衍射型多焦点人工晶状体植入术后临床效果

Prospective visual evaluation after apodized diffractive multifocal intraocular lens implantation

目的:探讨衍射型多焦点人工晶状体植入术后的临床效果。方法:所有患者按照植入的人工晶状体类型分成多焦组和单焦组。多焦组植入衍射型多焦点人工晶状体AcrySof ReSTOR(Alcon),72例(109眼);单焦组植入单焦点人工晶状体AcrySof SA60AT(Alcon)作为对照,88例(130眼)。术后随访6~24mo,观察瞳孔直径,远近视力,最佳矫正视力,脱镜率,术后屈光状态、夜间视觉干扰现象等指标。结果:两组间在远视力和最佳矫正远近视力方面没有显著性差异,而近视力多焦组达到或超过J3的患者101眼(92.7%),单焦组12眼(9.2%),差异具有显著性(χ2=166.44,P=0.00)。两组完全脱镜率分别为98眼(89.9%)和9眼(6.9%)。多焦组完全脱镜的患者术后平均等效球镜为-0.03±0.45D(-1.0^+0.50D),6例7眼(6.4%)视近远时都需戴镜矫正,术后平均等效球镜+1.14D。结论:衍射型多焦点人工晶状体植入后能够使患者获得理想的远近视力,大大降低了患者对眼镜的依赖性。人工晶状体的屈光力测量精确性是增加术后脱镜率的重要因素,应该尽量避免术后等效球镜大于+0.50D。

AIM： To evaluate visual quality in patients who had multifocal apodized diffractive intraocular lens （IOL） implantation. METHODS： In this comparative trial, the 72 patients （109 eyes） of multifocal group were implanted with apodized diffractive IOL （AcrySof ReSTOR） and the 88 patients （130 eyes） of control group were given with a monofocal IOL （AcrySof SA60AT）, respectively. The distance visual acuity, near visual acuity, best corrected distance visual acuity, best distance-corrected near visual acuity, contrast sensitivity, and diameter of pupil were measured. The follow-up time was for 6 to 24 months. RESULTS： There was no statistically significant difference of the best corrected distance visual acuity, best distance-corrected near visual acuity between two groups, For the near vision, 101 eyes （92. 7%） of the multifocal group and 12 eyes （9.2%） of the monofocal group achieved or exceeded J3, and the difference had statistical significance （X 2 = 166. 444, P = 0. 000）. The patients who never need for spectacles were 98 （ 89.9% eyes） with multifolcal IOL and 9% （6. 9% eyes） with monofocal IOL implantation. In multifocal group, the mean spherical equivalent （SE） refraction of patients who never wore spectacles was -0.03 ± 0.45D （ -1.0 ± 0.50D）, and 7 eyes of 6 patients （6.4%） needed constant wear spectacles, whose mean SE was ＋ 1.14D.CONCLUSION： The patients with apodized diffractive multifocal IOLs implantation can obtain better uncorrected distance and near VA, less spectacle dependency. Acuity measurement of IOL power and the postoperative SE refraction less ＋ 0.50D are very important for the freedom of spectacle.