Monovision法白内障术后屈光矫正

Monovision correction with monofocal intraocular lens implantation after cataract operation

目的 研究以Monovision法植入普通单焦点人工晶状体（IOL）进行白内障术后无调节状态矫正的疗效.方法 47例行双眼白内障超声乳化手术患者在术前调查视觉需求,检查最佳远、近矫正视力,主眼检测,分为两组.Monovision组39例植入单焦点折叠式IOL,其中主眼正视化矫正,非主眼保留-0.75～-2.50 D的近视矫正.对照组8例植入单焦点折叠式IOL,双眼均做常规正视化矫正.术后对视力、视觉质量满意度进行随访.结果 术后屈光度与术前预测预留度数具有较高的一致性,高度近视患者目标屈光度误差为-（0.46±0.39）D,略差于正常眼轴者的-（0.33±0.25）D,但差异无统计学意义（P＞0.05）.Monovision组中,87.2%者双眼同时视裸眼远视力达到20/20～20/30,与对照组（7/8例）的差异无统计学意义（x^2=0.79,P＞0.05）.Monovision组裸眼近视力均达到或优于J4,达到J1～J3者占77.2%;对照组则均为J4;两组间差异有统计学意义（x^2=17.0,P＜0.05）.所有患者生活质量得到提高,能够从事更多的个人自理和社会活动.两组术后主观满意度的差异无统计学意义（x^2=0.06,P＞0.05）.结论 Monovision法应用于白内障术后屈光矫正,能够满足一定程度的远、近视力日常需求,减少术后眼镜的依赖率.

Objective To evaluate the outcome of monovision correction with monofocal intraocular lens （IOL） implantation after cataract operation. Methods The visual quality, distant and near vision, and the dominance eye were examined in 47 patients who were to receive binocular phacoemulsification and monofocal IOL implantation. Monovision correction was chosen for 39 patients. Implantation of IOL was designed to yield a spherical equivalent of -0.75 to -2.50 D for the nondominant eye. Full correction was carried out for 8 control cases. Vision acuity and satisfactory rate of visual quality were followed up postoperatively. Results Predicted refraction and Meal distance binocular vision were achieved in all patients. Hyperopic patients had more severe myopic measuring bias （- [0.46 ± 0.39] D） than that normal patients （-[0. 33 ± 0.25] D） （P 〉 0.05）. We found that 87.2% patients in monovision group achieved 20/30 or better uncorrected distant acuity, which was similar to those in the control group （x^2 =0.94, P〉 0. 05） ; J4 or better uncorrected near acuity was achieved in the Monovision group, with 77.2% of them reaching J1-J3, which was better than that in the control group（J4, x^2 = 17.0, P 〈 0.05）. The life quality of patients in monovision group was improved and they could participate in more activities. There was no significant difference in the objective satisfactory rate between the 2 groups after operation （x^2 = 0.06, P 〉 0.05）. Conclusion Pseudophakic monovision is an effective approach for presbyopia correction, which can meet the daily demand of distant and near vision requirements and reduce the dependence of spectacle. （Shanghai Med J, 2007, 30： 814-817）