up for 1 to 12 months, the data was collected at 7, 30 and 90 days after surgery. Results Postoperatively, better uncorrected distance vision acuity, best corrected distance and near vision acuity were obtained in all of patients studied . At different time points after surgery near visual acuity with Jaeger 5 or better without spectacle was 81.9%, 85.1% ,and 84.0% at 7days, 30 days and 90 days respectively. The near visual acuity with Jaeger 5 or better after distance vision acuity correction in all of cases was 78.7% at 7days, 79. 8% at 30 days and 74. 5% at 90 days . The amplitude of accommodation was （ 1.96 ± 0. 63 ） D （ range 0. 75 to 4. 50 D） by push-up test, （ 1.74 ± 0. 59 ） D （ range 0. 75 to 4. 50 D） by defocusing at 7 days ; （ 1.68 ± 0. 47 ） D （ range 0.75 to 3.25 D） by push-up test, （1.89 _±0.54）D （range 0.75 to 3.25 D） by defocusing at 30 days; （ 1.77 ± 0. 53 ） D （ range 0. 75 to 2. 75 D） by push-up test, （ 1.66 ± 0. 50 ） D （ range 0. 75 to 2. 75 D） by defocusing at 90 days. The differences in amplitude of accommodation among 7, 30 and 90 days were not statistically significant （ P 〉 0.05 ）. Distance corrected near acuity and amplitude of accommodation showed a positive correlation. Conclusion The implantation of 1CU accommodative IOL provided both better distance and near vision acuity. （Chin J Ophthalmol , 2005,41：807-811 ）